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Published in: Immunity & Ageing 1/2020

Open Access 01-12-2020 | COVID-19 | Review

The lethal sex gap: COVID-19

Authors: Eladio J. Márquez, Jennifer Trowbridge, George A. Kuchel, Jacques Banchereau, Duygu Ucar

Published in: Immunity & Ageing | Issue 1/2020

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Abstract

While Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is disrupting lives across the globe for everyone, it has a more devastating impact on the health of older adults, especially that of older men. This pandemic has highlighted the crucial importance of considering an individual’s age and biological sex in the clinic in addition to other confounding diseases (Kuchel, G.A, J Am Geriatr Soc, 67, 203, 2019, Tannenbaum, C., Nature, 575 451-458, 2009) As an interdisciplinary team of scientists in immunology, hematology, genomics, bioinformatics, and geriatrics, we have been studying how age and sex shape the human immune system. Herein we reflect on how our recent findings on the alterations of the immune system in aging might contribute to our current understanding of COVID-19 infection rate and disease risk.
Literature
1.
go back to reference Jamieson DJ, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009;374(9688):451–8.PubMedCrossRef Jamieson DJ, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009;374(9688):451–8.PubMedCrossRef
2.
4.
go back to reference Quach A, et al. Epigenetic clock analysis of diet, exercise, education, and lifestyle factors. Aging (Albany NY). 2017;9(2):419.CrossRef Quach A, et al. Epigenetic clock analysis of diet, exercise, education, and lifestyle factors. Aging (Albany NY). 2017;9(2):419.CrossRef
7.
go back to reference Castelo-Branco C, Soveral I. The immune system and aging: a review. Gynecol Endocrinol. 2014;30(1):16–22.PubMedCrossRef Castelo-Branco C, Soveral I. The immune system and aging: a review. Gynecol Endocrinol. 2014;30(1):16–22.PubMedCrossRef
11.
go back to reference Nikolich-Žugich J. The twilight of immunity: emerging concepts in aging of the immune system. Nat Immunol. 2018;19(1):10.PubMedCrossRef Nikolich-Žugich J. The twilight of immunity: emerging concepts in aging of the immune system. Nat Immunol. 2018;19(1):10.PubMedCrossRef
12.
go back to reference Panda A, et al. Age-associated decrease in TLR function in primary human dendritic cells predicts influenza vaccine response. J Immunol. 2010;184(5):2518–27.PubMedCrossRef Panda A, et al. Age-associated decrease in TLR function in primary human dendritic cells predicts influenza vaccine response. J Immunol. 2010;184(5):2518–27.PubMedCrossRef
13.
go back to reference Pawelec G. Hallmarks of human “immunosenescence”: adaptation or dysregulation? 2012, BioMed Central; 2012. Pawelec G. Hallmarks of human “immunosenescence”: adaptation or dysregulation? 2012, BioMed Central; 2012.
15.
go back to reference Cesari M, et al. Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol Ser A Biol Med Sci. 2004;59(3):M242–8.CrossRef Cesari M, et al. Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol Ser A Biol Med Sci. 2004;59(3):M242–8.CrossRef
16.
go back to reference Benayoun BA, et al. Remodeling of epigenome and transcriptome landscapes with aging in mice reveals widespread induction of inflammatory responses. Genome Res. 2019;29(4):697–709.PubMedPubMedCentralCrossRef Benayoun BA, et al. Remodeling of epigenome and transcriptome landscapes with aging in mice reveals widespread induction of inflammatory responses. Genome Res. 2019;29(4):697–709.PubMedPubMedCentralCrossRef
17.
go back to reference Team, H.-C.S.P. and H.-I. Consortium. Multicohort analysis reveals baseline transcriptional predictors of influenza vaccination responses. Sci Immunol. 2017;2:14. Team, H.-C.S.P. and H.-I. Consortium. Multicohort analysis reveals baseline transcriptional predictors of influenza vaccination responses. Sci Immunol. 2017;2:14.
20.
go back to reference Pereira BI, et al. Sestrins induce natural killer function in senescent-like CD8+ T cells. Nat Immunol. 2020:1–11. Pereira BI, et al. Sestrins induce natural killer function in senescent-like CD8+ T cells. Nat Immunol. 2020:1–11.
21.
go back to reference Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical Infectious Diseases. 2020. https://doi.org/10.1093/cid/ciaa248 PMID: 32161940, PMCID:PMC7108125. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical Infectious Diseases. 2020. https://​doi.​org/​10.​1093/​cid/​ciaa248 PMID: 32161940, PMCID:PMC7108125.
