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Ilias I, Pratikaki M, Diamantopoulos A, Jahaj E, Mourelatos P, Athanasiou N, Tsipilis S, Zacharis A, Vassiliou AG, Vassiliadi DA, Tsagarakis S, Kotanidou A, Dimopoulou I. Testosterone, free, bioavailable and total, in patients with COVID-19. Minerva Endocrinol (Torino) 2021; 47:111-116. [PMID: 34546019 DOI: 10.23736/s2724-6507.21.03610-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low Testosterone (mainly total testosterone; TTe) has been noted in patients with COVID-19. Calculated free testosterone (FTe) and bioavailable testosterone (BavTe) may reflect more accurately this hormone's levels. In this study, we sought to assess TTe, FTe as well as BavTe in male patients with COVID-19. SUBJECTS/METHODS Sera were collected upon admission from 65 men (10 in the intensive care units [ICU] and 55 in the wards) with polymerase chain reaction - proven COVID-19. A group of age-matched COVID-19-negative men (n=29) hospitalized in general medical wards served as controls. Age, body mass index (BMI) and 28-day mortality were noted. Measurements included TTe, sex-hormone binding globulin, albumin (the latter two for calculating FTe and BavTe) and laboratory markers of inflammation (white blood cell count [WBC], D-Dimers [D-D], lactate dehydrogenease [LDH], ferritin [Fer] and C-reactive protein [CRP]). RESULTS Profoundly low TTe, FTe and BavTe were noted in most patients, and were associated with disease severity/outcome (being the lowest in COVID-19 patients in the ICU and overall being lower in non-survivors; analysis of covariance p<0.05). Pearson's correlations for logTe, logFTe or logBavTe versus WBC, D-D, LDH, Ferr or CRP were negative, ranging from -0.403 to -0.293 (p=0.009 to 0.014). CONCLUSIONS TTe, FTe and BavTe are prone to be low in patients with COVID-19, are negatively associated with disease severity and may be considered to have prognostic value.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece -
| | - Maria Pratikaki
- Department of Microbiology, Evangelismos Hospital, Athens, Greece
| | | | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Mourelatos
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Nikolaos Athanasiou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | | | - Alexandros Zacharis
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Alice G Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Dimitra A Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
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Lavorgna G, Cavalli G, Dagna L, Gregori S, Larcher A, Landoni G, Ciceri F, Montorsi F, Salonia A. A virus-free cellular model recapitulates several features of severe COVID-19. Sci Rep 2021; 11:17473. [PMID: 34471195 PMCID: PMC8410838 DOI: 10.1038/s41598-021-96875-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023] Open
Abstract
As for all newly-emergent pathogens, SARS-CoV-2 presents with a relative paucity of clinical information and experimental models, a situation hampering both the development of new effective treatments and the prediction of future outbreaks. Here, we find that a simple virus-free model, based on publicly available transcriptional data from human cell lines, is surprisingly able to recapitulate several features of the clinically relevant infections. By segregating cell lines (n = 1305) from the CCLE project on the base of their sole angiotensin-converting enzyme 2 (ACE2) mRNA content, we found that overexpressing cells present with molecular features resembling those of at-risk patients, including senescence, impairment of antibody production, epigenetic regulation, DNA repair and apoptosis, neutralization of the interferon response, proneness to an overemphasized innate immune activity, hyperinflammation by IL-1, diabetes, hypercoagulation and hypogonadism. Likewise, several pathways were found to display a differential expression between sexes, with males being in the least advantageous position, thus suggesting that the model could reproduce even the sex-related disparities observed in the clinical outcome of patients with COVID-19. Overall, besides validating a new disease model, our data suggest that, in patients with severe COVID-19, a baseline ground could be already present and, as a consequence, the viral infection might simply exacerbate a variety of latent (or inherent) pre-existing conditions, representing therefore a tipping point at which they become clinically significant.
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Affiliation(s)
- Giovanni Lavorgna
- grid.18887.3e0000000417581884Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Cavalli
- grid.15496.3fUniversity Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- grid.15496.3fUniversity Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Gregori
- grid.18887.3e0000000417581884San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- grid.18887.3e0000000417581884Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanni Landoni
- grid.15496.3fUniversity Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Ciceri
- grid.15496.3fUniversity Vita-Salute San Raffaele, Milan, Italy ,grid.18887.3e0000000417581884Hematology and Bone Marrow Transplant Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- grid.18887.3e0000000417581884Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy ,grid.15496.3fUniversity Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- grid.18887.3e0000000417581884Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy ,grid.15496.3fUniversity Vita-Salute San Raffaele, Milan, Italy
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53
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Jakobsson J, Cotgreave I, Furberg M, Arnberg N, Svensson M. Potential Physiological and Cellular Mechanisms of Exercise That Decrease the Risk of Severe Complications and Mortality Following SARS-CoV-2 Infection. Sports (Basel) 2021; 9:121. [PMID: 34564326 PMCID: PMC8472997 DOI: 10.3390/sports9090121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has unmasked mankind's vulnerability to biological threats. Although higher age is a major risk factor for disease severity in COVID-19, several predisposing risk factors for mortality are related to low cardiorespiratory and metabolic fitness, including obesity, cardiovascular disease, diabetes, and hypertension. Reaching physical activity (PA) guideline goals contribute to protect against numerous immune and inflammatory disorders, in addition to multi-morbidities and mortality. Elevated levels of cardiorespiratory fitness, being non-obese, and regular PA improves immunological function, mitigating sustained low-grade systemic inflammation and age-related deterioration of the immune system, or immunosenescence. Regular PA and being non-obese also improve the antibody response to vaccination. In this review, we highlight potential physiological, cellular, and molecular mechanisms that are affected by regular PA, increase the host antiviral defense, and may determine the course and outcome of COVID-19. Not only are the immune system and regular PA in relation to COVID-19 discussed, but also the cardiovascular, respiratory, renal, and hormonal systems, as well as skeletal muscle, epigenetics, and mitochondrial function.
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Affiliation(s)
- Johan Jakobsson
- Section of Sports Medicine, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden;
| | - Ian Cotgreave
- Division of Biomaterials and Health, Department of Pharmaceutical and Chemical Safety, Research Institutes of Sweden, 151 36 Södertälje, Sweden;
| | - Maria Furberg
- Department of Clinical Microbiology, Umeå University, 901 87 Umeå, Sweden; (M.F.); (N.A.)
| | - Niklas Arnberg
- Department of Clinical Microbiology, Umeå University, 901 87 Umeå, Sweden; (M.F.); (N.A.)
