Sex and bacterial infectious diseases

Mège, Jean‐Louis; Bretelle, Florence; Léone, Marc

doi:10.1016/j.nmni.2018.05.010

Cited by 17 publications

(17 citation statements)

References 37 publications

(42 reference statements)

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“…Male-female differences in infectious diseases have already been reported and explored in the literature [ 9 – 11 ]. These differences are usually attributed to three determinants: differences in immune function associated with the X chromosome, the effects of sex hormones and gender-related behavior [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, contrary to reports on MERS-CoV and SARS-CoV-1, women have been reported to suffer higher morbidity and mortality than men during influenza outbreaks [ 8 ]. Biological factors (referred to as sex-related variables) and sociocultural factors (referred as gender-related variables) are often put forward as explanations for the differences observed between men and women with regards to susceptibility and host response [ 9 – 12 ]. In this review we aimed to compile the data relating to men versus women in the literature on SARS-CoV-2.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 gender susceptibility and outcomes: A systematic review

et al. 2020

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Background Epidemiological differences between men and women have been reported with regards to sepsis, influenza and severe coronavirus infections including SARS-CoV and MERS-CoV. Aim To systematically review the literature relating to men versus women on SARS-CoV-2 in order to seek differences in disease characteristics (e.g. infectivity, severity) and outcomes (e.g. mortality). Methods We searched 3 electronic databases up or observational studies reporting differences between men and women in the SARS-CoV-2 disease characteristics stated. We identified and included 47 studies, reporting data for 21,454 patients mainly from China. Results The unadjusted mortality rates of men were higher than those of women, with a mortality OR 0.51 [0.42, 0.61] (p<0.001) for women. The proportion of men presenting with severe disease and admitted to the intensive care unit (ICU) was also higher than that of women (OR 0.75 [0.60–0.93] p<0.001 and OR 0.45 [0.40–0.52] p<0.001 respectively). Adjusted analyses could not be conducted due to lack of data. Conclusion COVID-19 may be associated with worse outcomes in males than in females. However, until more detailed data are provided in further studies enabling adjusted analysis, this remains an unproven assumption.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 gender susceptibility and outcomes: A systematic review

et al. 2020

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“…In infectious diseases, the health differences between men and women are a result of interactions between biological and sociocultural factors. Hence, age, comorbidities, genetic predispositions, geographical distribution of pathogens, health behaviors, and hormonal influences are just some of the examples of the diversity of mechanisms explaining sex differences (1). These different factors make it difficult to discriminate what is related to sex as a biological entity and gender as a social construct.…”

Section: Introductionmentioning

confidence: 99%

Sexual Dimorphism and Gender in Infectious Diseases

et al. 2021

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Epidemiological studies and clinical observations show evidence of sexual dimorphism in infectious diseases. Women are at less risk than men when it comes to developing most infectious diseases. However, understanding these observations requires a gender approach that takes into account an analysis of both biological and social factors. The host’s response to infection differs in males and females because sex differences have an impact on hormonal and chromosomal control of immunity. Estradiol appears to confer protective immunity, while progesterone and testosterone suppress anti-infectious responses. In addition, genetic factors, including those associated with sex chromosomes, also affect susceptibility to infections. Finally, differences in occupational activities, lifestyle, and comorbidities play major roles in exposure to pathogens and management of diseases. Hence, considering sexual dimorphism as a critical variable for infectious diseases should be one of the steps taken toward developing personalized therapeutic approaches.

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“…The last 2 decades have witnessed an exponential rise in the number of studies investigating the role of sex steroids on the progression of chronic infections (7)(8)(9)(10)(11)(12)(13). Many bacterial pathogens sense and respond to mammalian hormones, including sex steroids (5,8,13,14).…”

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confidence: 99%

Sex Steroids Induce Membrane Stress Responses and Virulence Properties in Pseudomonas aeruginosa

Vidaillac

Yong

Aschtgen

et al. 2020

mBio

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Estrogen, a major female sex steroid hormone, has been shown to promote the selection of mucoid Pseudomonas aeruginosa in the airways of patients with chronic respiratory diseases, including cystic fibrosis. This results in long-term persistence, poorer clinical outcomes, and limited therapeutic options. In this study, we demonstrate that at physiological concentrations, sex steroids, including testosterone and estriol, induce membrane stress responses in P. aeruginosa. This is characterized by increased virulence and consequent inflammation and release of proinflammatory outer membrane vesicles promoting in vivo persistence of the bacteria. The steroid-induced P. aeruginosa response correlates with the molecular polarity of the hormones and membrane fluidic properties of the bacteria. This novel mechanism of interaction between sex steroids and P. aeruginosa explicates the reported increased disease severity observed in females with cystic fibrosis and provides evidence for the therapeutic potential of the modulation of sex steroids to achieve better clinical outcomes in patients with hormone-responsive strains. IMPORTANCE Molecular mechanisms by which sex steroids interact with P. aeruginosa to modulate its virulence have yet to be reported. Our work provides the first characterization of a steroid-induced membrane stress mechanism promoting P. aeruginosa virulence, which includes the release of proinflammatory outer membrane vesicles, resulting in inflammation, host tissue damage, and reduced bacterial clearance. We further demonstrate that at nanomolar (physiological) concentrations, male and female sex steroids promote virulence in clinical strains of P. aeruginosa based on their dynamic membrane fluidic properties. This work provides, for the first-time, mechanistic insight to better understand and predict the P. aeruginosa related response to sex steroids and explain the interindividual patient variability observed in respiratory diseases such as cystic fibrosis that are complicated by gender differences and chronic P. aeruginosa infection.

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Sex and bacterial infectious diseases

Cited by 17 publications

References 37 publications

COVID-19 gender susceptibility and outcomes: A systematic review

COVID-19 gender susceptibility and outcomes: A systematic review

Sexual Dimorphism and Gender in Infectious Diseases

Sex Steroids Induce Membrane Stress Responses and Virulence Properties in Pseudomonas aeruginosa

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