22.
go back to reference Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020.
25.
go back to reference Bastard J-P, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4–12.PubMed Bastard J-P, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4–12.PubMed
26.
go back to reference Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-α and IL-6. Diabetes Res Clin Pract. 2005;69(1):29–35.PubMedCrossRef Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-α and IL-6. Diabetes Res Clin Pract. 2005;69(1):29–35.PubMedCrossRef
27.
go back to reference Liao, M., et al., The landscape of lung bronchoalveolar immune cells in COVID-19 revealed by single-cell RNA sequencing. medRxiv, 2020. Liao, M., et al., The landscape of lung bronchoalveolar immune cells in COVID-19 revealed by single-cell RNA sequencing. medRxiv, 2020.
28.
go back to reference Bartz D, et al. Clinical advances in sex-and gender-informed medicine to improve the health of all: a review. JAMA Int Med. 2020. Bartz D, et al. Clinical advances in sex-and gender-informed medicine to improve the health of all: a review. JAMA Int Med. 2020.
29.
30.
go back to reference vom Steeg LG, Klein SL. SeXX matters in infectious disease pathogenesis. PLoS Pathog. 2016;12:2. vom Steeg LG, Klein SL. SeXX matters in infectious disease pathogenesis. PLoS Pathog. 2016;12:2.
31.
go back to reference Smith JC, Sheltzer JM. Cigarette smoke triggers the expansion of a subpopulation of respiratory epithelial cells that express the SARS-CoV-2 receptor ACE2. bioRxiv. 2020;2020:013672. Smith JC, Sheltzer JM. Cigarette smoke triggers the expansion of a subpopulation of respiratory epithelial cells that express the SARS-CoV-2 receptor ACE2. bioRxiv. 2020;2020:013672.
33.
go back to reference Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respiratory Med. 2020. Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respiratory Med. 2020.
34.
go back to reference Bianchi I, et al. The X chromosome and immune associated genes. J Autoimmun. 2012;38(2–3):J187–92.PubMedCrossRef Bianchi I, et al. The X chromosome and immune associated genes. J Autoimmun. 2012;38(2–3):J187–92.PubMedCrossRef
35.
go back to reference Libert C, Dejager L, Pinheiro I. The X chromosome in immune functions: when a chromosome makes the difference. Nat Rev Immunol. 2010;10(8):594–604..PubMedCrossRef Libert C, Dejager L, Pinheiro I. The X chromosome in immune functions: when a chromosome makes the difference. Nat Rev Immunol. 2010;10(8):594–604..PubMedCrossRef
37.
go back to reference Souyris M, et al. TLR7 escapes X chromosome inactivation in immune cells. Science Immunology. 2018;3(19):eaap8855.PubMedCrossRef Souyris M, et al. TLR7 escapes X chromosome inactivation in immune cells. Science Immunology. 2018;3(19):eaap8855.PubMedCrossRef
39.
go back to reference Hatakeyama C, et al. The dynamics of X-inactivation skewing as women age. Clin Genet. 2004;66(4):327–32.PubMedCrossRef Hatakeyama C, et al. The dynamics of X-inactivation skewing as women age. Clin Genet. 2004;66(4):327–32.PubMedCrossRef
40.
go back to reference Márquez EJ, et al. Sexual-dimorphism in human immune system aging. Nat Commun. 2020;11(1):1–17.CrossRef Márquez EJ, et al. Sexual-dimorphism in human immune system aging. Nat Commun. 2020;11(1):1–17.CrossRef
41.
43.
go back to reference Zhavoronkov A. Geroprotective and senoremediative strategies to reduce the comorbidity, infection rates, severity, and lethality in gerophilic and gerolavic infections. Aging (Albany NY). 2020;12. Zhavoronkov A. Geroprotective and senoremediative strategies to reduce the comorbidity, infection rates, severity, and lethality in gerophilic and gerolavic infections. Aging (Albany NY). 2020;12.
44.
go back to reference Piasecka B, et al. Distinctive roles of age, sex, and genetics in shaping transcriptional variation of human immune responses to microbial challenges. Proc Natl Acad Sci. 2018;115(3):E488–97.PubMedCrossRef Piasecka B, et al. Distinctive roles of age, sex, and genetics in shaping transcriptional variation of human immune responses to microbial challenges. Proc Natl Acad Sci. 2018;115(3):E488–97.PubMedCrossRef
46.
go back to reference Zheng, Y., et al., Comparative study of the lymphocyte change between COVID-19 and non-COVID-19 pneumonia cases suggesting uncontrolled inflammation might not be the main reason of tissue injury. medRxiv, 2020. Zheng, Y., et al., Comparative study of the lymphocyte change between COVID-19 and non-COVID-19 pneumonia cases suggesting uncontrolled inflammation might not be the main reason of tissue injury. medRxiv, 2020.
