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Infection with SARS-CoV2, the virus that causes COVID-19, disproportionally affects men more than women in terms of both incidence and severity. Some evidence indicates that men are more than twice as likely to die from COVID-19 than women. Findings from a new study suggest that the testes serve as reservoirs for the virus due to increased expression of the ACE2 receptor.

The ACE2 receptor is widely distributed among the body’s tissues. SARS-CoV2 exploits ACE2 to gain entry into cells by binding to a cell’s ACE2 receptor and injecting its genetic material into the cytosol, where it can replicate.

The study involved 68 patients (48 males, 20 females) who had been diagnosed with COVID-19. The patients, who were between the ages of 3 and 57 years, underwent daily testing via oropharyngeal/nasopharyngeal swab to assess their viral load. The testing revealed that females cleared the virus roughly two days earlier than males.

The authors of the study then examined tissue expression patterns of ACE2 as reported in RNA expression databases. They found that testicular tissue is one of the highest sites of ACE2 expression. Ovarian tissue has very low ACE2 expression. These findings suggest that males have delayed viral clearance of SARS-CoV2 due to high expression of ACE2 receptors in testicular tissue, which serves as a reservoir for the virus.

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