![]() Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. Richardson S, Hirsch JS, Narasimhan M, et al. Anti-androgen therapy remains to be tested in humans as a possible therapy to modify this well-known host risk factor.ġ. Remdesivir failed to demonstrate benefit in experimental male mice survival (9). Prophylaxis with the anti-androgen agent flutamide improved survival: 20% of the treated vs 0% of the control group among males (8). Females presented resistance and ovariectomy increased their vulnerability. Male's lungs presented more viral load/damage. Male vulnerability to SARS-CoV-1 has well studied in murine experiments (8). In a preliminary study in 41 Spanish men admitted due to severe COVID-19, mean age was 58 years (range 23-79) and 71% had androgenetic alopecia (7). Individuals with excess androgen activity usually present with hyperandrogenic phenotypes, including a distinct, cumulative, irreversible feature: pattern scalp hair miniaturization (androgenetic alopecia) (6). ![]() Interestingly, the genes of ACE2 and the Androgen Receptor are located on the X chromosome (3).Įxcess androgen activity is likely to produce excessive TMPRSS2, increasing viral infectivity. ![]() Both TMPRSS2 and Angiotensin Converting Enzyme 2 (ACE2), the virus receptor, are expressed in male and female lungs (5). TMPRSS2 is expressed in the adult lungs (4). One biologic explanation for this vulnerability is that Transmembrane Protease, Serine 2 (TMPRSS2), the protease that primes the Spike protein of the virus for infectivity, is an androgen-expressed protein (3). 2020 18:844-847.Īlbert Einstein College of Medicine, New York, NY, USA and Federico II University, Naples, Italy Īlbert Einstein College of Medicine, Montefiore University Hospital, New York, NY, USA and Federico II University, Naples, et al (1) bring numbers from the American epicenter and important data regarding known male gender vulnerability (2): the drastic difference of over 6 times more male fatalities in a very productive age range (40-49 years) and approximately two times more male admissions from 30-49 years. Abnormal Coagulation Parameters are Associated with Poor Prognosis in Patients with Novel Coronavirus Pneumonia. Is COVID-19 an Endothelial Disease? Clinical and Basic Evidence. (4) Sardu C, Gambardella J, Morelli MB, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. (2) McMichael TM, Currie DW, Clark S, et al. (1) Richardson S, Hirsch JS, Narasimhan M, et al. Can they perform a multivariate analysis to verify whether such treatment(s) had any effect on the severity of disease? Equally important, the authors show an increased average value of D-dimer in their population: do they have any data on actual coagulation disorders? ![]() The authors show in the supplementary tables some data regarding the percentage of patients who were receiving ACE inhibitors and angiotensin II receptor blocker. If our theory is correct, drugs that have been shown to ameliorate endothelial function, such as modulators of the renin-angiotensin-aldosterone system, anti-coagulants, statins, and anti-inflammatory drugs, could be helpful in COVID-19 patients. Furthermore, all of the co-factors bound by SARS-CoV-2 coronavirus to access host cells, including ACE2, CD147, sialic acid receptor, and TMPRSS2, are expressed by human endothelial cells (4). Hence, we hypothesize that SARS-CoV-2 could directly affect endothelial cells (4), explaining all systemic manifestations observed in COVID-19 patients, including thrombotic complications (2, 5). A common underlying feature of all these disorders is endothelial dysfunction. Richardson and colleagues reported hypertension, cardiovascular disease, obesity, and diabetes mellitus, as frequent comorbidities in patients with COVID-19, consistent with previous studies (2, 3). Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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