Sex differences in immune responses to SARS-CoV-2 in patients with COVID-19.

Guolian Zhao,Xiaowen Tan,Yazhou Xu,Hongyue Zhang,Liyun Dang,Xiaoli Cui,Jing Li

doi:10.1042/bsr20202074

Abstract

Millions of people infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been diagnosed with coronavirus infectious disease 2019 (COVID-19). The prevalence and severity of COVID-19 differ between sexes. To explain these differences, we analyzed clinical features and laboratory values in male and female COVID-19 patients. The present study included a cohort of 111 people, i.e. 36 COVID-19 patients, 54 sex- and age-matched common viral community-acquired pneumonia (CAP) patients, and 21 healthy controls. Monocyte counts, lymphocyte subset counts, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels in the peripheral blood were analyzed. Higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, monocyte counts, and CRP and ALT levels were found in male COVID-19 patients. Decreased lymphocyte subset counts and proportions were observed in COVID-19 patients, except for the CD3+ and CD8+ T cell proportions. The lower CD4+ T cell proportions and higher CD8+ T cell proportions were observed in male and severe COVID-19 patients and the differences were independent of estrogen level. The CD4+ T cell proportion was negatively associated with the CD8+ T cell proportion in male COVID-19 patients; this correlation was non-significant in females. Our work demonstrates differences between sexes in circulating monocyte counts and CD4+ T cell and CD8+ T cell proportions in COVID-19 patients, independent of estrogen levels, are associated with the clinical manifestations in COVID-19 patients with high specificity.

Highlights

The coronavirus infectious disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2,3], is a huge challenge for public health throughout the world
The present study included a cohort of 111 people, i.e. 36 confirmed COVID-19 patients, 54 sex- and age-matched common viral community-acquired pneumonia (CAP) patients with respiratory symptoms, and 21 healthy controls
The present study included a cohort of 111 people, i.e. 36 confirmed COVID-19 patients, including 28 moderate and 8 severe cases on admission, 54 common viral CAP patients with respiratory symptoms, and 21 healthy controls

Summary

Introduction

The coronavirus infectious disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2,3], is a huge challenge for public health throughout the world. SARS-CoV-2, as many respiratory viruses, triggers the immune response of hosts and suppresses or even escapes the innate immune response, managing to establish infections and increase the efficiency of replication [6]. Patients with COVID-19 who develop from pneumonia to severe respiratory failure have hyper-inflammatory responses [7], which can be caused by either immune dysregulation or macrophage activation syndrome [8,9]. An increasing number of studies on immunopathology and biology have revealed the mechanics of viral infection and hyper-inflammatory responses [7,10].

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