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Sexual Inequality in Tuberculosis
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Journal Article
Sexual Inequality in Tuberculosis
2009
Overview
Summary Points * In most countries, tuberculosis (TB) notification is twice as high in men as in women. * Although there is clear evidence that socioeconomic and cultural factors leading to barriers in accessing health care may cause undernotification in women, particularly in developing countries, biological mechanisms may actually account for a significant part of this difference between male and female susceptibility to TB. * The role of biological gender has been determined in a number of infectious and noninfectious diseases. Key Research Actions on Sex Bias in TB * Parallel and homogeneous epidemiological surveys in human populations from different geographic and ethnic backgrounds to dissect simultaneously the various factors possibly contributing to the sex bias in TB in the most exhaustive manner, including: * Sociocultural components: income, stigmatization, awareness, etc. * Behavioural components: smoking, alcohol and drug abuse, exposure to toxic dusts at the work place, dietary differences, etc. * Biological components: sex hormones, genetic background * Detailed follow-ups of sex hormone profiles in men and women presenting TB, as well as in the corresponding healthy contacts exposed to the same environmental pressures * Development of an appropriate animal model that mimics the sex bias observed in TB in humans for subsequent in vivo dissection of the influence of sex hormones in castrated and hormone-reconstituted animals on immune response to M. tuberculosis and disease outcome * Development of suitable in vitro cell models to investigate the influence of sex hormones and immune modulators (cytokines and nutrients such as iron, vitamin D, etc.) on the immune response to M. tuberculosis (see Figure 3) * Genome-wide association studies in populations from diverse geographic areas, involving large cohorts of clinically well-defined TB cases and appropriate controls, stratified by sex * Genome-wide gene expression profiling in different in vitro and ex vivo biological settings (e.g., monocyte-derived phagocytes, blood samples, lung biopsies, broncho-alveolar lavages) from male and female TB patients and relevant controls [Figure omitted, see PDF] Figure 3.
Publisher
Public Library of Science,Public Library of Science (PLoS)
Subject
/ Bias
/ Female
/ Females
/ Gender
/ Genetics and Genomics/Genetics of the Immune System
/ Genomes
/ Gonadal Steroid Hormones - genetics
/ Gonadal Steroid Hormones - metabolism
/ Humans
/ Immunology/Genetics of the Immune System
/ Immunology/Immunity to Infections
/ Infectious Diseases/Bacterial Infections
/ Infectious Diseases/Respiratory Infections
/ LDCs
/ Male
/ Microbiology/Immunity to Infections
/ Mycobacterium tuberculosis - immunology
/ Physiology/Immunity to Infections
