Sexually dimorphic placental responses to maternal SARS-CoV-2 infection

Bordt, Evan A; Shook, Lydia L; Atyeo, Caroline; Pullen, Krista M; De Guzman, Rose M; Meinsohn, Marie-Charlotte; Chauvin, Maeva; Fischinger, Stephanie; Yockey, Laura J.; James, Kaitlyn; Lima, Rosiane; Yonker, Lael M; Fasano, Alessio; Brigida, Sara; Bebell, Lisa M; Roberts, Drucilla J; Pépin, David; Huh, Jun R; Bilbo, Staci D; Li, Jonathan Z; Kaimal, Anjali; Schust, Danny; Gray, Kathryn J; Lauffenburger, Douglas; Alter, Galit; Edlow, Andrea G

There is a persistent male bias in the prevalence and severity of COVID-19 disease. Underlying mechanisms accounting for this sex difference remain incompletely understood. Interferon responses have been implicated as a modulator of disease in adults, and play a key role in the placental anti-viral response. Moreover, the interferon response has been shown to alter Fc-receptor expression, and therefore may impact placental antibody transfer. Here we examined the intersection of viral-induced placental interferon responses, maternal-fetal antibody transfer, and fetal sex. Placental interferon stimulated genes (ISGs), Fc-receptor expression, and SARS-CoV-2 antibody transfer were interrogated in 68 pregnancies. Sexually dimorphic placental expression of ISGs, interleukin-10, and Fc receptors was observed following maternal SARS-CoV-2 infection, with upregulation in males. Reduced maternal SARS-CoV-2-specific antibody titers and impaired placental antibody transfer were noted in pregnancies with a male fetus. These results demonstrate fetal sex-specific maternal and placental adaptive and innate immune responses to SARS-CoV-2.