Understanding the cross-talk between mediators of infertility and COVID-19

Prem Rajak, Sumedha Roy, Moumita Dutta, Sayanti Podder, Saurabh Sarkar, Abhratanu Ganguly, Moutushi Mandi, Salma Khatun, Prem Rajak, Sumedha Roy, Moumita Dutta, Sayanti Podder, Saurabh Sarkar, Abhratanu Ganguly, Moutushi Mandi, Salma Khatun

Abstract

COVID-19 is the ongoing health emergency affecting individuals of all ages around the globe. Initially, the infection was reported to affect pulmonary structures. However, recent studies have delineated the impacts of COVID-19 on the reproductive system of both men and women. Hence, the present review aims to shed light on the distribution of SARS-CoV-2 entry factors in various reproductive organs. In addition, impacts of COVID-19 mediators like disrupted renin angiotensin system, oxidative stress, cytokine storm, fever, and the mental stress on reproductive physiology have also been discussed. For the present study, various keywords were used to search literature on PubMed, ScienceDirect, and Google Scholar databases. Articles were screened for relevancy and were studied in detail for qualitative synthesis of the review. Through our literature review, we found a multitude of effects of COVID-19 mediators on reproductive systems. Studies reported expression of receptors like ACE-2, TMPRSS2, and CD147 in the testes, epididymis, prostrate, seminal vesicles, and ovarian follicles. These proteins are known to serve as major SARS-CoV-2 entry factors. The expression of lysosomal cathepsins (CTSB/CTSL) and/ neuropilin-1 (NRP-1) are also evident in the testes, epididymis, seminal vesicles, fallopian tube, cervix, and endometrium. The binding of viral spike protein with ACE-2 was found to alter the renin-angiotensin cascade, which could invite additional infertility problems. Furthermore, COVID-19 mediated cytokine storm, oxidative stress, and elevated body temperature could be detrimental to gametogenesis, steroidogenesis, and reproductive cycles in patients. Finally, social isolation, confinement, and job insecurities have fueled mental stress and frustration that might promote glucocorticoid-mediated subnormal sperm quality in men and higher risk of miscarriage in women. Hence, the influence of COVID-19 on the alteration of reproductive health and fertility is quite apparent.

Keywords: COVID-19; Cytokine storm; Oxidative stress; Renin Angiotensin System; Reproductive health.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2021 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn. Published by Elsevier B.V. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Schematic representation of workflow demonstrating the literature search strategy.
Fig. 2
Fig. 2
Distribution of SARS-CoV-2 entry factors in male and female reproductive organs. Abbreviations: SV: Seminal vesicle; PT: Prostate gland; EP: Epididymis; TS: Testis; OV: Ovary; EM: Endometrium; FT: Fallopian tube; UT: Uterus; CR: Cervix; ACE-2: Angiotensin Converting Enzyme 2; TMPRSS2: Type II Membrane Serine Proteases; CSTB/CSTL: Lysosomal Cathepsin B / Cathepsin L; CD147: Cluster of Differentiation 147; NRP-1: Neuropilin-1.
Fig. 3
Fig. 3
COVID-19 fuels several mediators of infertility. ANG-II/AT1R axis. The sequential proteolytic cleavage of Angiotensinogen produces Angiotensin-II (ANG-II), which acts as ligand for Angiotensin type-1 receptor (AT1R). ACE-2 regulates the amount of ANG-II in the body by converting it into Ang 1–7. Ang 1–7 then counter-regulates ANG-II signaling using Mas-receptor. The binding of the SARS-CoV-2 spike protein with the ACE-2 receptor causes ectodomain shedding and ACE-2 down-regulation. This results in massive accumulation of ANG-II and profound activation of the ANG-II/AT1R axis. The ANG-II/AT1R axis promotes ERK1/2 and NF-kB signaling involved in vasoconstriction, fibrosis, hypertrophy, and oxidative stress (OS). NOX/Nrf signaling and OS. Ang 1–7 triggers the activation of PKC and Src, which help in the assembly of NADPH Oxidase (NOX) involved in ROS production and OS. Nrf catalyzes the transcriptional activation of endogenous antioxidants to combat OS. SARS-CoV-2 reduces Ang 1–7 levels and blocks Nrf activation to promote redox dyshomeostasis, which has been linked to reproductive problems. COVID-19 and cytokine storm. Spike protein/dsRNA of the virus interacts with TLRs to recruit downstream adaptors for the massive production of proinflammatory cytokines. Moreover, pathogen associated molecular patterns (PAMP) and damage associated molecular patterns (DAMP) can directly elicit the assembly of inflammasomes that are involved in the activation of proinflammatory cytokines. Fever and mental stress are obvious outcomes of COVID-19. All of these mediators have the potential to damage the reproductive health of men and women.

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