Do Anti-androgens Have Potential as Therapeutics for COVID-19?
Franck Mauvais-
Endocrinology, doi:10.1210/endocr/bqab114
Coronavirus disease 2019 (COVID-19 ) is characterized by a gender disparity in severity, with men exhibiting higher hospitalization and mortality rates than women. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, infects cells following recognition and attachment of the viral spike glycoprotein to the angiotensin-converting enzyme 2 transmembrane protein, followed by spike protein cleavage and activation by cell surface transmembrane protease serine 2 (TMPRSS2). In prostate cancer cells, androgen acting on the androgen receptor increases TMPRSS2 expression, which has led to the hypothesis that androgen-dependent expression of TMPRSS2 in the lung may increase men's susceptibility to severe COVID-19 and that, accordingly, suppressing androgen production or action may mitigate COVID-19 severity by reducing SARS-CoV-2 amplification. Several ongoing clinical trials are testing the ability of androgen deprivation therapies or anti-androgens to mitigate COVID-19. This perspective discusses clinical and molecular advances on the rapidly evolving field of androgen receptor (AR) action on cell surface transmembrane protease serine 2 (TMPRSS2) expression and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and the potential effect of anti-androgens on coronavirus disease 2019 (COVID-19) severity in male patients. It discusses limitations of current studies and offers insight for future directions.
Additional Information Correspondence: Franck Mauvais-Jarvis, MD, PhD, Tulane University School of Medicine, New Orleans, IL, USA. Email: fmauvais@ tulane.edu. Disclosures: The author declares no conflict of interest. Data Availability: Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study.
References
Baldassarri, Picchiotti, Fava, Shorter androgen receptor polyQ alleles protect against life-threatening COVID-19 disease in European males, Ebiomedicine
Bupp, Jorgensen, Androgen-induced immunosuppression, Front Immunol
Cadegiani, Mccoy, Wambier, Proxalutamide significantly accelerates viral clearance and reduces time to clinical remission in patients with mild to moderate COVID-19: results from a randomized, double-blinded, placebo-controlled trial, Cureus
Caffo, Zagonel, Baldessari, On the relationship between androgen-deprivation therapy for prostate cancer and risk of infection by SARS-CoV-2, Ann Oncol
Degauque, Haziot, Brouard, Mooney, Endothelial cell, myeloid, and adaptive immune responses in SARS-CoV-2 infection, Faseb J
Deng, Rasool, Russell, Natesan, Asangani, Targeting androgen regulation of TMPRSS2 and ACE2 as a therapeutic strategy to combat COVID-19, Iscience
Dhindsa, Zhang, Mcphaul, Association of circulating sex hormones with inflammation and disease severity in patients with COVID-19, JAMA Netw Open
Li, Han, Dai, Distinct mechanisms for TMPRSS2 expression explain organ-specific inhibition of SARS-CoV-2 infection by enzalutamide, Nat Commun
Mauvais-Jarvis, Klein, Levin, Estradiol, progesterone, immunomodulation, and COVID-19 outcomes, Endocrinology
Mccoy, Cadegiani, Wambier, 5-alpha-reductase inhibitors are associated with reduced frequency of COVID-19 symptoms in males with androgenetic alopecia, J Eur Acad Dermatol Venereol
Montopoli, Zumerle, Vettor, Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N = 4532), Ann Oncol
Patel, Zhong, Liaw, Does androgen deprivation therapy protect against severe complications from COVID-19?, Ann Oncol
Qiao, Wang, Mannan, Targeting transcriptional regulation of SARS-CoV-2 entry factors ACE2 and TMPRSS2, Proc Natl Acad Sci U S A
Rastrelli, Stasi, Inglese, Low testosterone levels predict clinical adverse outcomes in SARS-CoV-2 pneumonia patients, Andrology
{ 'indexed': {'date-parts': [[2024, 3, 5]], 'date-time': '2024-03-05T19:30:14Z', 'timestamp': 1709667014378},
'reference-count': 14,
'publisher': 'The Endocrine Society',
'issue': '8',
'license': [ { 'start': { 'date-parts': [[2021, 6, 5]],
'date-time': '2021-06-05T00:00:00Z',
'timestamp': 1622851200000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model'}],
'funder': [ { 'DOI': '10.13039/100000002',
'name': 'National Institutes of Health',
'doi-asserted-by': 'publisher',
'award': ['DK074970', 'DK107444']},
{'name': 'American Diabetes Association COVID-19 Research Award', 'award': ['7-20-COVID-051']},
