Coronavirus: For this reason, men develop Covid-19 more often and more severely

Coronavirus: For this reason, men develop Covid-19 more often and more severely

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COVID-19: Two thirds of all deceased are men

For some weeks now, some studies have indicated that men develop and die more frequently and more severely from COVID-19 (caused by the SARS-CoV-2 coronavirus). So far, it has been assumed that unhealthy lifestyles such as smoking have a major impact. Significantly more men smoke than women. A research team from Germany discovered another possible influencing factor at the cell level.

Around two thirds of all people who die from COVID-19 disease are men. This was noticed very early on among the first affected people in Wuhan. The reasons for this are not yet sufficiently understood. Researchers at the German Center for Lung Research (DZL) have now discovered a possible reason for this connection, which is independent of lifestyle. The scientists presented the results of their research in the “EMBO Journal”.

Lung cancer research helps with COVID-19 education

A team led by Professor Roland Eils, who normally researches the causes of lung cancer, discovered a possible reason or a possible influencing factor based on cellular findings about the lungs, why significantly more men than women are ill and die of COVID-19. The so-called ACE2 receptor plays a key role here.

The research was supposed to find out why some people who have never smoked develop lung cancer. To this end, the researchers compared lung tissue from non-smokers with and without lung cancer. During the coronavirus pandemic, the researchers recalled this unpublished data. "I was convinced that the data that we collected from patients not infected with coronavirus contained important information for understanding the virus infection," explains Professor Eils.

Which cells are preferentially affected by SARS-CoV-2?

"We wanted to know exactly which cells are affected by the coronavirus," adds Professor Christian Conrad from the research team. Based on the knowledge that the team around the virologist Professor Dr. Christian Drosten collected about the SARS-CoV-2 coronavirus, it was known that the virus binds to cells via the ACE2 receptor. In addition, the virus needs one or more cofactors to help it penetrate the cells. Eils's team has now found out which cells are particularly susceptible and why.

60,000 individual cells sequenced

"We examined a total of almost 60,000 cells to determine whether they switched on the genes for the receptor and any cofactors, so that they can in principle be infected by the coronavirus," says study author Soeren Lukassen. The analysis revealed that, particularly in the bronchi, progenitor cells for the receptors to which the coronavirus binds are produced. Most of these progenitor cells develop into cells in the respiratory tract, especially the cells with their cilia that ensure that mucus and bacteria are transported out of the lungs.

Gender and age influence the ACE-2 density

At this point, a possible explanation opens up why more men are more likely to develop fatal and severe COVID-19 courses than women. As a secondary finding of the study, the researchers discovered that men have a higher ACE-2 receptor density than women. It was also shown that the ACE-2 receptor density generally increases with age. "It was just a trend, but it could explain why more men than women are infected," emphasizes Professor Eils. In addition, this is also a possible influencing factor why children are not so strong and older people are more at risk from the virus.

Final proof is still pending

"However, our case numbers are still far too low for a verifiable statement - we have to repeat this examination in larger patient cohorts," summarizes Eils. However, the studies show that the virus is very targeted and relies on certain cells in the body to spread and multiply. Now the team around Eils wants to investigate in the next step on COVID-19 sufferers whether it is actually these cells that are mainly infected.

Research shows possible approaches for therapies

"With the knowledge of which cells are attacked, we can now develop targeted therapies," summarizes Professor Michael Kreuter from the thoracic clinic of the Heidelberg University Hospital. Before that, however, it was necessary to understand why the infection healed quickly in some people and why others developed into acute lung failure.

Another recent study in the Deutsches Ärtzeblatt also shows that severe COVID-19 courses are particularly common for people with previous respiratory diseases and overweight. For more information, read the article: Coronavirus: Obese people need artificial respiration more often. (Vb)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Graduate editor (FH) Volker Blasek


  • Soeren Lukassen, Robert Lorenz, Roland Eils, and others: SARS ‐ CoV ‐ 2 receptor ACE2 and TMPRSS2 are primarily expressed in bronchial transient secretory cells; in: EMBO Journal, 2020,
  • Berlin Institute of Health: Which cells attack the novel coronavirus (published: April 7th, 2020),

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