| | - Michael Svensson
- Section of Sports Medicine, Department of Community Medicine and Rehabilitation, Umeå University, 901 87 Umeå, Sweden;
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Salonia A, Pontillo M, Capogrosso P, Gregori S, Carenzi C, Ferrara AM, Rowe I, Boeri L, Larcher A, Ramirez GA, Tresoldi C, Locatelli M, Cavalli G, Dagna L, Castagna A, Zangrillo A, Tresoldi M, Landoni G, Rovere-Querini P, Ciceri F, Montorsi F. Testosterone in males with COVID-19: A 7-month cohort study. Andrology 2021; 10:34-41. [PMID: 34409772 PMCID: PMC8444879 DOI: 10.1111/andr.13097] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023]
Abstract
Background Circulating testosterone levels have been found to be reduced in men with severe acute respiratory syndrome coronavirus 2 infection, COVID‐19, with lower levels being associated with more severe clinical outcomes. Objectives We aimed to assess total testosterone levels and the prevalence of total testosterone still suggesting for hypogonadism at 7‐month follow‐up in a cohort of 121 men who recovered from laboratory‐confirmed COVID‐19. Materials and methods Demographic, clinical, and hormonal values were collected for all patients. Hypogonadism was defined as total testosterone ≤9.2 nmol/L. The Charlson Comorbidity Index was used to score health‐significant comorbidities. Descriptive statistics and multivariable linear and logistic regression models tested the association between clinical and laboratory variables and total testosterone levels at follow‐up assessment. Results Circulating total testosterone levels increased at 7‐month follow‐up compared to hospital admittance (p < 0.0001), while luteinizing hormone and 17β‐estradiol levels significantly decreased (all p ≤ 0.02). Overall, total testosterone levels increased in 106 (87.6%) patients, but further decreased in 12 (9.9%) patients at follow‐up, where a total testosterone level suggestive for hypogonadism was still observed in 66 (55%) patients. Baseline Charlson Comorbidity Index score (OR 0.36; p = 0.03 [0.14, 0.89]) was independently associated with total testosterone levels at 7‐month follow‐up, after adjusting for age, BMI, and IL‐6 at hospital admittance. Conclusions Although total testosterone levels increased over time after COVID‐19, more than 50% of men who recovered from the disease still had circulating testosterone levels suggestive for a condition of hypogonadism at 7‐month follow‐up. In as many as 10% of cases, testosterone levels even further decreased. Of clinical relevance, the higher the burden of comorbid conditions at presentation, the lower the probability of testosterone levels recovery over time.
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Affiliation(s)
- Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Marina Pontillo
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Silvia Gregori
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Carenzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Maria Ferrara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Isaline Rowe
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,IRCCS Foundation Ca' Granda, Maggiore Policlinico Hospital, Department of Urology, University of Milan, Milan, Italy
| | - Alessandro Larcher
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe A Ramirez
- University Vita-Salute San Raffaele, Milan, Italy.,Immunology, Rheumatology, Allergology and Rare Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Cavalli
- University Vita-Salute San Raffaele, Milan, Italy.,Immunology, Rheumatology, Allergology and Rare Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Dagna
- University Vita-Salute San Raffaele, Milan, Italy.,Immunology, Rheumatology, Allergology and Rare Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonella Castagna
- University Vita-Salute San Raffaele, Milan, Italy.,Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- University Vita-Salute San Raffaele, Milan, Italy.,Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanni Landoni
- University Vita-Salute San Raffaele, Milan, Italy.,Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere-Querini
- University Vita-Salute San Raffaele, Milan, Italy.,Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, Milan, Italy.,Hematology and Bone Marrow Transplant Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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Adamyan L, Elagin V, Vechorko V, Stepanian A, Dashko A, Doroshenko D, Aznaurova Y, Sorokin M, Suntsova M, Garazha A, Buzdin A. COVID-19 - associated inhibition of energy accumulation pathways in human semen samples. ACTA ACUST UNITED AC 2021; 2:355-364. [PMID: 34377996 PMCID: PMC8339600 DOI: 10.1016/j.xfss.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022]
Abstract
Objective To investigate transcriptional alterations in human semen samples associated with COVID-19 infection. Design Retrospective observational cohort study. Setting City hospital. Patient(s) Ten patients who had recovered from mild COVID-19 infection. Eight of these patients had different sperm abnormalities that were diagnosed before infection. The control group consisted of 5 healthy donors without known abnormalities and no history of COVID-19 infection. Intervention(s) We used RNA sequencing to determine gene expression profiles in all studied biosamples. Original standard bioinformatic instruments were used to analyze activation of intracellular molecular pathways. Main Outcome Measure(s) Routine semen analysis, gene expression levels, and molecular pathway activation levels in semen samples. Result(s) We found statistically significant inhibition of genes associated with energy production pathways in the mitochondria, including genes involved in the electron transfer chain and genes involved in toll-like receptor signaling. All protein-coding genes encoded by the mitochondrial genome were significantly down-regulated in semen samples collected from patients after recovery from COVID-19. Conclusion(s) Our results may provide a molecular basis for the previously observed phenomenon of decreased sperm motility associated with COVID-19 infection. Moreover, the data will be beneficial for the optimization of preconception care for men who have recently recovered from COVID-19 infection.
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Affiliation(s)
- Leila Adamyan
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, 20b1 Delegatskaya St., Moscow, 127473, Russian Federation
| | - Vladimir Elagin
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, 20b1 Delegatskaya St., Moscow, 127473, Russian Federation.,O.M. Filatov City clinical hospital №15, 23 Veshnjakovskaja St., Moscow, 111539, Russian Federation
| | - Valeriy Vechorko
- O.M. Filatov City clinical hospital №15, 23 Veshnjakovskaja St., Moscow, 111539, Russian Federation
| | - Assia Stepanian
- Academia of Women's Health and Endoscopic Surgery, 755 Mount Vernon Hwy, Atlanta, GA, 30328, USA
| | - Anton Dashko
- O.M. Filatov City clinical hospital №15, 23 Veshnjakovskaja St., Moscow, 111539, Russian Federation
| | - Dmitriy Doroshenko
- O.M. Filatov City clinical hospital №15, 23 Veshnjakovskaja St., Moscow, 111539, Russian Federation
| | - Yana Aznaurova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, 20b1 Delegatskaya St., Moscow, 127473, Russian Federation
| | - Maxim Sorokin
- Moscow Institute of Physics and Technology (National Research University), 9 Institutskij pereulok, Dolgoprudnyj city, Moscow region, 141700, Russian Federation.,OmicsWay Corp., 340 S Lemon Ave, Walnut, CA, 91789, USA.,World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University, 2-4 Bolshaya Pirogovskaya St., Moscow, 119435, Russian Federation
| | - Maria Suntsova
- World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University, 2-4 Bolshaya Pirogovskaya St., Moscow, 119435, Russian Federation
| | | | - Anton Buzdin
- Moscow Institute of Physics and Technology (National Research University), 9 Institutskij pereulok, Dolgoprudnyj city, Moscow region, 141700, Russian Federation.,OmicsWay Corp., 340 S Lemon Ave, Walnut, CA, 91789, USA.,World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University, 2-4 Bolshaya Pirogovskaya St., Moscow, 119435, Russian Federation
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COVID-19 pandemic: insights into molecular mechanisms leading to sex-based differences in patient outcomes. Expert Rev Mol Med 2021; 23:e7. [PMID: 34340720 PMCID: PMC8353216 DOI: 10.1017/erm.2021.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recent epidemiological studies analysing sex-disaggregated patient data of coronavirus disease 2019 (COVID-19) across the world revealed a distinct sex bias in the disease morbidity as well as the mortality - both being higher for the men. Similar antecedents have been known for the previous viral infections, including from coronaviruses, such as severe acute respiratory syndrome (SARS) and middle-east respiratory syndrome (MERS). A sound understanding of molecular mechanisms leading to the biological sex bias in the survival outcomes of the patients in relation to COVID-19 will act as an essential requisite for developing a sex-differentiated approach for therapeutic management of this disease. Recent studies which have explored molecular mechanism(s) behind sex-based differences in COVID-19 pathogenesis are scarce; however, existing evidence, for other respiratory viral infections, viz. SARS, MERS and influenza, provides important clues in this regard. In attempt to consolidate the available knowledge on this issue, we conducted a systematic review of the existing empirical knowledge and recent experimental studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The qualitative analysis of the collected data unravelled multiple molecular mechanisms, such as evolutionary and genetic/epigenetic factors, sex-linkage of viral host cell entry receptor and immune response genes, sex hormone and gut microbiome-mediated immune-modulation, as the possible key reasons for the sex-based differences in patient outcomes in COVID-19.
