title: Gender differences in sepsis: cardiovascular and immunological aspects.
abstract: During sepsis, a complex network of cytokine, immune, and endothelial cell interactions occur and disturbances in the microcirculation cause organ dysfunction or even failure leading to high mortality in those patients. In this respect, numerous experimental and clinical studies indicate sex-specific differences in infectious diseases and sepsis. Female gender has been demonstrated to be protective under such conditions, whereas male gender may be deleterious due to a diminished cell-mediated immune response and cardiovascular functions. Male sex hormones, i.e., androgens, have been shown to be suppressive on cell-mediated immune responses. In contrast, female sex hormones exhibit protective effects which may contribute to the natural advantages of females under septic conditions. Thus, the hormonal status has to be considered when treating septic patients. Therefore, potential therapies could be derived from this knowledge. In this respect, administration of female sex hormones (estrogens and their precursors) may exert beneficial effects. Alternatively, blockade of male sex hormone receptors could result in maintained immune responses under adverse circulatory conditions. Finally, administration of agents that influence enzymes synthesizing female sex hormones which attenuate the levels of pro-inflammatory agents might exert salutary effects in septic patients. Prospective patient studies are required for transferring those important experimental findings into the clinical arena.
authors.affiliation: Department of Surgery; Klinikum Grosshadern; Munich, Germany.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Angele
authors.affiliation: Department of Surgery; Klinikum Grosshadern; Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pratschke
authors.affiliation: Center for Surgical Research; University of Alabama at Birmingham; Birmingham, AL USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Hubbard
authors.affiliation: Center for Surgical Research; University of Alabama at Birmingham; Birmingham, AL USA.
authors.forename: Irshad H
authors.initials: IH
authors.lastname: Chaudry
mesh_terms: D059002:Androgen Receptor Antagonists / Q000627:therapeutic use; D000728:Androgens / Q000276:immunology*; D000818:Animals; D002319:Cardiovascular System / Q000276:immunology; D003687:Dehydroepiandrosterone / Q000627:therapeutic use; D004967:Estrogens / Q000276:immunology*; D005260:Female; D005485:Flutamide / Q000627:therapeutic use; D006801:Humans; D007111:Immunity, Cellular; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D051379:Mice; D012737:Sex Factors; D012772:Shock, Septic / Q000453:epidemiology* / Q000276:immunology* / Q000517:prevention & control
chemical_list: D059002:Androgen Receptor Antagonists; D000728:Androgens; D004967:Estrogens; D003687:Dehydroepiandrosterone; D005485:Flutamide
keywords: estrogen; immune depression; immune modulation; sex steroids