47.
go back to reference Shen C, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA. 2020. Shen C, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA. 2020.
48.
go back to reference Morrone SR, Lok S-M. Structural perspectives of antibody-dependent enhancement of infection of dengue virus. Curr Opin Virology. 2019;36:1–8.CrossRef Morrone SR, Lok S-M. Structural perspectives of antibody-dependent enhancement of infection of dengue virus. Curr Opin Virology. 2019;36:1–8.CrossRef
49.
go back to reference Liu L, et al. Anti–spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARS-CoV infection. JCI Insight. 2019;4:4. Liu L, et al. Anti–spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARS-CoV infection. JCI Insight. 2019;4:4.
50.
go back to reference Olson NC, et al. Decreased naive and increased memory CD4(+) T cells are associated with subclinical atherosclerosis: the multi-ethnic study of atherosclerosis. PLoS One. 2013;8(8):e71498.PubMedPubMedCentralCrossRef Olson NC, et al. Decreased naive and increased memory CD4(+) T cells are associated with subclinical atherosclerosis: the multi-ethnic study of atherosclerosis. PLoS One. 2013;8(8):e71498.PubMedPubMedCentralCrossRef
51.
go back to reference Clave E, et al. Human thymopoiesis is influenced by a common genetic variant within the TCRA-TCRD locus. Science Translational Med. 2018;10(457):eaao2966.CrossRef Clave E, et al. Human thymopoiesis is influenced by a common genetic variant within the TCRA-TCRD locus. Science Translational Med. 2018;10(457):eaao2966.CrossRef
53.
go back to reference Zheng M, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol. 2020:1–3. Zheng M, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol. 2020:1–3.
54.
go back to reference Young K, et al. Progressive alterations in multipotent hematopoietic progenitors underlie lymphoid cell loss in aging. J Exp Med. 2016;213(11):2259–67.PubMedPubMedCentralCrossRef Young K, et al. Progressive alterations in multipotent hematopoietic progenitors underlie lymphoid cell loss in aging. J Exp Med. 2016;213(11):2259–67.PubMedPubMedCentralCrossRef
55.
59.
go back to reference Clerkin KJ, et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation. 2020. Clerkin KJ, et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation. 2020.
61.
go back to reference Fuster JJ, et al. Clonal hematopoiesis associated with TET2 deficiency accelerates atherosclerosis development in mice. Science. 2017;355(6327):842–7.PubMedPubMedCentralCrossRef Fuster JJ, et al. Clonal hematopoiesis associated with TET2 deficiency accelerates atherosclerosis development in mice. Science. 2017;355(6327):842–7.PubMedPubMedCentralCrossRef
62.
go back to reference Sano S, et al. CRISPR-mediated gene editing to assess the roles of Tet2 and Dnmt3a in clonal hematopoiesis and cardiovascular disease. Circ Res. 2018;123(3):335–41.PubMedPubMedCentralCrossRef Sano S, et al. CRISPR-mediated gene editing to assess the roles of Tet2 and Dnmt3a in clonal hematopoiesis and cardiovascular disease. Circ Res. 2018;123(3):335–41.PubMedPubMedCentralCrossRef
63.
go back to reference Sano S, et al. Tet2-mediated clonal hematopoiesis accelerates heart failure through a mechanism involving the IL-1β/NLRP3 inflammasome. J Am Coll Cardiol. 2018;71(8):875–86.PubMedPubMedCentralCrossRef Sano S, et al. Tet2-mediated clonal hematopoiesis accelerates heart failure through a mechanism involving the IL-1β/NLRP3 inflammasome. J Am Coll Cardiol. 2018;71(8):875–86.PubMedPubMedCentralCrossRef
64.
go back to reference Loberg MA, et al. Sequentially inducible mouse models reveal that Npm1 mutation causes malignant transformation of Dnmt3a-mutant clonal hematopoiesis. Leukemia. 2019;33(7):1635–49.PubMedPubMedCentralCrossRef Loberg MA, et al. Sequentially inducible mouse models reveal that Npm1 mutation causes malignant transformation of Dnmt3a-mutant clonal hematopoiesis. Leukemia. 2019;33(7):1635–49.PubMedPubMedCentralCrossRef
65.
go back to reference Celik H, et al. Enforced differentiation of Dnmt3a-null bone marrow leads to failure with c-kit mutations driving leukemic transformation. Blood. 2015;125(4):619–28.PubMedPubMedCentralCrossRef Celik H, et al. Enforced differentiation of Dnmt3a-null bone marrow leads to failure with c-kit mutations driving leukemic transformation. Blood. 2015;125(4):619–28.PubMedPubMedCentralCrossRef