{'name': 'US Department of Veterans Affairs Merit Review Award', 'award': ['BX003725']},
{'name': 'Tulane Center of Excellence in Sex-Based Biology & Medicine'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'published-print': {'date-parts': [[2021, 8, 1]]},
'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:p>Coronavirus disease 2019 (COVID-19) is characterized by a gender '
'disparity in severity, with men exhibiting higher hospitalization and mortality rates than '
'women. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible '
'for COVID-19, infects cells following recognition and attachment of the viral spike '
'glycoprotein to the angiotensin-converting enzyme 2 transmembrane protein, followed by spike '
'protein cleavage and activation by cell surface transmembrane protease serine 2 (TMPRSS2). In '
'prostate cancer cells, androgen acting on the androgen receptor increases TMPRSS2 expression, '
'which has led to the hypothesis that androgen-dependent expression of TMPRSS2 in the lung may '
'increase men’s susceptibility to severe COVID-19 and that, accordingly, suppressing androgen '
'production or action may mitigate COVID-19 severity by reducing SARS-CoV-2 amplification. '
'Several ongoing clinical trials are testing the ability of androgen deprivation therapies or '
'anti-androgens to mitigate COVID-19.</jats:p>\n'
' <jats:p>This perspective discusses clinical and molecular advances on the '
'rapidly evolving field of androgen receptor (AR) action on cell surface transmembrane '
'protease serine 2 (TMPRSS2) expression and severe acute respiratory syndrome coronavirus 2 '
'(SARS-CoV-2) infection, and the potential effect of anti-androgens on coronavirus disease '
'2019 (COVID-19) severity in male patients. It discusses limitations of current studies and '
'offers insight for future directions.</jats:p>',
'DOI': '10.1210/endocr/bqab114',
'type': 'journal-article',
'created': {'date-parts': [[2021, 6, 5]], 'date-time': '2021-06-05T16:28:36Z', 'timestamp': 1622910516000},
'source': 'Crossref',
'is-referenced-by-count': 11,
'title': 'Do Anti-androgens Have Potential as Therapeutics for COVID-19?',
'prefix': '10.1210',
'volume': '162',
'author': [ { 'ORCID': 'http://orcid.org/0000-0002-0874-0754',
'authenticated-orcid': False,
'given': 'Franck',
'family': 'Mauvais-Jarvis',
'sequence': 'first',
'affiliation': [ { 'name': 'Department of Medicine, Section of Endocrinology, Tulane '
'University School of Medicine, New Orleans, LA, USA'},
{ 'name': 'Tulane Center of Excellence in Sex-Based Biology & Medicine, New '
'Orleans, LA, USA'},
{'name': 'Southeast Louisiana VA Medical Center, New Orleans, LA, USA'}]}],
'member': '80',
'published-online': {'date-parts': [[2021, 6, 5]]},
'reference': [ { 'issue': '9',
'key': '2021121717595546900_CIT0001',
'doi-asserted-by': 'crossref',
'DOI': '10.1210/endocr/bqaa127',
'article-title': 'Estradiol, progesterone, immunomodulation, and COVID-19 outcomes',
'volume': '161',
'author': 'Mauvais-Jarvis',
'year': '2020',
'journal-title': 'Endocrinology'},
{ 'issue': '8',
'key': '2021121717595546900_CIT0002',
'doi-asserted-by': 'crossref',
'first-page': '1040',
'DOI': '10.1016/j.annonc.2020.04.479',
'article-title': 'Androgen-deprivation therapies for prostate cancer and risk of '
'infection by SARS-CoV-2: a population-based study (N = 4532)',
'volume': '31',
'author': 'Montopoli',
'year': '2020',
'journal-title': 'Ann Oncol'},
{ 'issue': '10',
'key': '2021121717595546900_CIT0003',
'doi-asserted-by': 'crossref',
'first-page': '1419',
'DOI': '10.1016/j.annonc.2020.06.023',
'article-title': 'Does androgen deprivation therapy protect against severe complications '
'from COVID-19?',
'volume': '31',
'author': 'Patel',
'year': '2020',
'journal-title': 'Ann Oncol.'},
{ 'issue': '10',
'key': '2021121717595546900_CIT0004',
'doi-asserted-by': 'crossref',
'first-page': '1415',
'DOI': '10.1016/j.annonc.2020.06.005',
'article-title': 'On the relationship between androgen-deprivation therapy for prostate '
'cancer and risk of infection by SARS-CoV-2',
'volume': '31',
'author': 'Caffo',
'year': '2020',
'journal-title': 'Ann Oncol.'},
{ 'issue': '4',
'key': '2021121717595546900_CIT0005',
'doi-asserted-by': 'crossref',
'first-page': 'e243',
'DOI': '10.1111/jdv.17021',
'article-title': '5-alpha-reductase inhibitors are associated with reduced frequency of '
'COVID-19 symptoms in males with androgenetic alopecia',
