New Coronavirus infection of people, there is a gender difference?
One topic of interest in the outbreak has been whether there is a differential impact on the infection of neocollins based on the different genders of men and women, and the consequent vast differences in the body's construction and biological dimensions.
In earlier publications, researchers were not unanimous in their conclusions about the incidence and mortality rates of C. neoformans among people of different genders, with some believing there was no difference, some believing that women were more susceptible, and some believing that mortality rates were higher among male patients than among women.
Now, there's a clearer, more convincing answer to that question.
A meta-analysis of 77,932 patients
On March 30, an article titled Sex Differences in Severity and Mortality Among Patients With COVID-19: Evidence from PooledLiterature Analysis and Insights from Integrated Bioinformatic Analysism.
The paper was published by Prof. Ren Shancheng's team from Changhai Hospital in Shanghai, China, and was authored by Xiyi Wei, Yutian Xiao, Jian Wang, Rui Chen, and Wei Zhang.
The paper attempts to explore gender differences in severity and mortality in COVID-19 patients through evidence from pooled literature analysis, as well as insights from comprehensive bioinformatic analysis.
It can be argued that this is the first big data analytic study done to address the correlation between incidence/severity/mortality rates of neocoronary pneumonia and male and female gender in accordance with meta-analysis and systematic review.
According to BioArtReports' report on the paper, the study searched ***1561 papers including preprint articles, and after independent screening by multiple people, 39 studies***77932 patients were finally included in the meta-analysis, of which 41,510 or 53.3% were male, and all the cases came from China and Japan, Korea, Singapore, Italy, and the United Kingdom and six other countries.
The results showed that the incidence of new coronaviruses was significantly higher in men than in women in 39 overall studies of all cases, with 34 studies from Chinese populations supporting this finding.
Meanwhile, 21 and 8 studies*** reported the number of severe cases and deaths, respectively, and meta-analysis results showed that the rates of severe cases and deaths were also significantly higher in men than in women.
Further subgroup analyses also found that the proportion of severe illnesses did not differ significantly by gender in the population with a mean age of less than 50 years, whereas the rate of severe illnesses in the population with a mean age of more than 50 years was significantly higher in male than in female patients.
From the above subgroup analysis, it can be seen that the proportion of severe illnesses in males is higher than that in females as the age of the patients increases, which suggests that healthcare professionals should pay more attention to middle-aged and elderly males in the treatment of patients with new coronary pneumonia.
Overall, the article concludes that the incidence, severity, and mortality rates of novel coronavirus pneumonia are higher in men than in women.
Biological Reasons for Gender Differences
So why does novel coronavirus pneumonia appear to be different in men and women?
Previously, researchers found that the key to infection of human cells by the new coronavirus lies in the binding of the coronavirus' S protein to the ACE2 protein in the body. To be more precise, it is the S protein of the virus that hijacks ACE2, which is supposed to control blood pressure, and invades the body and triggers the infection by binding to it.
However, according to research published by Cell in March, the new coronavirus needs to utilize the serine protease TMPRSS2, a protease found in human cells, to activate its S-protein.
The point is that TMPRSS2, a key molecule in the development of prostate cancer in men, is positively regulated by androgen in the body. As a result, Prof. Ren Shancheng's team concluded that an important factor contributing to the male-female difference in CKP is the higher level of androgens in men and their regulation of a key molecule in viral invasion.
The researchers identified several key ACE2 features of the lung associated with SARS-CoV-2 virus infection by analyzing lung single-cell sequencing data as well as other important databases.
1. Single-cell RNA-seq analysis showed that the number of type II alveolar cells capable of expressing ACE2 was significantly higher in the lungs of males than females, meaning that the number of host cells that the virus could attack was greater in males than in females.
Meanwhile, single-cell RNA-seq data from the prostate and testis revealed that ACE2 is commonly expressed in these two male-specific organs, suggesting that the prostate and testis may be potential targets for SARS-Cov-2 infection in the male population.
Previously, on March 12, the website of the Hubei Provincial People's Government published an article, "Fertility screening should be performed for males of the appropriate age who are infected with SARS-Cov-2," based on the same reason.
2, androgen receptor can directly positively regulate ACE2 expression.
Analysis found that androgen receptor and ACE2 were *** expression pattern; further analysis found that androgen receptor and ACE2 and TMPRSS2 expression was positively correlated with this phenomenon, which is prevalent in many tissues and organs of the human body, and androgen deprivation, the expression of ACE2 and TMPRSS2 is also down-regulated; in addition, it is further suggested that androgen receptor may bind to the enhancer region upstream of ACE2 and promote ACE2 expression.
3. The analysis revealed that a number of pro-inflammatory cytokines and chemokines were predominantly expressed in the male population. In particular, IL6ST, the receptor for IL_6, which is the core factor of cytokine storm, was highly expressed in a number of cells of male lungs, suggesting that males are more susceptible to the occurrence of cytokine storms, which may lead to the worsening of the condition of neocoronaryngitis. In contrast, some cytokines such as CCL2, CCL3, and CCL4, which play a protective role against viral infections, were highly expressed in the female population.
4. T cells in the lung microenvironment of men are less capable of killing viruses than those of women. This gender-based difference in natural immune response results in weaker resistance to viral attack in male lung cells than in females.
Bio Art Reports says the study clearly demonstrates for the first time in a large sample meta-analysis that men have a higher incidence of neocoronavirus pneumonia, a higher rate of severe illness, and a higher mortality rate than women.
It also uncovers the underlying biology, demonstrating that ACE2, a key molecule in the invasion of C. neoformans, is positively regulated by the androgen receptor and is expressed and distributed in male lung cells more than in female lungs, and that the autoimmune response to viral attack in male lung cells is weaker than in female lungs.
These point to a simple conclusion: men are more vulnerable than women to new coronaviruses.
Summary
In fact, before this paper, there have been studies on the association of gender differences between men and women with neococcal pneumonia.
Among them, in mid-February, the Chinese Center for Disease Control and Prevention (CDC) released a statistical report on the outbreak, showing that of the 44,672 confirmed cases of neocoronavirus pneumonia nationwide as of Feb. 11, 51.4% of the patients in the national data were male; because the male-to-female sex ratio was close to 1:1, the CDC concluded that neocoronavirus pneumonia did not show a clear gender predisposition.
But at the same time, this CDC report also shows that male patients had a significantly higher mortality rate than women, with the former having a 2.8 percent mortality rate and the latter only 1.7 percent.
In early March, a study published on the preprint platform SSRN by a team from Wuhan University People's Hospital gave a new perspective. Specifically, the researchers analyzed data from 6,013 cases from Jan. 1 to 29 and found that 55.9 percent of patients were male; 58.8 percent of those who entered the intensive care unit were male.
That is, not only are men more likely to be infected with the new coronavirus, but they also seem to have more severe symptoms.
Also, 47 of the 67 asymptomatic infections identified in this study were female, suggesting that women also accounted for a large percentage of asymptomatic infections The researchers hypothesized that the gender difference in infections may be due not to the fact that the virus prefers to infect men, but rather to the fact that men and women have different resistances to the virus.
Now, with the publication of the results of the paper by Prof. Ren Shancheng's team, the relationship between NKP and gender differences seems to have a clearer and more evidence-based interpretation.
Last question: do you think this interpretation is reliable?
For more information, see "New Crown pneumonia 'sexist'! Men are more likely to be infected, the mortality rate is higher" for more information, please continue to pay attention to the deep space of science and technology information column, deep space editor will continue to update you with more science and technology news.
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