Renin-angiotensin system: A possible clue for gender bias in coronavirus disease 2019 infection

The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has been declared as a pandemic by WHO on March 11, 2020. Previous history of viral infections such as Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV had shown high risk for maternal and neonates, with vertical transmission (VT) and perinatal as well as maternal mortality; hence, the possibility of the same cannot be ruled out in case of COVID-19. Authors’ literature survey on Scopus/Embase/ PubMed/Google using the terms “COVID-19* and pregnancy, VT, and gender difference in COVID-19 infection. All the relevant literatures were included in this review. Like other respiratory infections made by coronavirusesMERS-CoV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV), the Viral spike of SARS-Cov-2 catches angiotensin converting enzyme 2 (ACE2) (a part of renin angiotensin system [RAS]) to enter the body. For those with risk factors, namely, cardiovascular complications, diabetes, and respiratory disorders, this entry is fatal We suggest that pregnancy is a well-orchestrated event capable of tackling COVID-19 infection by virtue of its hormone dependency which is capable of curbing the cytokine storm despite increased ACE2 expression. This review summarizes the gender bias of RAS; importance of RAS in pregnancy and sex hormonal influence on COVID-19 infection.