17β-Estradiol, a potential ally to alleviate SARS-CoV-2 infection
17β-Estradiol, a potential ally to alleviate SARS-CoV-2 infection
复制标题
DOI：
10.6061/clinics/2020/e1980
复制
发表时间：
2020-01-01
期刊：
影响因子：
2.7
通讯作者：
Moreira, Luiz Felipe Pinho
中科院分区：
文献类型：
--
作者：
Breithaupt-Faloppa, Ana Cristina;Correia, Cristiano de Jesus;Moreira, Luiz Felipe Pinho
考虑到女性性激素可以调节炎症反应，也表现出对免疫系统细胞的直接影响，在此，我们打算讨论性别差异和雌二醇在调节肺部和全身炎症反应中的作用，重点是其可能的应用作为治疗模式的SARS-CoV-2患者。COVID-19患者在病程早期会出现严重的低氧血症，大多数时间是无声的。在死亡的COVID-19病例的尸检中观察到肺小动脉中的小血栓和内皮肿胀。研究表明，病毒感染诱导肺血管过程，包括血管舒张和内皮功能障碍。此外，严重SARS-CoV-2感染患者的CD 4 + T和CD 8 + T淋巴细胞比例显著降低。Escherichia coli与CD 4 + T细胞数量有关，并增加T-reg细胞群，影响对感染的免疫反应。已知雌二醇对内皮功能发挥保护作用，通过内皮一氧化氮合酶激活一氧化氮（NO）的产生。雌激素减弱对各种刺激的血管收缩反应，并在缺氧等应激情况下诱导肺血管系统的血管舒张。它发挥各种快速作用，这些作用在与膜受体偶联后启动，这反过来又可以积极调节肺部疾病中的血管反应，并有助于维持微血管流动。对雌二醇作用的直接和间接机制进行了研究，结果表明雌二醇可能对COVID-19具有保护作用，这表明它可能被认为是治疗受新型冠状病毒影响的患者的辅助治疗元素。
Considering that female sexual hormones may modulate the inflammatory response and also exhibit direct effects on the cells of the immune system, herein, we intend to discuss the sex differences and the role of estradiol in modulating the lung and systemic inflammatory response, focusing on its possible application as a treatment modality for SARS-CoV-2 patients. COVID-19 patients develop severe hypoxemia early in the course of the disease, which is silent most of the time. Small fibrinous thrombi in pulmonary arterioles and a tumefaction of endothelial were observed in the autopsies of fatal COVID-19 cases. Studies showed that the viral infection induces a vascular process in the lung, which included vasodilation and endothelial dysfunction. Further, the proportions of CD4+ T and CD8+ T lymphocytes were strongly reduced in patients with severe SARS-CoV-2 infection. Estradiol is connected with CD4+ T cell numbers and increases T-reg cell populations, affecting immune responses to infection. It is known that estradiol exerts a protective effect on endothelial function, activating the generation of nitric oxide (NO) via endothelial nitric oxide synthase. Estrogen attenuates the vasoconstrictor response to various stimuli and induces vasodilation in the pulmonary vasculature during stress situations like hypoxia. It exerts a variety of rapid actions, which are initiated after its coupling with membrane receptors, which in turn, may positively modulate vascular responses in pulmonary disease and help to maintain microvascular flow. Direct and indirect mechanisms underlying the effects of estradiol were investigated, and the results point to a possible protective effect of estradiol against COVID-19, indicating that it may be considered as an adjuvant therapeutic element for the treatment of patients affected by the novel coronavirus.