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Cinislioglu AE, Cinislioglu N, Demirdogen SO, Sam E, Akkas F, Altay MS, Utlu M, Sen IA, Yildirim F, Kartal S, Aydin HR, Karabulut I, Ozbey I. The relationship of serum testosterone levels with the clinical course and prognosis of COVID-19 disease in male patients: A prospective study. Andrology 2021; 10:24-33. [PMID: 34288536 PMCID: PMC8444851 DOI: 10.1111/andr.13081] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022]
Abstract
Background A potential role of testosterone among sex hormones has been hypothesized in identifying sex‐related differences in the clinical consequences of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection. Due to the high global prevalence of hypogonadism, the relationship between hypogonadism and SARS‐CoV‐2 infection outcomes deserves an in‐depth study. Objective The present study aimed to investigate the relationship of serum testosterone with other laboratory parameters on the prognosis of coronavirus disease‐19 (COVID‐19) in male patients with COVID‐19 diagnosis. Materials and methods This prospective cohort study included 358 male patients diagnosed with COVID‐19 and 92 COVID‐19 negative patients admitted to the urology outpatient clinics as a control group. The COVID‐19 patients were divided into groups according to prognosis (mild‐moderate and severe group), lung involvement in chest computed tomography (<50% and >50%), intensive care unit needs, and survival. Results The measured serum total testosterone level of the COVID‐19 patients group was found to be significantly lower than that of the control group (median, 140 ng/dl; range, 0.21–328, 322 ng/dl; range, median, 125–674, p < 0.001, respectively). The serum TT levels were statistically significantly lower in severe COVID‐19 patients compared to mild‐moderate COVID‐19 patients (median, 85.1 ng/dl; range, 0.21–532, median, 315 ng/dl; range, 0.88–486, p < 0.001, respectively), in COVID‐19 patients in need of intensive care compared to COVID‐19 patients who did not need intensive care (median, 64.0 ng/dl; range, 0.21–337, median, 286 ng/dl; range, 0.88–532 p < 0.001, respectively), and in COVID‐19 patients who died compared to survivors (median, 82.9 ng/dl; range, 2.63–165, median, 166 ng/dl; range, 0.21–532, p < 0.001, respectively). Discussion and conclusion Our data are compatible with low TT levels playing a role on the pathogenesis of the disease in Covid‐19 patients with poor prognosis and a mortal course and may guide clinicians in determining the clinical course of the disease.
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Affiliation(s)
- Ahmet Emre Cinislioglu
- Department of Urology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Nazan Cinislioglu
- Department of Infectious Diseases and Clinical Microbiology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Saban Oguz Demirdogen
- Department of Urology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Emre Sam
- Department of Urology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Fatih Akkas
- Department of Urology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Mehmet Sefa Altay
- Department of Urology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Mustafa Utlu
- Department of Internal Medicine, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Irem Akin Sen
- Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Fatih Yildirim
- Department of Urology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Seyfi Kartal
- Department of Urology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Hasan Riza Aydin
- Department of Urology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Ibrahim Karabulut
- Department of Urology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Isa Ozbey
- Department of Urology, Ataturk University Medical Faculty, Erzurum, Turkey
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COVID-19 and male reproductive system: pathogenic features and possible mechanisms. J Mol Histol 2021; 52:869-878. [PMID: 34232425 PMCID: PMC8260577 DOI: 10.1007/s10735-021-10003-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/28/2021] [Indexed: 12/30/2022]
Abstract
Multiorgan dysfunction is the main characteristic of severe COVID-19 patients and the involvement of male reproductive system may occur among these patients. Although there is a limited evidence to confirm the orchitis and virus presence in the semen of patients, there are concerns about the transmission of virus through the semen. In addition, reduced fertility or infertility can be seen as consequences of severe COVID-19 in recovered subjects. In this study, we aimed to review articles related to COVID-19 and male reproductive system to find the possible underlying mechanisms of SARS-CoV-2 in affecting male fertility. The following keywords of SARS-CoV-2, COVID-19, testis, orchitis, semen, angiotensin-converting enzyme 2 (ACE2), hypothalamic-pituitary-testicular (HPT) axis, Hypothalamus, etc., were defined to find the related publications from standard search engines, e.g., PUBMED, SCOPUS, Google Scholar. According to studies, COVID-19 occurs in severe patients as respiratory disease, along with multi-organ failure. The most important mechanisms are classified as direct and indirect pathogenesis of SARS-CoV-2. The presence of ACE2 on the cell surface of various cells in testis increases the risk of direct infection by this virus. SARS-CoV-2 also affects the testis through the cytokine storm. In addition, the important role of HPT axis dysregulation through impaired Leydig cells and hypothalamus should be considered. Using antiviral and immunomodulatory therapy can be harmful for testis function. Further investigations are required to investigate potential mechanisms of male infertility in survivals of COVID-19. Since involvement of testis is essential for fertility, increasing the knowledge of health system may improve the outcomes.
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Lisco G, De Tullio A, Stragapede A, Solimando AG, Albanese F, Capobianco M, Giagulli VA, Guastamacchia E, De Pergola G, Vacca A, Racanelli V, Triggiani V. COVID-19 and the Endocrine System: A Comprehensive Review on the Theme. J Clin Med 2021; 10:jcm10132920. [PMID: 34209964 PMCID: PMC8269331 DOI: 10.3390/jcm10132920] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
Background and aim. The review aimed to summarize advances in the topic of endocrine diseases and coronavirus disease 2019 (COVID-19). Methods. Scientific and institutional websites and databases were searched and data were collected and organized, when plausible, to angle the discussion toward the following clinical issues. (1) Are patients with COVID-19 at higher risk of developing acute or late-onset endocrine diseases or dysfunction? (2) May the underlying endocrine diseases or dysfunctions be considered risk factors for poor prognosis once the infection has occurred? (3) Are there defined strategies to manage endocrine diseases despite pandemic-related constraints? Herein, the authors considered only relevant and more frequently observed endocrine diseases and disorders related to the hypothalamic-pituitary region, thyroid and parathyroid glands, calcium-phosphorus homeostasis and osteoporosis, adrenal glands, and gonads. Main. Data highlight the basis of some pathophysiological mechanisms and anatomical alterations of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-induced endocrine dysfunctions. Some conditions, such as adrenal insufficiency and cortisol excess, may be risk factors of worse clinical progression once the infection has occurred. These at-risk populations may require adequate education to avoid the SARS-CoV-2 infection and adequately manage medical therapy during the pandemic, even in emergencies. Endocrine disease management underwent a palpable restraint, especially procedures requiring obligate access to healthcare facilities for diagnostic and therapeutic purposes. Strategies of clinical triage to prioritize medical consultations, laboratory, instrumental evaluations, and digital telehealth solutions should be implemented to better deal with this probably long-term situation.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.L.); (A.D.T.); (V.A.G.); (E.G.); (V.T.)
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.L.); (A.D.T.); (V.A.G.); (E.G.); (V.T.)
| | - Assunta Stragapede
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine “G. Baccelli”, University of Bari School of Medicine, 70124 Bari, Italy; (A.S.); (A.G.S.); (F.A.); (M.C.); (A.V.)
| | - Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine “G. Baccelli”, University of Bari School of Medicine, 70124 Bari, Italy; (A.S.); (A.G.S.); (F.A.); (M.C.); (A.V.)
| | - Federica Albanese
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine “G. Baccelli”, University of Bari School of Medicine, 70124 Bari, Italy; (A.S.); (A.G.S.); (F.A.); (M.C.); (A.V.)
| | - Martina Capobianco
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine “G. Baccelli”, University of Bari School of Medicine, 70124 Bari, Italy; (A.S.); (A.G.S.); (F.A.); (M.C.); (A.V.)
