Sex-Biased Regulation of Extracellular Matrix Genes in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) often develops at an earlier age in women than in men, with worse respiratory symptoms despite lower smoking exposure. However, most preventive and therapeutic strategies ignore biological sex differences in COPD. Our goal was to better understand sex-specific gene regulatory processes in lung tissue and the molecular basis for sex differences in COPD onset and severity. We analyzed lung tissue gene expression and DNA methylation data from 747 individuals in the Lung Tissue Research Consortium and 85 individuals in an independent dataset. We identified sex differences in COPD-associated gene regulation using gene regulatory networks. We used linear regression to test for sex-biased associations of methylation with lung function, emphysema, smoking, and age. Analyzing gene regulatory networks in the control group, we identified that genes involved in the extracellular matrix (ECM) have higher transcriptional factor targeting in female subjects than in male subjects. However, this pattern is reversed in COPD, with men showing stronger regulatory targeting of ECM-related genes than women. Smoking exposure, age, lung function, and emphysema were all associated with sex-specific differential methylation of ECM-related genes. We identified sex-based gene regulatory patterns of ECM-related genes associated with lung function and emphysema. Multiple factors, including epigenetics, smoking, aging, and cell heterogeneity, influence sex-specific gene regulation in COPD. Our findings underscore the importance of considering sex as a key factor in disease susceptibility and severity.