HPI/UKE hormone study reveals sex differences in the course of COVID-19 infections

The research department "Viral Zoonoses - One Health" at the Leibniz Institute for Experimental Virology (HPI) in Hamburg under the direction of Prof. Gülşah Gabriel, professor at the University of Veterinary Medicine Hannover (TiHo), has investigated the influence of gender on COVID-19 infections in a joint study with the University Medical Center Hamburg-Eppendorf (UKE). The results have now been published in the renowned journal "Emerging Microbes & Infections".

Men are more severely affected by COVID-19 than women. This has been shown in several independent studies. Sex hormones could play an important role in gender-specific infection severity, as they are important modulators of the immune system. That has now been investigated in a joint study between the HPI and the UKE. For this purpose, the hormone balance of a total of 181 patients was determined: COVID-19 patients requiring intensive care, patients requiring intensive care without COVID-19, patients with underlying diseases as well as healthy control groups.

The vast majority of male COVID-19 patients had elevated estradiol and low testosterone levels. It was shown that elevated estradiol levels are associated with a significant increase in inflammatory markers and a critical disease course. In contrast, no statistically significant differences in sex hormone levels were observed in female COVID-19 patients.

"These findings argue for a possible influence of sex hormones on sex-specific disease progression in COVID-19 and lay a basis for further mechanistic studies," explains Prof. Gülşah Gabriel, head of the HPI research department "Viral Zoonoses - One Health" and professor at the University of Veterinary Medicine Hannover.

"We were very surprised to find that men are significantly more likely to develop severe COVID-19, although they are infected with SARS-CoV-2 at a similar rate as women. Our study provides first insights into the underlying mechanisms," adds Prof. Stefan Kluge, Director of the Department of Intensive Care Medicine at the UKE.

The findings have been published in the journal Emerging Microbes & Infections:

Maria Schroeder, Berfin Schaumburg, Zacharias Mueller, Ann Parplys, Dominik Jarczak, Kevin Roedl, Axel Nierhaus, Geraldine de Heer, Joern Grensemann, Bettina Schneider, Fabian Stoll, Tian Bai, Henning Jacobsen, Martin Zickler, Stephanie Stanelle- Bertram, Kristin Klaetschke, Thomas Renné, Andreas Meinhardt, Jens Aberle, Jens Hiller, Sven Peine, Lothar Kreienbrock, Karin Klingel, Stefan Kluge & Guelsah Gabriel (2021). High estradiol and low testosterone levels are associated with critical illness in male but not in female COVID-19 patients: a retrospective cohort study. Emerging Microbes & Infections, August, 2021. https://doi.org/10.1080/22221751.2021.1969869    

HPI contact:

Prof. Gülşah Gabriel

guelsah.gabriel(at)leibniz-hpi.de

Tel.: 040/48051-315

UKE contact:

Prof. Stefan Kluge

skluge(at)uke.de

Tel.: 040/7410-57010