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      Estrogen and COVID-19 symptoms: Associations in women from the COVID Symptom Study

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          Abstract

          It has been widely observed that adult men of all ages are at higher risk of developing serious complications from COVID-19 when compared with women. This study aimed to investigate the association of COVID-19 positivity and severity with estrogen exposure in women, in a population based matched cohort study of female users of the COVID Symptom Study application in the UK. Analyses included 152,637 women for menopausal status, 295,689 women for exogenous estrogen intake in the form of the combined oral contraceptive pill (COCP), and 151,193 menopausal women for hormone replacement therapy (HRT). Data were collected using the COVID Symptom Study in May-June 2020. Analyses investigated associations between predicted or tested COVID-19 status and menopausal status, COCP use, and HRT use, adjusting for age, smoking and BMI, with follow-up age sensitivity analysis, and validation in a subset of participants from the TwinsUK cohort. Menopausal women had higher rates of predicted COVID-19 (P = 0.003). COCP-users had lower rates of predicted COVID-19 (P = 8.03E-05), with reduction in hospital attendance (P = 0.023). Menopausal women using HRT or hormonal therapies did not exhibit consistent associations, including increased rates of predicted COVID-19 (P = 2.22E-05) for HRT users alone. The findings support a protective effect of estrogen exposure on COVID-19, based on positive association between predicted COVID-19 with menopausal status, and negative association with COCP use. HRT use was positively associated with COVID-19, but the results should be considered with caution due to lack of data on HRT type, route of administration, duration of treatment, and potential unaccounted for confounders and comorbidities.

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          Most cited references48

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          Sex differences in immune responses

          Males and females differ in their immunological responses to foreign and self-antigens and show distinctions in innate and adaptive immune responses. Certain immunological sex differences are present throughout life, whereas others are only apparent after puberty and before reproductive senescence, suggesting that both genes and hormones are involved. Furthermore, early environmental exposures influence the microbiome and have sex-dependent effects on immune function. Importantly, these sex-based immunological differences contribute to variations in the incidence of autoimmune diseases and malignancies, susceptibility to infectious diseases and responses to vaccines in males and females. Here, we discuss these differences and emphasize that sex is a biological variable that should be considered in immunological studies.
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            DNA methylation age of human tissues and cell types

            Background It is not yet known whether DNA methylation levels can be used to accurately predict age across a broad spectrum of human tissues and cell types, nor whether the resulting age prediction is a biologically meaningful measure. Results I developed a multi-tissue predictor of age that allows one to estimate the DNA methylation age of most tissues and cell types. The predictor, which is freely available, was developed using 8,000 samples from 82 Illumina DNA methylation array datasets, encompassing 51 healthy tissues and cell types. I found that DNA methylation age has the following properties: first, it is close to zero for embryonic and induced pluripotent stem cells; second, it correlates with cell passage number; third, it gives rise to a highly heritable measure of age acceleration; and, fourth, it is applicable to chimpanzee tissues. Analysis of 6,000 cancer samples from 32 datasets showed that all of the considered 20 cancer types exhibit significant age acceleration, with an average of 36 years. Low age-acceleration of cancer tissue is associated with a high number of somatic mutations and TP53 mutations, while mutations in steroid receptors greatly accelerate DNA methylation age in breast cancer. Finally, I characterize the 353 CpG sites that together form an aging clock in terms of chromatin states and tissue variance. Conclusions I propose that DNA methylation age measures the cumulative effect of an epigenetic maintenance system. This novel epigenetic clock can be used to address a host of questions in developmental biology, cancer and aging research.
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              Minfi: a flexible and comprehensive Bioconductor package for the analysis of Infinium DNA methylation microarrays.

              The recently released Infinium HumanMethylation450 array (the '450k' array) provides a high-throughput assay to quantify DNA methylation (DNAm) at ∼450 000 loci across a range of genomic features. Although less comprehensive than high-throughput sequencing-based techniques, this product is more cost-effective and promises to be the most widely used DNAm high-throughput measurement technology over the next several years. Here we describe a suite of computational tools that incorporate state-of-the-art statistical techniques for the analysis of DNAm data. The software is structured to easily adapt to future versions of the technology. We include methods for preprocessing, quality assessment and detection of differentially methylated regions from the kilobase to the megabase scale. We show how our software provides a powerful and flexible development platform for future methods. We also illustrate how our methods empower the technology to make discoveries previously thought to be possible only with sequencing-based methods. http://bioconductor.org/packages/release/bioc/html/minfi.html. khansen@jhsph.edu; rafa@jimmy.harvard.edu Supplementary data are available at Bioinformatics online.
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                Author and article information

