agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-890210.17650/2070-9781-2022-23-3-41-47agx-583Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWМеханизмы воздействия вируса SARS-CoV-2 на ткань предстательной железы, включая ассоциации с гормональным статусом пациента и поствакцинальные реакцииMechanisms of SARS-CoV-2 virus effects on prostate tissues, including associations with patient hormonal state and postvaccination reactionshttps://orcid.org/0000-0002-4393-8707СевергинаЛ. О.SeverginaL. O.

Любовь Олеговна Севергина

119991 Москва, ул. Трубецкая, 8, стр. 2

Lubov Olegovna Severgina

Bld. 2, 8 Trubetskaya St., Moscow 119991

losevergina@gmail.comГлыбочкоП. В.GlybochkoP. V.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

https://orcid.org/0000-0003-4009-346XКоровинИ. А.КоrovinI. A.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

https://orcid.org/0000-0001-7787-1240РапопортЛ. М.RapoportL. M.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

БеляковА. В.BelyakovA. V.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

КрюковаА. И.KryukovaA. I.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

ЕфимочкинаС. М.EfimochkinaS. M.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

https://orcid.org/0000-0001-5103-0304ЯворовскийА. Г.YaworovskyA. G.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

ЦариченкоД. Г.TsarichenkoT. G.

119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya St., Moscow 119991

https://orcid.org/0000-0001-8861-8187КоролевД. О.KorolevD. O.

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Bld. 2, 8 Trubetskaya St., Moscow 119991

ФГАОУ ВО Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава России (Сеченовский Университет)РоссияI. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian Federation2022090920222334147Copyright © Севергина Л.О., Глыбочко П.В., Коровин И.А., Рапопорт Л.М., Беляков А.В., Крюкова А.И., Ефимочкина С.М., Яворовский А.Г., Цариченко Д.Г., Королев Д.О., 20222022Севергина Л.О., Глыбочко П.В., Коровин И.А., Рапопорт Л.М., Беляков А.В., Крюкова А.И., Ефимочкина С.М., Яворовский А.Г., Цариченко Д.Г., Королев Д.О.Severgina L.O., Glybochko P.V., Коrovin I.A., Rapoport L.M., Belyakov A.V., Kryukova A.I., Efimochkina S.M., Yaworovsky A.G., Tsarichenko T.G., Korolev D.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://agx.elpub.ru/jour/article/view/583

К настоящему времени наиболее изученными негативными эффектами вируса SARS-CoV-2 являются его легочные проявления, а также поражение сердечно-сосудистой системы. Оценка постковидных изменений в органах мужской репродуктивной системы, а также анализ механизмов их возникновения представляются нам важными, поскольку они оказывают непосредственное влияние на фертильность, т. е. играют существенную роль в долгосрочной перспективе. Исследования, основанные на применении флуоресцентной гибридизации in situ, показали, что большинство эпителиальных клеток ацинусов, а также некоторые мезенхимальные и эндотелиальные клетки были положительны на РНК SARS-CoV-2. Что же касается коэкспрессии клеточных рецепторов ACE2 и сериновой протеазы TMPRSS2, которые вирус использует для проникновения в клетки, то она также была обнаружена в большинстве эпителиальных и стромальных клеток предстательной железы. Механизм поражения предстательной железы при COVID-19 может быть также связан с дисрегуляцией ренин-ангиотензиновой системы. Повышенный уровень секреции ангиотензина II в предстательной железе у пациентов с доброкачественной гиперплазией предстательной железы может усиливать влияние вируса непосредственно на клетки органа. Эти механизмы могут объяснить повышение уровня простатического специфического антигена в сыворотке пациентов, страдающих доброкачественной гиперплазией предстательной железы, в активный период COVID-19. Неспецифический механизм поражения предстательной железы связан с развитием коагулопатии – тромбозом ее венозного сплетения и гемодинамическими нарушениями, которые могут вызывать вторичное поражение паренхимы железы. Существует определенная связь между гормональным статусом пациента и тяжестью течения инфекции: низкие уровни как тестостерона, так и дигидротестостерона способствуют развитию тяжелых осложнений у пациентов, инфицированных SARS-CoV-2. Рассматривается возможность применения препаратов тестостерона у пациентов, страдающих гипогонадизмом и COVID-19, в качестве альтернативного варианта лечения – для подавления феномена цитокинового шторма. Пациенты с раком предстательной железы в анамнезе, с локализованным раком предстательной железы при отсутствии метастазов участвовали в исследованиях вакцин: среди побочных эффектов вакцинации в нескольких случаях отмечалась лишь регионарная лимфаденопатия на стороне инъекции препарата.

Nowadays, the most notable negative effects of SARS-CoV-2 are the pulmonary manifestations as well as cardiovascular system damage. Evaluation of postvaccination changes in the male reproductive system and analysis of their mechanisms seem to be important because of their direct effect on fertility. Thus, it may play a significant role in perspective. Studies based on the application of fluorescence in situ hybridization showed that most acini epithelial cells, as well as some mesenchymal and endothelial cells were positive for SARS-CoV-2 RNA. As for co-expression of the ACE2 cell receptor and the serine protease TMPRSS2, which the virus uses to enter cells, it was also detected in most prostate epithelial and stromal cells. The mechanism of prostate damage in COVID-19 may also be related to dysregulation of the renin-angiotensin system. Increased levels of angiotensin-2 secretion in the prostate in patients with benign prostatic hyperplasia may increase the effect of the virus directly on the cells of the organ. These mechanisms may explain the elevated serum prostatic specific antigen levels in patients with benign prostatic hyperplasia during the active period of COVID-19. Non-specific mechanism of prostate damage is connected with coagulopathy development – thrombosis of venous plexus and hemodynamic disturbances, which can cause secondary damage of parenchyma. There is a definite relationship between the hormonal status of the patient and the severity of the infection – low levels of both testosterone and dihydrotestosterone contribute to the development of severe complications in patients infected with SARS-CoV-2. The possibility of using testosterone drugs in patients with hypogonadism and COVID-19 as an alternative treatment option – to suppress the cytokine storm phenomenon – is being considered. Patients with a history of prostate cancer, with localized prostate cancer in the absence of metastases participated in vaccine studies – among the side effects of vaccination in several cases only regional lymphadenopathy on the injection side of the drug was noted.

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The authors declare that there are no conflicts of interest present.