Sex and gender in interstitial lung diseases

Abstract

Sex and gender differences influence key domains of research, lung health, healthcare access and healthcare delivery. In interstitial lung diseases (ILDs), mouse models of pulmonary fibrosis are clearly influenced by sex hormones. Additionally, short telomeres, a biomarker of telomere regulation gene mutations, are impacted by sex, while heritability unexplained by genetic variation may be attributable to gendered environmental factors that drive epigenetic control. Diseases like idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, occupational ILDs, connective tissue-associated ILDs and lymphangioleiomyomatosis have different prevalence and prognosis between men and women. These differences arise from a complex interplay between biological sex and sociocultural gender influencing genetics, epigenomic modifiers, hormones, immune function, response to treatment and interaction with healthcare systems. Much work remains to be done to systematically integrate sex and gender analysis into relevant domains of science and clinical care in ILD, from strategic considerations for establishing research priorities to guidelines for establishing best clinical practices. Accounting for sex and gender in ILD is essential to the practice of individualised, patient-centred medicine.

Evaluation of cases with hypersensitivity pneumonia: 10 year analysis

“…While a relatively gender‐balanced prevalence emerges in HP, it may differ by gender, particularly as exposure to certain etiologic antigens in occupational HP may be gender‐based. Men appear to be more likely than women to develop HP due to exposure to agricultural and metalworking fluids 14 . In our study, the mean age of the patients diagnosed with HP was 49.36 ± 14.0 years, and the minimum age of diagnosis was 20, and the highest age of diagnosis was 76.…”

“…Men appear to be more likely than women to develop HP due to exposure to agricultural and metalworking fluids. 14 In our study, the mean age of the patients diagnosed with HP was 49.36 ± 14.0 years, and the minimum age of diagnosis was 20, and the highest age of diagnosis was 76. In the study of Kumar et al 15 in India with 103 HP patients, the mean age was found to be 47 ± 12.8 years, and it was found to be similar to our study.…”

Beyond the Lungs: O2 Supplementation Improves Cerebral Oxygenation and Fatigue during Exercise in Interstitial Lung Disease

“…We also aimed to limit the number of experimental visits considering patients' frailty and mobility issues. Although a male-predominant disease, our male-to-female ratio may not be representative of the general f-ILD population (53). For practical reasons (patients' availability in a small clinical center), sex was not considered a covariate in the present study.…”

Unusual X chromosome inactivation maintenance in female alveolar type 2 cells is correlated with increased numbers of X-linked escape genes and sex-biased gene expression

“…Our findings suggest that these expression differences may underlie the observed sex differences in pulmonary disease prevalence and severity. Human males are at higher risk for severe COVID-19 disease ( Scully et al., 2020 ; Takahashi et al., 2020 ), and males also experience greater prevalence and severity of interstitial lung disease and pulmonary fibrosis ( Kawano-Dourado et al., 2021 ). Intriguingly, these pathologies are increasingly recognized as being driven by defects in the lung epithelium, primarily AT2 cells ( Camelo et al., 2014 ; Katzen and Beers, 2020 ; Parimon et al., 2020 ), reinforcing the relevance of the AT2 transcriptomic differences between the sexes.…”