Sexual dimorphism in immunometabolism and autoimmunity: Impact on personalized medicine

• Published in: Autoimmunity reviews Vol. 20; no. 4; p. 102775
• Main Authors: Manuel, Robbie S.J., Liang, Yun
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2021
• Subjects: Autoimmune Diseases; Autoimmunity; Female; Humans; Immunometabolism; Lupus Erythematosus, Systemic - therapy; Male; Multiple sclerosis; Precision Medicine; Pregnancy; Sex Characteristics; Sexual dimorphism; Sjögren's syndrome; Systemic lupus erythematous; FFA; ILC; Multiple sclerosis; PRR(s); FLT3; PVM; MHC; OXPHOS; HIF-1α; IRF-1; E2; SLE; PI3K; Th; GM-CSF; Tfh; mTOR; iNOS; PBL; AARDA; EC; FOXP; FOXO; NOD; IL; LFA-1; PKB/Akt; MS; RPS6; TSC2; MAPK; AAM; CAM; RA; BCR; Systemic lupus erythematous; AS; TCA; Sjögren's syndrome; ROS; AMPK; PIP3; 5-HT; HLA; PDK-1; NK; dsDNA; Ig; PIP2; ERK; VGLL3; NO; MCP-1; TCR; IRAK-1; PGC1β; SREBP-1; MCL-2; CNS; IRS; PPP; NADH; SGEC; T; PAMP(s); Sexual dimorphism; TLR; AKG; mTORc; CCA; SS; CD; GH; P4; STAT1; FADH2; COX5b; VLA-4; TB; Immunometabolism; APC; HIV; FAO; MCP; Autoimmune diseases; SHBG; ATP; cTfh; MCT
• ISSN: 1568-9972; 1568-9972; 1873-0183
• DOI: 10.1016/j.autrev.2021.102775

Immune cells play essential roles in metabolic homeostasis and thus, undergo analogous changes in normal physiology (e.g., puberty and pregnancy) and in various metabolic and immune diseases. An essential component of this close relationship between the two is sex differences. Many autoimmune diseases, such as systemic lupus erythematous and multiple sclerosis, feature strikingly increased prevalence in females, whereas in contrast, infectious diseases, such as Ebola and Middle East Respiratory Syndrome, affect more men than women. Therefore, there are fundamental aspects of metabolic homeostasis and immune functions that are regulated differently in males and females. This can be observed in sex hormone-immune interaction where androgens, such as testosterone, have shown immunosuppressive effects whilst estrogen is on the opposite side of the spectrum with immunoenhancing facilitation of mechanisms. In addition, the two sexes exhibit significant differences in metabolic regulation, with estrous cycles in females known to induce variability in traits and more pronounced metabolic disease phenotype exhibited by males. It is likely that these differences underlie both the development of metabolic and autoimmune diseases and the response to current treatment options. Sexual dimorphism in immunometabolism has emerged to become an area of intense research, aiming to uncover sex-biased effector molecules in the various metabolic tissues and immune cell types, identify sex-biased cell-type-specific functions of common effector molecules, and understand whether the sex differences in metabolic and immune functions influence each other during autoimmune pathogenesis. In this review, we will summarize recent findings that address these critical questions of sexual dimorphism in immunometabolism as well as their translational implications for the clinical management of autoimmune diseases. •Sex differences of autoimmune diseases necessitate sex-specific prevention and treatment strategies•Fundamental differences in immunometabolic homeostasis between men and women underlie sex differences in autoimmune diseases•Recent discoveries in the area of immunometabolism represent exciting opportunities to combat autoimmune diseases•Sex-specific metabolic reprogramming can be implored as novel approaches to enhance outcomes in autoimmune diseases