“It is not economical to go to bed early to save the candles if the result is twins.” ~ Chinese Proverb.
In thinking about my commentary on this latest IMMpress Magazine issue entitled ‘Sex, Immunity, and Reproduction,’ I asked AI to reveal quotations that sum up how we collectively view the topic. I got a lot of quotations from Mae West, Marlene Dietrich, Mark Twain, George Burns, and, of course, Alfred Kinsey. My favourite, however, was this one:
I should mention that twins run in our department – just ask Kate Sedore or Christina Ditlof.
Joking aside, the idea of drawing a new map for how we interrogate the immune system that incorporates the impact of sex, hormones including gender-affirming hormone therapy (GAHT), and a knowledge of how these variables intersect with age, environmental exposures (e.g., viruses), and the microbiome is long overdue. It is imperative that we not exclude participants in research based on sex and gender and that sex and gender be considered as covariates in research where applicable. However, this is not the only reason to put sex and gender on the immunological map – when we ignore sex-specific organ systems that have evolved to harness the immune system, we are missing key insights into the immune system itself. Take the examples described in this issue on the placenta or the testis. How does immune privilege operate in these structures? Is a little bit of inflammation a good thing or a bad thing? What can we learn about these systems that teaches us about other organs that are “immune privileged”? What can we learn about the relationship between the reproductive tract, sex, and partner microbiota exchange that teaches us about host-immune interactions at other mucosal surfaces?
Another article that challenged my preconceptions was about Polycystic Ovarian Syndrome (PCOS). It turns out that PCOS is actually a metabolic disorder and has been renamed Polyendocrine Metabolic Ovarian Syndrome, or PMOS. The renaming of the syndrome has opened new avenues of research – imagine using therapies like metformin or GLP-1 inhibitors to treat a syndrome that is associated with infertility. Similarly, endometriosis, which in the 20th century was thought of as the “career woman’s disease” (ugh), has been associated with carriage of Fusobacterium species. Studying these heavily stigmatized disorders through an immunological lens offers new hope for effective treatments and cures.
We used to approach the cartography of sex and science as “Beyond this point there be dragons.” For the sake of improving our immunological health, it’s time to update the map. Enjoy this read. No need to hide it under your mattress! Leave it out on your coffee table for all to see.
Jennifer Gommerman
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