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.L.); (A.D.T.); (V.A.G.); (E.G.); (V.T.)
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.L.); (A.D.T.); (V.A.G.); (E.G.); (V.T.)
| | - Giovanni De Pergola
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, 70124 Bari, Italy;
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, 70013 Castellana Grotte, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine “G. Baccelli”, University of Bari School of Medicine, 70124 Bari, Italy; (A.S.); (A.G.S.); (F.A.); (M.C.); (A.V.)
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine “G. Baccelli”, University of Bari School of Medicine, 70124 Bari, Italy; (A.S.); (A.G.S.); (F.A.); (M.C.); (A.V.)
- Correspondence: ; Tel.: +39-(0)-80-547-82-54
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.L.); (A.D.T.); (V.A.G.); (E.G.); (V.T.)
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60
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Leong R, Lee TSJ, Chen Z, Zhang C, Xu J. Global Temporal Patterns of Age Group and Sex Distributions of COVID-19. Infect Dis Rep 2021; 13:582-596. [PMID: 34205538 PMCID: PMC8293195 DOI: 10.3390/idr13020054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Since the beginning of 2020, COVID-19 has been the biggest public health crisis in the world. To help develop appropriate public health measures and deploy corresponding resources, many governments have been actively tracking COVID-19 in real time within their jurisdictions. However, one of the key unresolved issues is whether COVID-19 was distributed differently among different age groups and between the two sexes in the ongoing pandemic. The objectives of this study were to use publicly available data to investigate the relative distributions of COVID-19 cases, hospitalizations, and deaths among age groups and between the sexes throughout 2020; and to analyze temporal changes in the relative frequencies of COVID-19 for each age group and each sex. Fifteen countries reported age group and/or sex data of patients with COVID-19. Our analyses revealed that different age groups and sexes were distributed differently in COVID-19 cases, hospitalizations, and deaths. However, there were differences among countries in both their age group and sex distributions. Though there was no consistent temporal change across all countries for any age group or either sex in COVID-19 cases, hospitalizations, and deaths, several countries showed statistically significant patterns. We discuss the potential mechanisms for these observations, the limitations of this study, and the implications of our results on the management of this ongoing pandemic.
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Affiliation(s)
- Russell Leong
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Tin-Suet Joan Lee
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Zejia Chen
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Chelsea Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada; (R.L.); (T.-S.J.L.); (Z.C.); (C.Z.)
| | - Jianping Xu
- Department of Biology and Institute of Infectious Diseases Research, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence:
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61
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Lanser L, Burkert FR, Thommes L, Egger A, Hoermann G, Kaser S, Pinggera GM, Anliker M, Griesmacher A, Weiss G, Bellmann-Weiler R. Testosterone Deficiency Is a Risk Factor for Severe COVID-19. Front Endocrinol (Lausanne) 2021; 12:694083. [PMID: 34226825 PMCID: PMC8253686 DOI: 10.3389/fendo.2021.694083] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 12/22/2022] Open
Abstract
Background Male sex is related to increased COVID-19 severity and fatality although confirmed infections are similarly distributed between men and women. The aim of this retrospective analysis was to investigate the impact of sex hormones on disease progression and immune activation in men with COVID-19. Patients and Methods We studied for effects of sex hormones on disease severity and immune activation in 377 patients (230 men, 147 women) with PCR-confirmed SARS-CoV-2 infections hospitalized at the Innsbruck University Hospital between February and December 2020. Results Men had more severe COVID-19 with concomitant higher immune system activation upon hospital admission when compared to women. Men with a severe course of infection had lower serum total testosterone (tT) levels whereas luteinizing hormone (LH) and estradiol (E2) levels were within the normal range. tT deficiency was associated with elevated CRP (rs = - 0.567, p < 0.001), IL-6 levels (rs = - 0.563, p < 0.001), lower cholesterol levels (rs = 0.407, p < 0.001) and an increased morbidity and mortality. Men with tT levels < 100 ng/dL had a more than eighteen-fold higher in-hospital mortality risk (OR 18.243 [95%CI 2.301 - 144.639], p = 0.006) compared to men with tT levels > 230 ng/dL. Moreover, while morbidity and mortality showed a positive correlation with E2 levels at admission, we detected a negative correlation with the tT/E2 ratio upon hospital admission. Conclusion Hospitalized men with COVID-19 present with rather low testosterone levels linked to more advanced immune activation, severe clinical manifestations translating into an increased risk for ICU admission or death. The underlying mechanisms remain elusive but may include infection driven hypogonadism as well as inflammation mediated cholesterol reduction causing gonadotropin suppression and impaired androgen formation. Finally, in elderly late onset hypogonadism might also contribute to lower testosterone levels.
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Affiliation(s)
- Lukas Lanser
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | | | - Lis Thommes
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Alexander Egger
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck University Hospital, Innsbruck, Austria
| | - Gregor Hoermann
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck University Hospital, Innsbruck, Austria
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - Susanne Kaser
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
| | | | - Markus Anliker
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck University Hospital, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnosis, Innsbruck University Hospital, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
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62
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Saylam B, Uguz M, Yarpuzlu M, Efesoy O, Akbay E, Çayan S. The presence of SARS-CoV-2 virus in semen samples of patients with COVID-19 pneumonia. Andrologia 2021; 53:e14145. [PMID: 34115405 PMCID: PMC8420322 DOI: 10.1111/and.14145] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/17/2022] Open
Abstract
The SARS‐CoV‐2 set off a pandemic involving millions of people around the world. The topic of discussion is the possible viral detection in different body fluids than respiratory droplets. Therefore, we evaluated the possible presence of SARS‐CoV‐2 in semen and urine samples. Thirty patients were included in the study aged 35.67 ± 6.84 years. The day after the pharyngeal and/or nose swab of SARS‐CoV‐2 was positive, urine and semen samples were taken from patients, and the presence of SARS‐CoV‐2 was investigated. Laboratory tests and chest CT findings were evaluated simultaneously. SARS‐CoV‐2 was detected in four (13.3%) patients’ semen samples and in seven (23.3%) patients’ urine samples. White blood cell (WBC), neutrophil, C‐reactive protein (CRP), ferritin, alanine transaminase (ALT), lactate dehydrogenase (LDH) and procalcitonin were significantly higher in patients with SARS‐CoV‐2 in semen (p < .05), though no statistical difference was found in urine (p > .05). Patients with severe pneumonia findings in Chest CT images are likely to be PCR positive in semen and urine samples (p = .005, p = .001). SARS‐CoV‐2 was not detected in urine and semen samples of patients after they had recovered (average duration 23 ± 4 days). SARS‐CoV‐2 can be detected in the urogenıtal fluıds of patients with severe clinical conditions and high viral load.
