Immunological aspects and gender bias during respiratory viral infections including novel Coronavirus disease-19 (COVID-19): A scoping review

J Med Virol. 2021 Sep;93(9):5295-5309. doi: 10.1002/jmv.27081. Epub 2021 May 19.

Abstract

The human immune system is not adequately equipped to eliminate new microbes and could result in serious damage on first exposure. This is primarily attributed to the exaggerated immune response (inflammatory disease), which may prove detrimental to the host, as evidenced by SARS-CoV-2 infection. From the experiences of Novel Coronavirus Disease-19 to date, male patients are likely to suffer from high-intensity inflammation and disease severity than the female population. Hormones are considered the significant pillars of sex differences responsible for the discrepancy in immune response exhibited by males and females. Females appear to be better equipped to counter invading respiratory viral pathogens, including the novel SARS-CoV-2, than males. It can be hypothesized that females are more shielded from disease severity, probably owing to the diverse action/influence of estrogen and other sex hormones on both cellular (thymus-derived T lymphocytes) and humoral immunity (antibodies).

Keywords: COVID-19; SARS-CoV-2; estrogen; gender biasness; immune system; inflammation; sex hormones.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2 / immunology*
  • COVID-19* / epidemiology
  • COVID-19* / immunology
  • Estrogens / immunology*
  • Female
  • Humans
  • Immunity, Humoral
  • Male
  • Sex Factors*
  • T-Lymphocytes / cytology
  • T-Lymphocytes / immunology

Substances

  • Estrogens
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2