                Contributors
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ResourcesRole: Software
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ResourcesRole: Software
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 September 2021
                2021
                10 September 2021
                : 16
                : 9
                : e0257051
                Affiliations
                [1 ] Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
                [2 ] School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
                [3 ] Zoe Global Limited, London, United Kingdom
                [4 ] National Health Service, London, United Kingdom
                [5 ] Department of Women’s and Children’s Health, University of Liverpool, Liverpool, United Kingdom
                [6 ] Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
                [7 ] Department of Women’s Health, King’s College London, London, United Kingdom
                [8 ] Newson Health Menopause & Wellbeing Centre, Stratford-Upon-Avon, United Kingdom
                Imperial College London, UNITED KINGDOM
                Author notes

                Competing Interests: Zoe Global Limited co-developed the app pro bono for non-commercial purposes. JCP and JW work for Zoe Global, and TDS is a consultant to Zoe Global. IB is Chief Data Scientist Advisor for AstraZeneca. These do not alter our adherence to PLoS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0001-5904-5586
                https://orcid.org/0000-0002-6756-3823
                Article
                PONE-D-21-02705
                10.1371/journal.pone.0257051
                8432854
                34506535
                64cea5b7-3d6c-4401-9168-af92d0d1d14b
                © 2021 Costeira et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 February 2021
                : 22 August 2021
                Page count
                Figures: 0, Tables: 2, Pages: 14
                Funding
                Funded by: zoe global
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, wellcome trust;
                Funded by: medical research council/british heart foundation
                Funded by: Alzheimer’s Society Chronic Disease Research Foundation
                Funded by: Economic and Social Research Council
                Award ID: ES/N000404/1
                Award Recipient :
                Funded by: European Community’s Seventh Framework Programme
                Award ID: FP7/2007–2013
                Funded by: National Institute for Health Research
                Award ID: BioResource
                Funded by: funder-id http://dx.doi.org/10.13039/501100000272, national institute for health research;
                Award ID: NIHR300159
                Award Recipient :
                Zoe Global provided in kind support for all aspects of building, running, and supporting the app and service to all users worldwide. Investigators received support from the Wellcome Trust, the MRC/BHF, Alzheimer’s Society, EU, NIHR, CDRF, ESRC. The TwinsUK study was funded by the Wellcome Trust; European Community’s Seventh Framework Programme (FP7/2007–2013); National Institute for Health Research (NIHR)- funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. Epigenetic ageing estimates were generated from the UK Economic and Social Research Council (ES/N000404/1 to JTB). MNL is supported by an NIHR Doctoral Fellowship (grant code NIHR300159). Zoe Global provided support in the form of salaries for authors JCP and JW and contributed to data collection which was carried via the Zoe app. The roles of these authors are articulated in the ‘Author Contributions’ section. The funders did not have any additional role in the study design, data analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Biology and Life Sciences
                Biochemistry
                Hormones
                Estrogens
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Hormonal Therapy
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                Genetics
                Epigenetics
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                Diagnostic Medicine
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                Immunology
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                Immunology
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                Cell biology
                Chromosome biology
                Chromatin
                Chromatin modification
                DNA methylation
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                Genetics
                Epigenetics
                Chromatin
                Chromatin modification
                DNA methylation
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                Genetics
                Gene expression
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                Biology and life sciences
                Biochemistry
                Nucleic acids
                DNA
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                Biology and life sciences
                Genetics
                Epigenetics
                DNA modification
                DNA methylation
                Biology and life sciences
                Genetics
                Gene expression
                DNA modification
                DNA methylation
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Custom metadata
                Data collected in the COVID Symptom Study smartphone application are being shared with other health researchers through the UK NHS-funded Health Data Research UK (HDRUK) and Secure Anonymised Information Linkage consortium, housed in the UK Secure Research Platform (Swansea, UK). Anonymised data are available to be shared with HDRUK researchers according to their protocols in the public interest using the following link https://healthdatagateway.org/detail/9b604483-9cdc-41b2-b82c-14ee3dd705f6.
                COVID-19

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