'volume': '35',
'author': 'McCoy',
'year': '2021',
'journal-title': 'J Eur Acad Dermatol Venereol.'},
{ 'issue': '2',
'key': '2021121717595546900_CIT0006',
'first-page': 'e13492',
'article-title': 'Proxalutamide significantly accelerates viral clearance and reduces '
'time to clinical remission in patients with mild to moderate COVID-19: '
'results from a randomized, double-blinded, placebo-controlled trial',
'volume': '13',
'author': 'Cadegiani',
'year': '2021',
'journal-title': 'Cureus.'},
{ 'issue': '1',
'key': '2021121717595546900_CIT0007',
'doi-asserted-by': 'crossref',
'first-page': 'e2021450118',
'DOI': '10.1073/pnas.2021450118',
'article-title': 'Targeting transcriptional regulation of SARS-CoV-2 entry factors ACE2 '
'and TMPRSS2',
'volume': '118',
'author': 'Qiao',
'year': '2021',
'journal-title': 'Proc Natl Acad Sci'},
{ 'issue': '1',
'key': '2021121717595546900_CIT0008',
'doi-asserted-by': 'crossref',
'first-page': '866',
'DOI': '10.1038/s41467-021-21171-x',
'article-title': 'Distinct mechanisms for TMPRSS2 expression explain organ-specific '
'inhibition of SARS-CoV-2 infection by enzalutamide',
'volume': '12',
'author': 'Li',
'year': '2021',
'journal-title': 'Nat Commun.'},
{ 'issue': '3',
'key': '2021121717595546900_CIT0009',
'doi-asserted-by': 'crossref',
'first-page': '102254',
'DOI': '10.1016/j.isci.2021.102254',
'article-title': 'Targeting androgen regulation of TMPRSS2 and ACE2 as a therapeutic '
'strategy to combat COVID-19',
'volume': '24',
'author': 'Deng',
'year': '2021',
'journal-title': 'Iscience.'},
{ 'issue': '5',
'key': '2021121717595546900_CIT0010',
'doi-asserted-by': 'crossref',
'first-page': 'e21577',
'DOI': '10.1096/fj.202100024R',
'article-title': 'Endothelial cell, myeloid, and adaptive immune responses in SARS-CoV-2 '
'infection',
'volume': '35',
'author': 'Degauque',
'year': '2021',
'journal-title': 'Faseb J.'},
{ 'key': '2021121717595546900_CIT0011',
'doi-asserted-by': 'crossref',
'first-page': '794',
'DOI': '10.3389/fimmu.2018.00794',
'article-title': 'Androgen-induced immunosuppression',
'volume': '9',
'author': 'Gubbels Bupp',
'year': '2018',
'journal-title': 'Front Immunol.'},
{ 'issue': '1',
'key': '2021121717595546900_CIT0012',
'doi-asserted-by': 'crossref',
'first-page': '88',
'DOI': '10.1111/andr.12821',
'article-title': 'Low testosterone levels predict clinical adverse outcomes in SARS-CoV-2 '
'pneumonia patients',
'volume': '9',
'author': 'Rastrelli',
'year': '2021',
'journal-title': 'Andrology.'},
{ 'issue': '5',
'key': '2021121717595546900_CIT0013',
'doi-asserted-by': 'crossref',
'first-page': 'e2111398',
'DOI': '10.1001/jamanetworkopen.2021.11398',
'article-title': 'Association of circulating sex hormones with inflammation and disease '
'severity in patients with COVID-19',
'volume': '4',
'author': 'Dhindsa',
'year': '2021',
'journal-title': 'JAMA Netw Open.'},
{ 'key': '2021121717595546900_CIT0014',
'doi-asserted-by': 'crossref',
'first-page': '103246',
'DOI': '10.1016/j.ebiom.2021.103246',
'article-title': 'Shorter androgen receptor polyQ alleles protect against '
'life-threatening COVID-19 disease in European males',
'volume': '65',
'author': 'Baldassarri',
'year': '2021',
'journal-title': 'Ebiomedicine.'}],
'container-title': 'Endocrinology',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'http://academic.oup.com/endo/advance-article-pdf/doi/10.1210/endocr/bqab114/38496550/bqab114.pdf',
'content-type': 'application/pdf',
'content-version': 'am',
'intended-application': 'syndication'},
{ 'URL': 'https://academic.oup.com/endo/article-pdf/162/8/bqab114/41810651/bqab114.pdf',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'syndication'},
{ 'URL': 'https://academic.oup.com/endo/article-pdf/162/8/bqab114/41810651/bqab114.pdf',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2021, 12, 17]],
'date-time': '2021-12-17T19:26:56Z',
'timestamp': 1639769216000},
'score': 1,
'resource': { 'primary': { 'URL': 'https://academic.oup.com/endo/article/doi/10.1210/endocr/bqab114/6293822'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2021, 6, 5]]},
'references-count': 14,
'journal-issue': {'issue': '8', 'published-print': {'date-parts': [[2021, 8, 1]]}},
'URL': 'http://dx.doi.org/10.1210/endocr/bqab114',
'relation': {},
'ISSN': ['0013-7227', '1945-7170'],
'subject': [],
'published-other': {'date-parts': [[2021, 8, 1]]},
'published': {'date-parts': [[2021, 6, 5]]}}