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In a second phase, results were combined with an independent Spanish cohort (1598 COVID-19 cases and 1068 population controls), revealing in the overall analysis two novel risk loci in 9p13.3 and 19q13.12, with fine-mapping prioritized variants functionally associated with AQP3 (P = 2.7 × 10) and ARHGAP33 (P = 1.3 × 10), respectively. The meta-analysis of both phases with four European studies stratified by sex from the Host Genetics Initiative (HGI) confirmed the association of the 3p21.31 and 21q22.11 loci predominantly in males and replicated a recently reported variant in 11p13 (ELF5, P = 4.1 × 10). Six of the COVID-19 HGI discovered loci were replicated and an HGI-based genetic risk score predicted the severity strata in SCOURGE. We also found more SNP-heritability and larger heritability differences by age (<60 or ≥60 years) among males than among females. Parallel genome-wide screening of inbreeding depression in SCOURGE also showed an effect of homozygosity in COVID-19 hospitalization and severity and this effect was stronger among older males. In summary, new candidate genes for COVID-19 severity and evidence supporting genetic disparities among sexes are provided. 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Abstract: Here, we describe the results of a genome-wide study conducted in 11 939 coronavirus disease 2019 (COVID-19) positive cases with an extensive clinical information that were recruited from 34 hospitals across Spain (SCOURGE consortium). In sex-disaggregated genome-wide association studies for COVID-19 hospitalization, genome-wide significance (P < 5 × 10) was crossed for variants in 3p21.31 and 21q22.11 loci only among males (P = 1.3 × 10 and P = 8.1 × 10, respectively), and for variants in 9q21.32 near TLE1 only among females (P = 4.4 × 10). In a second phase, results were combined with an independent Spanish cohort (1598 COVID-19 cases and 1068 population controls), revealing in the overall analysis two novel risk loci in 9p13.3 and 19q13.12, with fine-mapping prioritized variants functionally associated with AQP3 (P = 2.7 × 10) and ARHGAP33 (P = 1.3 × 10), respectively. The meta-analysis of both phases with four European studies stratified by sex from the Host Genetics Initiative (HGI) confirmed the association of the 3p21.31 and 21q22.11 loci predominantly in males and replicated a recently reported variant in 11p13 (ELF5, P = 4.1 × 10). Six of the COVID-19 HGI discovered loci were replicated and an HGI-based genetic risk score predicted the severity strata in SCOURGE. We also found more SNP-heritability and larger heritability differences by age (<60 or ≥60 years) among males than among females. Parallel genome-wide screening of inbreeding depression in SCOURGE also showed an effect of homozygosity in COVID-19 hospitalization and severity and this effect was stronger among older males. In summary, new candidate genes for COVID-19 severity and evidence supporting genetic disparities among sexes are provided. Keywords: Creator: LaTeX with hyperref package Producer: Acrobat Distiller 22.0 (Windows) CreationDate: Sat Oct 29 13:00:41 CEST 2022 ModDate: Sat Oct 29 13:00:41 CEST 2022 ID: 0xa8caaf2d3a686a711aa812e14acd8320, 0x98041d596f7949a518968512d2a34a47 Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 2000 ImageHeight: 2027 ColorSpace: black is zero BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 2100 ImageHeight: 419 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1000 ImageHeight: 2001 ColorSpace: black is zero BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 950 ImageHeight: 794 ColorSpace: black is zero BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1000 ImageHeight: 2134 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1500 ImageHeight: 1470 ColorSpace: black is zero BitsPerSample: 8 BitsPerSampleUnit: integer Fonts: Type1: Font: BaseFont: CPLKHN+CaeciliaLTStd-Bold FontSubset: true FirstChar: 45 LastChar: 122 FontDescriptor: FontName: CPLKHN+CaeciliaLTStd-Bold Flags: Serif, Symbolic, ForceBold FontBBox: -166, -273, 1141, 938 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPLKHO+CaeciliaLTStd-Roman FontSubset: true FirstChar: 40 LastChar: 250 FontDescriptor: FontName: CPLKHO+CaeciliaLTStd-Roman Flags: Serif, Symbolic FontBBox: -167, -270, 1136, 926 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPLKPM+CaeciliaLTStd-Italic FontSubset: true FirstChar: 44 LastChar: 117 FontDescriptor: FontName: CPLKPM+CaeciliaLTStd-Italic Flags: Serif, Symbolic, Italic FontBBox: -166, -270, 1053, 915 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPMADO+CaeciliaLTStd-Heavy FontSubset: true FirstChar: 46 LastChar: 124 FontDescriptor: FontName: CPMADO+CaeciliaLTStd-Heavy Flags: Serif, Symbolic, ForceBold FontBBox: -170, -277, 1146, 970 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPLLEL+CaeciliaLTStd-Light FontSubset: true FirstChar: 35 LastChar: 252 FontDescriptor: FontName: CPLLEL+CaeciliaLTStd-Light Flags: Serif, Symbolic FontBBox: -164, -266, 1130, 908 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPMAKM+MTSYN FontSubset: true FirstChar: 2 LastChar: 215 FontDescriptor: FontName: CPMAKM+MTSYN Flags: Symbolic FontBBox: 0, -954, 1043, 900 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPMCAF+MTMI FontSubset: true FirstChar: 2 LastChar: 62 FontDescriptor: FontName: CPMCAF+MTMI Flags: Serif, Symbolic, Italic FontBBox: 0, -213, 987, 680 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPMDCP+CaeciliaLTStd-BoldItalic FontSubset: true FirstChar: 78 LastChar: 80 FontDescriptor: FontName: CPMDCP+CaeciliaLTStd-BoldItalic Flags: Serif, Symbolic, Italic, ForceBold FontBBox: -169, -273, 1082, 932 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPMDDP+CaeciliaLTStd-LightItalic FontSubset: true FirstChar: 44 LastChar: 122 FontDescriptor: FontName: CPMDDP+CaeciliaLTStd-LightItalic Flags: Serif, Symbolic, Italic FontBBox: -166, -267, 1033, 909 FontFile3: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CPNBPG+BLEX FontSubset: true FirstChar: 2 LastChar: 5 FontDescriptor: FontName: CPNBPG+BLEX Flags: Symbolic FontBBox: 18, -1400, 1373, 46 FontFile3: true EncodingDictionary: Differences: true XMP: application/pdf Novel genes and sex differences in COVID-19 severity Cruz RaquelDiz-de Almeida SilviaLópez de Heredia MiguelQuintela InésCeballos Francisco C.Pita GuillermoLorenzo-Salazar José M.González-Montelongo RafaelaGago-Domínguez ManuelaSevilla Porras MartaTenorio Castaño Jair AntonioNevado JulianAguado Jose MaríaAguilar CarlosAguilera-Albesa SergioAlmadana VirginiaAlmoguera BertaAlvarez NuriaAndreu-Bernabeu ÁlvaroArana-Arri EunateArango CelsoArranz María J.Artiga Maria-JesusBaptista-Rosas Raúl C.Barreda-Sánchez MaríaBelhassen-Garcia MoncefBezerra Joao F.Bezerra Marcos A.C.Boix-Palop LucíaBrion MaríaBrugada RamónBustos MatildeCalderón Enrique J.Carbonell CristinaCastano LuisCastelao Jose E.Conde-Vicente RosaCordero-Lorenzana M. LourdesCortes-Sanchez Jose L.Corton MartaDarnaude M. TeresaDe Martino-Rodríguez Albadel Campo-Pérez VictorDiaz de Bustamante AranzazuDomínguez-Garrido ElenaLuchessi Andre D.Eiros RocíoEstigarribia Sanabria Gladys