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Affiliation(s)
- Barış Saylam
- Department of Urology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mustafa Uguz
- Department of Infectious Diseases, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mehmet Yarpuzlu
- Department of Medical Microbiology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Ozan Efesoy
- Department of Urology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Erdem Akbay
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
| | - Selahittin Çayan
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
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63
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Borges E, Setti AS, Iaconelli A, Braga DPDAF. Current status of the COVID-19 and male reproduction: A review of the literature. Andrology 2021; 9:1066-1075. [PMID: 33998143 PMCID: PMC8222884 DOI: 10.1111/andr.13037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/09/2021] [Accepted: 05/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), which causes serious respiratory illnesses such as pneumonia and lung failure, was first reported in mid-December 2019 in China and has spread around the world. In addition to causing serious respiratory illnesses such as pneumonia and lung failure, there have been conflicting reports about the presence of SARS-CoV-2 in the semen of patients who were previously diagnosed with COVID-19 and possible implications for the male reproductive tract. OBJECTIVE The goal for the present study was to review the current status of the literature concerning COVID-19 and male reproduction. MATERIAL AND METHODS An electronic literature search was done by using PubMed and Google Scholar databases. Relevant papers, concerning SARS-COV-2 and COVID-19 and male reproduction, published between January 2020 and December 2020 were selected, analyzed and eventually included in the present literature review. RESULTS SARS-CoV-2 may infect any cell type expressing angiotensin-converting enzyme 2 (ACE2), including reproductive cells. Besides the presence of the SARS-CoV-2 receptor, the expression of host proteases, such as transmembrane serine protease 2 (TMPRSS2), is needed to cleave the viral S protein, allowing permanent fusion of the viral and host cell membranes. Here, we aimed to review the current status of the literature concerning COVID-19 and male reproduction. The lack of co-expression of ACE2 and TMPRSS2 in the testis suggests that sperm cells may not be at increased risk of viral entry and spread. However, the presence of orchitis in COVID-19-confirmed patients and compromised sex-related hormonal balance among these patients intrigues reproductive medicine. DISCUSSION SARS-CoV-2 may use alternate receptors to enter certain cell types, or the expression of ACE2 and TMPRSS2 may not be detected in healthy individuals. CONCLUSION COVID-19 challenges all medical areas, including reproductive medicine. It is not yet clear what effects, if any, the COVID-19 pandemic will have on male reproduction. Further research is needed to understand the long-term impact of SARS-CoV-2 on male reproductive function.
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Affiliation(s)
- Edson Borges
- Fertility Medical Group, São Paulo, Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | - Amanda Souza Setti
- Fertility Medical Group, São Paulo, Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
| | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo, Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, Brazil
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Corona G, Pizzocaro A, Vena W, Rastrelli G, Semeraro F, Isidori AM, Pivonello R, Salonia A, Sforza A, Maggi M. Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:275-296. [PMID: 33616801 PMCID: PMC7899074 DOI: 10.1007/s11154-021-09630-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
The presence of SARS-CoV-2 was officially documented in Europe at the end of February 2020. Despite many observations, the real impact of COVID-19 in the European Union (EU), its underlying factors and their contribution to mortality and morbidity outcomes were never systematically investigated. The aim of the present work is to provide an overview and a meta-analysis of main predictors and of country differences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-associated mortality rate (MR) in hospitalized patients. Out of 3714 retrieved articles, 87 studies were considered, including 35,486 patients (mean age 60.9 ± 8.2 years) and 5867 deaths. After adjustment for confounders, diabetes mellitus was the best predictors of MR in an age- and sex-dependent manner, followed by chronic pulmonary obstructive diseases and malignancies. In both the US and Europe, MR was higher than that reported in Asia (25[20;29] % and 20[17;23] % vs. 13[10;17]%; both p < 0.02). Among clinical parameters, dyspnea, fatigue and myalgia, along with respiratory rate, emerged as the best predictors of MR. Finally, reduced lymphocyte and platelet count, along with increased D-dimer levels, all significantly contributed to increased mortality. The optimization of glucose profile along with an adequate thrombotic complications preventive strategy must become routine practice in diseased SARS-CoV-2 infected patients.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli, 2 - 40133, Bologna, Italy.
| | - Alessandro Pizzocaro
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Walter Vena
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulia Rastrelli
- Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome - Policlinico Umberto I Hospital, Rome, Italy
| | - Rosario Pivonello
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Unità Di Andrologia E Medicina Della Riproduzione E Della SessualitàMaschile E Femminile, Università Federico II Di Napoli, Naples, Italy
- Staff of UNESCO, Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli, 2 - 40133, Bologna, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Abdel-Moneim A. COVID-19 Pandemic and Male Fertility: Clinical Manifestations and Pathogenic Mechanisms. BIOCHEMISTRY (MOSCOW) 2021; 86:389-396. [PMID: 33941061 PMCID: PMC7978437 DOI: 10.1134/s0006297921040015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The novel coronavirus disease-2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a major public health emergency worldwide with over 118.27-million confirmed COVID-19 cases and 2.62-million deaths recorded, as of March 12, 2021. Although this disease primarily targets lungs, damages in other organs, such as heart, kidney, liver, and testis, may occur. Testis is the cornerstone of male reproduction, while reproductive health is the most valuable resource for continuity of the human race. Given the unique nature of SARS-CoV-2, the mechanisms of its impact on the testes have yet to be fully explored. Notably, coronaviruses have been found to invade target cells through the angiotensin-converting enzyme 2 receptor, which can be found in the respiratory, gastrointestinal, cardiovascular, urinary tract, and reproductive organs, such as testes. Coronavirus studies have suggested that testes might be a potential target for SARS-CoV-2 infection. The first etiopathogenic concept proposed by current hypotheses indicates that the virus can invade testes through the angiotensin-converting enzyme 2 receptor. Next, the activated inflammatory response in the testes, disease-associated fever, and COVID-19 medications might be implicated in testicular alterations. Although evidence regarding the presence of SARS-CoV-2 mRNA in semen remains controversial, this emphasizes the need for researchers to pay closer attention to sexually transmitted diseases and male fertility after recovering from COVID-19. In this review the latest updates regarding COVID-19-associated testicular dysfunction are summarized and possible pathogenic mechanisms are discussed.
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Affiliation(s)
- Adel Abdel-Moneim
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Beni-Suef, 62511, Egypt.
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66
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Dhindsa S, Zhang N, McPhaul MJ, Wu Z, Ghoshal AK, Erlich EC, Mani K, Randolph GJ, Edwards JR, Mudd PA, Diwan A. Association of Circulating Sex Hormones With Inflammation and Disease Severity in Patients With COVID-19. JAMA Netw Open 2021; 4:e2111398. [PMID: 34032853 PMCID: PMC8150664 DOI: 10.1001/jamanetworkopen.2021.11398] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
Importance Male sex is a risk factor for developing severe COVID-19 illness. It is not known whether sex hormones contribute to this predisposition. Objective To investigate the association of concentrations of serum testosterone, estradiol, and insulinlike growth factor 1 (IGF-1, concentrations of which are regulated by sex hormone signaling) with COVID-19 severity. Design, Setting, and Participants This prospective cohort study was conducted using serum samples collected from consecutive patients who presented from March through May 2020 to the Barnes Jewish Hospital in St Louis, Missouri, with COVID-19 (diagnosed using nasopharyngeal swabs). Exposures Testosterone, estradiol, and IGF-1 concentrations were measured at the time of presentation (ie, day 0) and at days 3, 7, 14, and 28 after admission (if the patient remained hospitalized). Main Outcomes and Measures Baseline hormone concentrations were compared among patients who had severe COVID-19 vs those with milder COVID-19 illness. RNA sequencing was performed on circulating mononuclear cells to understand the mechanistic association of altered circulating hormone concentrations with cellular signaling pathways. Results Among 152 patients (90 [59.2%] men; 62 [40.8%] women; mean [SD] age, 63 [16] years), 143 patients (94.1%) were hospitalized. Among 66 men with severe COVID-19, median [interquartile range] testosterone concentrations were lower at day 0 (53 [18 to 114] ng/dL vs 151 [95 to 217] ng/dL; P = .01) and day 3 (19 [6 to 68] ng/dL vs 111 [49 to 274] ng/dL; P = .006) compared with 24 men with milder disease. Testosterone concentrations were inversely associated with concentrations of interleukin 6 (β = -0.43; 95% CI, -0.52 to -0.17; P < .001), C-reactive protein (β = -0.38; 95% CI, -0.78 to -0.16; P = .004), interleukin 1 receptor antagonist (β = -0.29; 95% CI, -0.64 to -0.06; P = .02), hepatocyte growth factor (β = -0.46; 95% CI, -0.69 to -0.25; P < .001), and interferon γ-inducible protein 10 (β = -0.32; 95% CI, -0.62 to -0.10; P = .007). Estradiol and IGF-1 concentrations were not associated with COVID-19 severity in men. Testosterone, estradiol, and IGF-1 concentrations were similar in women with and without severe COVID-19. Gene set enrichment analysis revealed upregulated hormone signaling pathways in CD14+CD16- (ie, classical) monocytes and CD14-CD16+ (ie, nonclassical) monocytes in male patients with COVID-19 who needed intensive care unit treatment vs those who did not. Conclusions and Relevance In this single-center cohort study of patients with COVID-19, lower testosterone concentrations during hospitalization were associated with increased disease severity and inflammation in men. Hormone signaling pathways in monocytes did not parallel serum hormone concentrations, and further investigation is required to understand their pathophysiologic association with COVID-19.
