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Review
. 2020 May 21:17:13.
doi: 10.1186/s12979-020-00183-z. eCollection 2020.

The lethal sex gap: COVID-19

Eladio J Márquez  1 , Jennifer Trowbridge  2 , George A Kuchel  3 , Jacques Banchereau  4 , Duygu Ucar  4
Affiliations
Review

The lethal sex gap: COVID-19

Eladio J Márquez et al. Immun Ageing. .

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.

Keywords: COVID-19; Immunosenescence; Inflammaging; Sex differences.

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Conflict of interest statement

Competing interestsGK serves on the scientific advisory boards of resTORbio and Spring Discovery. EJM is an employee of Sanofi. JB is a shareholder of the two companies behind the Sarilumab treatment (Sanofi and Regeneron).

Figures

Fig. 1
Fig. 1
Summary of age- and sex-related changes in the immune system in relation to COVID-19. Inflammation increases with age in both sexes with age, albeit at higher rates in men. Severe COVID-19 cases have been associated with increased inflammation markers in blood and lung. The efficacy of anti-inflammatory drugs are in trials for COVID-19 patients. B cell numbers decline with age specifically in men. Severe cases of COVID-19 have been associated with reduced B cell numbers. Convalescent plasma transfer is being investigated as a potential therapy for COVID-19 patients. T cell functions decline with age, including declining naïve T cell numbers as well as reduced ability to mount strong responses to immune threats. Declines in T cell numbers have been observed in severe COVID-19 patients. Anti-viral drugs can be useful to boost immune cell responses. These observations might also be useful in assessing disease risk in healthy individuals by studying their immune status. For example, individuals who have less B/T cells, more inflammation or more monoclonal hematopoiesis, might be more prone to devastating health consequences of COVID-19
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