Could Sex/Gender Differences in ACE2 Expression in the Lungs Contribute to the Large Gender Disparity in the Morbidity and Mortality of Patients Infected With the SARS-CoV-2 Virus?

Gregor Majdic

doi:10.3389/fcimb.2020.00327

Abstract

COVID-19 morbidity and mortality have significant gender disparities, with higher prevalence and mortality in men. SARS-CoV-2 enters the lungs through the ACE2 enzyme, a member of the renin-angiotensin system (RAS). Although there are no data for the lung, the expressions of RAS components in other tissues are modulated by sex hormones, androgens, and estrogens. However, there are no data on sex-specific differences in ACE2 expression. If there is a sex difference in the expression of ACE2 in the lung, this could theoretically explain the gender disparity in COVID-19 disease. More importantly, although modulation of ACE2 will certainly not provide a cure for the COVID-19 disease, modulation of ACE2 by sex hormone modulators, if they affect the expression of ACE2, could potentially be developed into a supportive therapy for COVID-19 patients.

Highlights

A novel coronaviral disease, COVID-19, caused by the SARS-CoV-2 virus (Guo et al, 2020), is affecting a disproportionally higher number of men than women
There are no data for the lung, the expressions of renin-angiotensin system (RAS) components in other tissues are modulated by sex hormones, androgens, and estrogens
This large gender difference has been shown both in China (Guan et al, 2020; Jin et al, 2020), the first country affected by COVID-19, and recently in Italy (Riccardo et al, 2020), a country that is currently, in the middle of March 2020, the most affected by this disease

Summary

Introduction

A novel coronaviral disease, COVID-19, caused by the SARS-CoV-2 virus (Guo et al, 2020), is affecting a disproportionally higher number of men than women. Edited by: Slobodan Paessler, The University of Texas Medical Branch at Galveston, United States

Results

Conclusion