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Affiliation(s)
- Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, St Louis University School of Medicine, St Louis, Missouri
| | - Nan Zhang
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, Missouri
| | - Michael J. McPhaul
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Zengru Wu
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Amit K. Ghoshal
- LC-MS Core Lab, Quest Diagnostics Nichols Institute, Valencia, California
| | - Emma C. Erlich
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, Missouri
| | - Kartik Mani
- Cardiovascular Division, Washington University School of Medicine in St Louis, Missouri
- Center for Cardiovascular Research, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
- John Cochran Veterans Hospital, St Louis, Missouri
| | - Gwendalyn J. Randolph
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, Missouri
| | - John R. Edwards
- Center for Pharmacogenomics, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
| | - Philip A. Mudd
- Department of Emergency Medicine, Washington University School of Medicine in St Louis, Missouri
| | - Abhinav Diwan
- Cardiovascular Division, Washington University School of Medicine in St Louis, Missouri
- Center for Cardiovascular Research, Department of Medicine, Washington University School of Medicine in St Louis, Missouri
- John Cochran Veterans Hospital, St Louis, Missouri
- Department of Cell Biology and Physiology, Washington University School of Medicine in St Louis, Missouri
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, Missouri
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67
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Subramanian A, Anand A, Adderley NJ, Okoth K, Toulis KA, Gokhale K, Sainsbury C, O'Reilly MW, Arlt W, Nirantharakumar K. Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study. Eur J Endocrinol 2021; 184:637-645. [PMID: 33635829 PMCID: PMC8052516 DOI: 10.1530/eje-20-1163] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/25/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Several recent observational studies have linked metabolic comorbidities to an increased risk from COVID-19. Here we investigated whether women with PCOS are at an increased risk of COVID-19 infection. DESIGN Population-based closed cohort study between 31 January 2020 and 22 July 2020 in the setting of a UK primary care database (The Health Improvement Network, THIN). METHODS The main outcome was the incidence of COVID-19 coded as suspected or confirmed by the primary care provider. We used Cox proportional hazards regression model with stepwise inclusion of explanatory variables (age, BMI, impaired glucose regulation, androgen excess, anovulation, vitamin D deficiency, hypertension, and cardiovascular disease) to provide unadjusted and adjusted hazard risks (HR) of COVID-19 infection among women with PCOS compared to women without PCOS. RESULTS We identified 21 292 women with a coded diagnosis of PCO/PCOS and randomly selected 78 310 aged and general practice matched control women. The crude COVID-19 incidence was 18.1 and 11.9 per 1000 person-years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without PCOS (HR: 1.51 (95% CI: 1.27-1.80), P < 0.001). After adjusting for age and BMI, HR reduced to 1.36 (1.14-1.63)], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased risk of COVID-19 (aHR: 1.28 (1.05-1.56), P = 0.015). CONCLUSION Women with PCOS are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to infection control measures during the COVID-19 pandemic. SIGNIFICANCE STATEMENT Women with polycystic ovary syndrome (PCOS) have an increased risk of cardio-metabolic disease, which have been identified as a risk factor for COVID-19. To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, we carried out a population-based closed cohort study in the UK during its first wave of the SARS-CoV-2 pandemic (January to July 2020), including 21 292 women with PCOS and 78 310 controls matched for sex, age and general practice location. Results revealed a 52% increased risk of COVID-19 infection in women with PCOS, which remained increased at 28% above controls after adjustment for age, BMI, impaired glucose regulation and other explanatory variables.
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Affiliation(s)
| | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Michael W O'Reilly
- Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Republic of Ireland
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Correspondence should be addressed to W Arlt;
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
- Correspondence should be addressed to K Nirantharakumar;
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68
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Sharma GT, Chandra V, Mankuzhy P, Thirupathi Y, Swain DK, Pillai H, Patel SK, Pathak M, Guttula S. Physiological implications of COVID-19 in reproduction: angiotensin-converting enzyme 2 a key player. Reprod Fertil Dev 2021; 33:381-391. [PMID: 33731252 DOI: 10.1071/rd20274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/19/2021] [Indexed: 12/18/2022] Open
Abstract
The COVID-19 outbreak, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first identified in China, and it has quickly become a global threat to public health due to its rapid rate of transmission and fatalities. Angiotensin-converting enzyme 2 (ACE2) has been identified as a receptor that mediates the entry of SARS-CoV-2 into human cells, as in the case of severe acute respiratory syndrome coronavirus (SARS-CoV). Several studies have reported that ACE2 expression is higher in Leydig, Sertoli and seminiferous ductal cells of males, as well as in ovarian follicle cells of females, suggesting possible potential pathogenicity of the coronavirus in the reproductive system. Higher ACE2 expression in the human placenta and reports of vertical transmission of SARS-CoV-2 among clinical cases have increased the relevance of further studies in this area. This review focuses on the interaction between SARS-CoV-2 and the ACE2 receptor and speculates on the mechanistic interplay in association with male and female reproductive physiology. In addition, based on the available literature, we discuss the alleged sex differences in terms of the infectivity of SARS-CoV-2, which is claimed greater among males, and further explore the physiological role of ACE2 and 17β-oestradiol for the same.
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Affiliation(s)
- G Taru Sharma
- Department of Physiology, Indian Council of Agricultural Research (ICAR) - Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttarpradesh, India; and Corresponding author.
| | - Vikash Chandra
- Department of Physiology, Indian Council of Agricultural Research (ICAR) - Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttarpradesh, India
| | - Pratheesh Mankuzhy
- Department of Physiology, Kerala Veterinary and Animal Sciences University, Lakkidi, Pookode, Kerala, India
| | - Yasotha Thirupathi
- Department of Physiology, Indian Council of Agricultural Research (ICAR) - Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttarpradesh, India
| | - Dilip Kumar Swain
- Department of Physiology, UP Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan, Mathura, Uttarpradesh, India
| | | | - Shailesh Kumar Patel
- Department of Pathology, Indian Council of Agricultural Research (ICAR) - Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttarpradesh, India
| | - Mamta Pathak
- Department of Pathology, Indian Council of Agricultural Research (ICAR) - Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttarpradesh, India
| | - SaiKumar Guttula
- Department of Pathology, Indian Council of Agricultural Research (ICAR) - Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttarpradesh, India
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69
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Zhang J, Wu Y, Li S, Wang X, Wang R, Wang X. Bioinformatic and mouse model reveal the potential high vulnerability of Leydig cells on SARS-CoV-2. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:678. [PMID: 33987376 PMCID: PMC8106040 DOI: 10.21037/atm-21-936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in China and spread rapidly since the end of 2019. Previous studies have confirmed that SARS-CoV-2 infects host cells via binding to angiotensin converting enzyme II (ACE2). Methods To explore the expression of ACE2 and the potential risk of infection in testis, we performed a bioinformatic analysis based on public databases, and conducted a pilot study using a mouse model. We also collected clinical follow-up date on male patients who had recovered from COVID-19 for 6 months. Results The results showed that the RNA expression of ACE2 was higher in testis compared with other organs. Single-cell analysis and immunocytochemistry further indicated that Leydig cells were at risk of SARS-CoV-2 infection. Green fluorescence was only detected in the Leydig cells after intratesticular injection of pseudovirus SARS-CoV-2 in the mouse model. In the clinical follow-up, serum total testosterone level was statistically lower in patients who had recovered from COVID-19 compared with healthy men (P=0.010). Conclusions The findings of the present study indicate the potential vulnerability of Leydig cells. It is important to monitor the reproductive system and its complications in male COVID-19 patients. Further studies are still needed on SARS-CoV-2-associated reproductive complications.