66.
go back to reference Challen GA, et al. Dnmt3a is essential for hematopoietic stem cell differentiation. Nat Genet. 2012;44(1):23.CrossRef Challen GA, et al. Dnmt3a is essential for hematopoietic stem cell differentiation. Nat Genet. 2012;44(1):23.CrossRef
67.
go back to reference Cole CB, et al. Haploinsufficiency for DNA methyltransferase 3A predisposes hematopoietic cells to myeloid malignancies. J Clin Invest. 2017;127(10):3657–74.PubMedPubMedCentralCrossRef Cole CB, et al. Haploinsufficiency for DNA methyltransferase 3A predisposes hematopoietic cells to myeloid malignancies. J Clin Invest. 2017;127(10):3657–74.PubMedPubMedCentralCrossRef
68.
go back to reference Guryanova OA, et al. DNMT3A mutations promote anthracycline resistance in acute myeloid leukemia via impaired nucleosome remodeling. Nat Med. 2016;22(12):1488.PubMedPubMedCentralCrossRef Guryanova OA, et al. DNMT3A mutations promote anthracycline resistance in acute myeloid leukemia via impaired nucleosome remodeling. Nat Med. 2016;22(12):1488.PubMedPubMedCentralCrossRef
69.
go back to reference Ko M, et al. Ten-eleven-translocation 2 (TET2) negatively regulates homeostasis and differentiation of hematopoietic stem cells in mice. Proc Natl Acad Sci. 2011;108(35):14566–71.PubMedCrossRefPubMedCentral Ko M, et al. Ten-eleven-translocation 2 (TET2) negatively regulates homeostasis and differentiation of hematopoietic stem cells in mice. Proc Natl Acad Sci. 2011;108(35):14566–71.PubMedCrossRefPubMedCentral
70.
go back to reference Cull, A.H., et al., Tet2 restrains inflammatory gene expression in macrophages. Exp Hematology, 2017. 55: p. 56–70. e13.PubMedCrossRef Cull, A.H., et al., Tet2 restrains inflammatory gene expression in macrophages. Exp Hematology, 2017. 55: p. 56–70. e13.PubMedCrossRef
73.
75.
76.
go back to reference Kotliarov Y, et al. Broad immune activation underlies shared set point signatures for vaccine responsiveness in healthy individuals and disease activity in patients with lupus. Nat Med. 2020:1–12. Kotliarov Y, et al. Broad immune activation underlies shared set point signatures for vaccine responsiveness in healthy individuals and disease activity in patients with lupus. Nat Med. 2020:1–12.
78.
79.
go back to reference Krieg C, et al. High-dimensional single-cell analysis predicts response to anti-PD-1 immunotherapy. Nat Med. 2018;24(2):144.PubMedCrossRef Krieg C, et al. High-dimensional single-cell analysis predicts response to anti-PD-1 immunotherapy. Nat Med. 2018;24(2):144.PubMedCrossRef
80.
go back to reference Satpathy AT, et al. Massively parallel single-cell chromatin landscapes of human immune cell development and intratumoral T cell exhaustion. Nat Biotechnol. 2019;37(8):925–36.PubMedCrossRefPubMedCentral Satpathy AT, et al. Massively parallel single-cell chromatin landscapes of human immune cell development and intratumoral T cell exhaustion. Nat Biotechnol. 2019;37(8):925–36.PubMedCrossRefPubMedCentral
81.
go back to reference Papalexi E, Satija R. Single-cell RNA sequencing to explore immune cell heterogeneity. Nat Rev Immunol. 2018;18(1):35.PubMedCrossRef Papalexi E, Satija R. Single-cell RNA sequencing to explore immune cell heterogeneity. Nat Rev Immunol. 2018;18(1):35.PubMedCrossRef
82.
go back to reference Kuchel GA. Inclusion of older adults in research: ensuring relevance, feasibility, and rigor. J Am Geriatr Soc. 2019;67(2):203.PubMedCrossRef Kuchel GA. Inclusion of older adults in research: ensuring relevance, feasibility, and rigor. J Am Geriatr Soc. 2019;67(2):203.PubMedCrossRef
83.
go back to reference Tannenbaum C, et al. Sex and gender analysis improves science and engineering. Nature. 2019;575(7781):137–46.PubMedCrossRef Tannenbaum C, et al. Sex and gender analysis improves science and engineering. Nature. 2019;575(7781):137–46.PubMedCrossRef
84.
go back to reference Koff WC, Williams MA. Covid-19 and immunity in aging populations - a new research agenda. N Engl J Med. 2020. Koff WC, Williams MA. Covid-19 and immunity in aging populations - a new research agenda. N Engl J Med. 2020.
Metadata
Title
The lethal sex gap: COVID-19
Authors
Eladio J. Márquez
Jennifer Trowbridge
George A. Kuchel
Jacques Banchereau
Duygu Ucar
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
COVID-19
Published in
Immunity & Ageing / Issue 1/2020
Electronic ISSN: 1742-4933
DOI
https://doi.org/10.1186/s12979-020-00183-z

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