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29/04/2026 - Press release

Study shows that COPD mechanisms differ according to biological sex

• Evidence indicates that Chronic Obstructive Pulmonary Disease (COPD) manifests clinically in different ways in men and women. According to a collaborative study led by the Hospital del Mar Research Institute, the possible cause is that the mechanisms of this disease differ according to the patient’s sex
• Several metabolites present in the blood differ between the two groups, which implies that the disease has different mechanisms depending on biological sex
• This finding also identifies potential therapeutic targets for addressing personalised treatment according to the patient’s sex

Chronic Obstructive Pulmonary Disease, COPD, affects patients differently depending on their biological sex. It is a condition that causes more symptoms and a faster deterioration of lung capacity in women, even when they have consumed the same amount of tobacco. Despite this, it is not that baseline differences between sexes cause the disease to affect them differently, but rather that it is COPD itself that causes the body’s response to differ depending on whether the patients are men or women. This advance may make it possible to obtain new biomarkers on the progression of these patients and possible personalised treatments focused on these therapeutic targets. This is highlighted by a study published in the journal Metabolites, led by the Hospital del Mar Research Institute (HMRIB), with the collaboration of researchers from the CIBER Respiratory Diseases area (CIBERES) and several hospitals in Spain and international research centres.

To reach this conclusion, blood samples from 88 people with COPD, 46 men and 42 women, were analysed, and the results obtained were compared with those from 64 people of both sexes without the disease. Altered metabolites were identified using mass spectrometry tools, in order to determine differences between the two groups and by biological sex. In this way, it was found that there were nine altered metabolites, with lower expression, in the patient group compared with the control group. A further six were altered according to biological sex among patients with COPD.

"We have found plasma markers that indicate which metabolic pathways are most altered in patients with COPD depending on their biological sex, compared with control subjects", explains Dr Joaquim Gea, coordinator of the Myogenesis, Inflammation and Muscle Function Research Group at the Hospital del Mar Research Institute and CIBERES, and emeritus head of the Pneumology Department at Hospital del Mar. These markers indicate that "the mechanisms that cause the disease are not the same if we take the variable of biological sex into account", notes the study’s principal investigator, who also states that "this makes it possible to identify differently affected mechanisms, suggesting new differentiated therapeutic targets".

Differently affected aspects

The altered markers in women are mainly related to lipid metabolism, inflammation and oxidative stress, aspects linked to the activity of female hormones. They are also related to the gut microbiota, revealing an altered interaction between the bacteria present in the intestines and the biology of the patient’s body. "It is clear that the gut microbiota of women with COPD interacts much more strongly with their metabolism, causing reactions in their body", explains Gea.

In men, the altered metabolites are different. They show alterations in factors linked to the body’s energy generation and in muscle metabolism.

The researchers point out that these results open the door to personalising diagnosis and treatment in patients with COPD, both in terms of symptoms and in acting on the mechanisms of the disease. "Future treatments will have to be developed on the basis of differentiated therapeutic targets according to the patient’s biological sex", concludes Dr Gea, adding that "we now need to analyse whether these differences can be modulated through the potential therapeutic targets we have identified".

Reference article

Casadevall, C.; Enríquez-Rodríguez, C.J.; Eliassaf, A.; Castro-Acosta, A.; Faner, R.; López-Campos, J.L.; Monsó, E.; Pascual-Guàrdia, S.; Camps-Ubach, R.; Cosío, B.G.; et al. Sex-Specific Plasma Metabolomic Signatures in COPD Reveal Creatine, Purine/Urate, and Bile-Acid Axes. Metabolites 2026, 16, 178. https://doi.org/10.3390/metabo16030178

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