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Affiliation(s)
- Jiawei Zhang
- Department of Urology and Carson International Cancer Center, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy Center, Shenzhen University, Shenzhen, China
| | - Yuqi Wu
- Department of Urology and Carson International Cancer Center, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy Center, Shenzhen University, Shenzhen, China
| | - Shulin Li
- Department of Urology and Carson International Cancer Center, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy Center, Shenzhen University, Shenzhen, China
| | - Xiaobin Wang
- Department of Urology and Carson International Cancer Center, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy Center, Shenzhen University, Shenzhen, China
| | - Rui Wang
- Department of Urology and Carson International Cancer Center, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy Center, Shenzhen University, Shenzhen, China
| | - Xiangwei Wang
- Department of Urology and Carson International Cancer Center, Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy Center, Shenzhen University, Shenzhen, China.,Department of Urology, Southern University of Science and Technology Hospital, Shenzhen, China.,Department of Perioperative Medicine, Southern University of Science and Technology, Shenzhen, China
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70
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Salciccia S, Eisenberg ML, Maggi M, Lai S, Mastroianni CM, Pasculli P, Ciardi MR, Canale V, Ferro M, Busetto GM, De Berardinis E, Ricciuti GP, Sciarra A, Del Giudice F. Modeling the Contribution of Male Testosterone Levels to the Duration of Positive COVID Testing among Hospitalized Male COVID-19 Patients. Diagnostics (Basel) 2021; 11:581. [PMID: 33804969 PMCID: PMC8063957 DOI: 10.3390/diagnostics11040581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: A growing body of evidence is emerging suggesting testosterone can affect all cells involved in the immune response to both bacterial and viral infections, and the testosterone effect on the immune response could explain the greater susceptibility of men to infections including COVID-19. We aimed to explore the predictive role of male serum total testosterone (TT) levels on the time till viral negativity testing among hospitalized COVID-19 patients. Methods: The univariate effect of risk factors for the duration of COVID-19 viral positivity was evaluated using the log-rank test and Kaplan-Meier estimates. A multivariable Cox regression model was developed to test the role of TT levels and the subsequent odds for shorter viral positivity intervals. Results: Increasing serum TT levels and the need for an oxygen administration strategy were independently predictive for respectively reduced and increased days to negativization (Hazard Ratio [HR]: 1.39, 95% CI: 0.95-2.03 and HR: 0.19, 95% CI: 0.03-1.18). Conclusion: Baseline higher TT levels for male COVID-19 patients at hospital admission are associated with shorter durations of positive COVID-19 testing and thus viral clearance. Our preliminary findings might play a relevant to help pandemic control strategies if these will be verified in future larger multicentric and possibly randomized trials.
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Affiliation(s)
- Stefano Salciccia
- Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (S.S.); (M.M.); (V.C.); (E.D.B.); (G.P.R.); (A.S.); (F.D.G.)
| | - Michael L. Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (S.S.); (M.M.); (V.C.); (E.D.B.); (G.P.R.); (A.S.); (F.D.G.)
| | - Silvia Lai
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (C.M.M.); (P.P.); (M.R.C.)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (C.M.M.); (P.P.); (M.R.C.)
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (C.M.M.); (P.P.); (M.R.C.)
| | - Vittorio Canale
- Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (S.S.); (M.M.); (V.C.); (E.D.B.); (G.P.R.); (A.S.); (F.D.G.)
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy;
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (S.S.); (M.M.); (V.C.); (E.D.B.); (G.P.R.); (A.S.); (F.D.G.)
| | - Gian Piero Ricciuti
- Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (S.S.); (M.M.); (V.C.); (E.D.B.); (G.P.R.); (A.S.); (F.D.G.)
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (S.S.); (M.M.); (V.C.); (E.D.B.); (G.P.R.); (A.S.); (F.D.G.)
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy; (S.S.); (M.M.); (V.C.); (E.D.B.); (G.P.R.); (A.S.); (F.D.G.)
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA;
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71
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Alwani M, Yassin A, Al-Zoubi RM, Aboumarzouk OM, Nettleship J, Kelly D, Al-Qudimat AR, Shabsigh R. Sex-based differences in severity and mortality in COVID-19. Rev Med Virol 2021; 31:e2223. [PMID: 33646622 PMCID: PMC8014761 DOI: 10.1002/rmv.2223] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 01/08/2023]
Abstract
The current coronavirus disease (COVID‐19) pandemic caused by novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has a male bias in severity and mortality. This is consistent with previous coronavirus pandemics such as SARS‐CoV and MERS‐CoV, and viral infections in general. Here, we discuss the sex‐disaggregated epidemiological data for COVID‐19 and highlight underlying differences that may explain the sexual dimorphism to help inform risk stratification strategies and therapeutic options.
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Affiliation(s)
- Mustafa Alwani
- Surgical Research Section, Hamad Medical Corporation, Doha, Qatar.,Jordan University of Science and Technology, School of Medicine, Irbid, Jordan
| | - Aksam Yassin
- Surgical Research Section, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Hamad Medical Corporation, Division of Urology/Andrology & Men's Health, Doha, Qatar.,Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Raed M Al-Zoubi
- Surgical Research Section, Hamad Medical Corporation, Doha, Qatar.,Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,College of Medicine, University of Glasgow, Glasgow, UK
| | - Joanne Nettleship
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Daniel Kelly
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK.,Biomolecular Research Centre, Sheffield Hallam University, Sheffield, UK
| | | | - Ridwan Shabsigh
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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72
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Wang SC, Wang YF. Cardiovascular protective properties of oxytocin against COVID-19. Life Sci 2021; 270:119130. [PMID: 33513400 PMCID: PMC7837104 DOI: 10.1016/j.lfs.2021.119130] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
SARS-CoV-2 infection or COVID-19 has become a worldwide pandemic; however, effective treatment for COVID-19 remains to be established. Along with acute respiratory distress syndrome (ARDS), new and old cardiovascular injuries are important causes of significant morbidity and mortality in COVID-19. Exploring new approaches managing cardiovascular complications is essential in controlling the disease progression and preventing long-term complications. Oxytocin (OXT), an immune-regulating neuropeptide, has recently emerged as a strong candidate for treatment and prevention of COVID-19 pandemic. OXT carries special functions in immunologic defense, homeostasis and surveillance. It suppresses neutrophil infiltration and inflammatory cytokine release, activates T-lymphocytes, and antagonizes negative effects of angiotensin II and other key pathological events of COVID-19. Additionally, OXT can promote γ-interferon expression to inhibit cathepsin L and increases superoxide dismutase expression to reduce heparin and heparan sulphate fragmentation. Through these mechanisms, OXT can block viral invasion, suppress cytokine storm, reverse lymphocytopenia, and prevent progression to ARDS and multiple organ failures. Importantly, besides prevention of metabolic disorders associated with atherosclerosis and diabetes mellitus, OXT can protect the heart and vasculature through suppressing hypertension and brain-heart syndrome, and promoting regeneration of injured cardiomyocytes. Unlike other therapeutic agents, exogenous OXT can be used safely without the side-effects seen in remdesivir and corticosteroid. Importantly, OXT can be mobilized endogenously to prevent pathogenesis of COVID-19. This article summarizes our current understandings of cardiovascular pathogenesis caused by COVID-19, explores the protective potentials of OXT against COVID-19-associated cardiovascular diseases, and discusses challenges in applying OXT in treatment and prevention of COVID-19. Chemical compounds Angiotensin-converting enzyme 2 (ACE2); atrial natriuretic peptide (ANP); cathepsin L; heparan sulphate proteoglycans (HSPGs); interferon; interleukin; oxytocin; superoxide dismutase; transmembrane serine protease isoform 2 (TMPRSS2).
