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Editorials |

Sepsis and Sex : Can We Look Beyond Our Hormones?

David M. Berkowitz, MD; Greg S. Martin, MD, MSc, FCCP
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Affiliations: Atlanta, GA ,  Dr. Berkowitz is a senior fellow in Pulmonary and Critical Care Medicine at Emory University School of Medicine. Dr. Martin is the Director of the Medical and Cardiac Intensive Care Units at Grady Memorial Hospital and an Assistant Professor of Medicine at Emory University School of Medicine.

Correspondence to: Greg S. Martin, MD, MSc, FCCP, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303; e-mail: greg.martin@emory.org



Chest. 2007;132(6):1725-1727. doi:10.1378/chest.07-2001
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Although men and women may only be separated by a single chromosome, there is nothing straightforward in delineating the biological differences between sexes. Hormonal differences have often been implicated in the higher incidence of chronic autoimmune and inflammatory diseases such as multiple sclerosis, lupus, or rheumatoid arthritis in women.1 Estrogen promotes adaptive immune responses,2 whereas testosterone and 5α-dihydrotestosterone suppress immune and cardiac function in several animal models.23 This is supported by evidence that women in their reproductive years have more vigorous cellular and hormonal immune responses including higher T-lymphocyte count and Ig concentrations than men.24 In a recent study by van Eijk et al,5 15 healthy men and women volunteers were injected with low-dose lipopolysaccharide (LPS). Women demonstrated a greater proinflammatory response evidenced by higher levels of tumor necrosis factor-α and interferon-γ and a greater increase in LPS-binding protein. Interestingly, although women had a greater drop in mean arterial pressure in response to LPS, vascular sensitivity to norephinephrine was most attenuated in men.

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