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Affiliation(s)
- Stephani C Wang
- Division of Cardiology, Department of Medicine, University of California-Irvine, Irvine, CA, USA.
| | - Yu-Feng Wang
- Department of Physiology, School of Basic Medical Sciences, Harbin Medical University, Harbin, China.
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73
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Wolfe J, Safdar B, Madsen TE, Sethuraman KN, Becker B, Greenberg MR, McGregor AJ. Sex- or Gender-specific Differences in the Clinical Presentation, Outcome, and Treatment of SARS-CoV-2. Clin Ther 2021; 43:557-571.e1. [PMID: 33583576 PMCID: PMC7833665 DOI: 10.1016/j.clinthera.2021.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/14/2022]
Abstract
This review describes the sex and gender differences in COVID-19 presentation, treatment, and outcomes. We discuss the differences between the sexes in susceptibility to infection, the role of sex chromosomes on the body's immunologic response and the influence of hormones on the body's response to the virus. Additionally, the sex differences in clinical and laboratory presentation, complications of infection and outcomes, as well as differences in response to treatment and prevention are reviewed.
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Affiliation(s)
- Jeannette Wolfe
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kinjal N Sethuraman
- Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Bruce Becker
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Marna Rayl Greenberg
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/Morsani College of Medicine, University of South Florida, Allentown, PA, USA
| | - Alyson J McGregor
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
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74
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Selvaraj K, Ravichandran S, Krishnan S, Radhakrishnan RK, Manickam N, Kandasamy M. Testicular Atrophy and Hypothalamic Pathology in COVID-19: Possibility of the Incidence of Male Infertility and HPG Axis Abnormalities. Reprod Sci 2021; 28:2735-2742. [PMID: 33415647 PMCID: PMC7790483 DOI: 10.1007/s43032-020-00441-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19), which resulted from the pandemic outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a massive inflammatory cytokine storm leading to multi-organ damage including that of the brain and testes. While the lungs, heart, and brain are identified as the main targets of SARS-CoV-2-mediated pathogenesis, reports on its testicular infections have been a subject of debate. The brain and testes are physiologically synchronized by the action of gonadotropins and sex steroid hormones. Though the evidence for the presence of the viral particles in the testicular biopsies and semen samples from COVID-19 patients are highly limited, the occurrence of testicular pathology due to abrupt inflammatory responses and hyperthermia has incresingly been evident. The reduced level of testosterone production in COVID-19 is associated with altered secretion of gonadotropins. Moreover, hypothalamic pathology which results from SARS-CoV-2 infection of the brain is also evident in COVID-19 cases. This article revisits and supports the key reports on testicular abnormalities and pathological signatures in the hypothalamus of COVID-19 patients and emphasizes that testicular pathology resulting from inflammation and oxidative stress might lead to infertility in a significant portion of COVID-19 survivors. Further investigations are required to monitor the reproductive health parameters and HPG axis abnormalities related to secondary pathological complications in COVID-19 patients and survivors.
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Affiliation(s)
- Kaviya Selvaraj
- School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India.,Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
| | - Sowbarnika Ravichandran
- School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India.,Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
| | - Sushmita Krishnan
- School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
| | - Risna Kanjirassery Radhakrishnan
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
| | - Nivethitha Manickam
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
| | - Mahesh Kandasamy
- School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India. .,Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India. .,Faculty Recharge Programme, University Grants Commission (UGC-FRP), New Delhi, 110002, India.
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75
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Salciccia S, Del Giudice F, Eisenberg ML, Mastroianni CM, De Berardinis E, Ricciuti GP, Viscuso P, Zingaropoli A, Pasculli P, Ciardi MR, Sciarra A, Maggi M. Testosterone target therapy: focus on immune response, controversies and clinical implications in patients with COVID-19 infection. Ther Adv Endocrinol Metab 2021; 12:20420188211010105. [PMID: 34104394 PMCID: PMC8072920 DOI: 10.1177/20420188211010105] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/13/2021] [Indexed: 12/13/2022] Open
Abstract
The pandemic acute respiratory syndrome coronavirus 2 (SARS-CoV-2) named COVID-19 is causing a severe health emergency, and an individual's hormonal milieu may play an important role in both susceptibility to infection and severity of clinical course. We analyzed the role of testosterone in the immune response, and we hypothesized possible mechanisms to explain the high incidence of COVID-19 infection and a worse clinical course in elderly male patients. Testosterone may impair the immune response, and this effect could explain the greater susceptibility of men to infection. Transmembrane serine protease 2 (TMPRSS2) plays a crucial role in the entry of the virus into the respiratory epithelial cells, leading to COVID-19 disease. It is crucial to emphasize that testosterone levels and chemical castration (e.g. by androgen deprivation therapy for prostate cancer) may have contrasting roles in the phases of COVID-19 infection. Whereas low testosterone levels may be protective against the initial susceptibility (due to a restoration of immunological functions and a block of TMPRSS2), low testosterone may stimulate a worse clinical course in the advanced COVID-19 infection as it could exacerbate or activate the cytokine storm. If testosterone levels play these different roles, it is necessary to carefully identify patients for any indicated testosterone manipulation.
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Affiliation(s)
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Prostate Cancer Unit, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael L. Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Claudio M. Mastroianni
- Department of Public Health and Infectious Diseases, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Prostate Cancer Unit, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Gian Piero Ricciuti
- Department of Maternal-Infant and Urological Sciences, Prostate Cancer Unit, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Pietro Viscuso
- Department of Maternal-Infant and Urological Sciences, Prostate Cancer Unit, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Prostate Cancer Unit, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Prostate Cancer Unit, “Sapienza” Rome University, Policlinico Umberto I Hospital, Rome, Italy
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Madhu SV, Raizada N. COVID-19 and Endocrine Disorders - Emerging Links in this Puzzle. Indian J Endocrinol Metab 2021; 25:1-3. [PMID: 34386385 PMCID: PMC8323628 DOI: 10.4103/2230-8210.322027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- S. V. Madhu
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Nishant Raizada
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Hackett G, Kirby M. Testosterone deficiency in men infected with
COVID
‐19. TRENDS IN UROLOGY & MEN'S HEALTH 2020. [PMCID: PMC7753528 DOI: 10.1002/tre.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As our understanding of the SARS‐CoV‐2 virus develops, recent research has highlighted the potential role of testosterone in the severity of illness. Here, the authors explain the role of testosterone in men infected with COVID‐19.
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