MercedesCarmen Fariñas MaríaFernández-Robelo UxíaFernández-Rodríguez AmandaFernández-Villa TaniaGil-Fournier BelénGómez-Arrue JavierGonzález Álvarez BeatrizGonzalez Bernaldo de Quirós FernanGonzález-Peñas JavierGutiérrez-Bautista Juan F.Herrero María JoséHerrero-Gonzalez AntonioJimenez-Sousa María A.Lattig María ClaudiaLiger Borja AnabelLopez-Rodriguez RosarioMancebo EstherMartín-López CaridadMartín VicenteMartinez-Nieto OscarMartinez-Lopez IciarMartinez-Resendez Michel F.Martinez-Perez AngelMazzeu Juliana F.Merayo Macías EleuterioMinguez PabloMoreno Cuerda VictorSilbiger Vivian N.Oliveira Silviene F.Ortega-Paino EvaParellada MaraPaz-Artal EstelaSantos Ney P.C.Pérez-Matute PatriciaPerez PatriciaPérez-Tomás M. ElenaPerucho TeresaPinsach-Abuin Mel LinaPompa-Mera Ericka N.Porras-Hurtado Gloria L.Pujol AuroraRamiro León SorayaResino SalvadorFernandes Marianne R.Rodríguez-Ruiz EmilioRodriguez-Artalejo FernandoRodriguez-Garcia José A.Ruiz Cabello FranciscoRuiz-Hornillos JavierRyan PabloSoria José ManuelSouto Juan CarlosTamayo EduardoTamayo-Velasco AlvaroTaracido-Fernandez Juan CarlosTeper AlejandroTorres-Tobar LilianUrioste MiguelValencia-Ramos JuanYáñez ZuleimaZarate RuthNakanishi TomokoPigazzini SaraDegenhardt FraukeButler-Laporte GuillaumeMaya-Miles DouglasBujanda LuisBouysran YoussefPalom AdrianaEllinghaus DavidMartínez-Bueno ManuelRolker SelinaAmitrano SaraRoade LuisaFava FrancescaSpinner Christoph D.Prati DanieleBernardo DavidGarcia FedericoDarcis GillesFernández-Cadenas IsraelHolter Jan CatoBanales Jesus M.Frithiof RobertDuga StefanoAsselta RosannaPereira Alexandre C.Romero-Gómez ManuelNafría-Jiménez BeatrizHov Johannes R.Migeotte IsabelleRenieri AlessandraPlanas Anna M.Ludwig Kerstin U.Buti MariaRahmouni SouadAlarcón-Riquelme Marta E.Schulte Eva C.Franke AndreKarlsen Tom H.Valenti LucaZeberg HugoRichards BrentGanna AndreaBoada Mercède Rojas ItziarRuiz AgustínSánchez-Juan PascualReal Luis MiguelCohort Group SCOURGECohort Group HOSTAGECohort Group GRA@CEGuillen-Navarro EncarnaAyuso CarmenGonzález-Neira AnnaRiancho José A.Rojas-Martinez AugustoFlores CarlosLapunzina PabloCarracedo Angel AcademicSubjects/SCI01140, DOI: 10.1093/hmg/ddac132, Human Molecular Genetics, 31, 22, 16 06 2022. Abstract: Here, we describe the results of a genome-wide study conducted in 11 939 coronavirus disease 2019 (COVID-19) positive cases with an extensive clinical information that were recruited from 34 hospitals across Spain (SCOURGE consortium). In sex-disaggregated genome-wide association studies for COVID-19 hospitalization, genome-wide significance (P < 5 × 10) was crossed for variants in 3p21.31 and 21q22.11 loci only among males (P = 1.3 × 10 and P = 8.1 × 10, respectively), and for variants in 9q21.32 near TLE1 only among females (P = 4.4 × 10). In a second phase, results were combined with an independent Spanish cohort (1598 COVID-19 cases and 1068 population controls), revealing in the overall analysis two novel risk loci in 9p13.3 and 19q13.12, with fine-mapping prioritized variants functionally associated with AQP3 (P = 2.7 × 10) and ARHGAP33 (P = 1.3 × 10), respectively. The meta-analysis of both phases with four European studies stratified by sex from the Host Genetics Initiative (HGI) confirmed the association of the 3p21.31 and 21q22.11 loci predominantly in males and replicated a recently reported variant in 11p13 (ELF5, P = 4.1 × 10). Six of the COVID-19 HGI discovered loci were replicated and an HGI-based genetic risk score predicted the severity strata in SCOURGE. We also found more SNP-heritability and larger heritability differences by age (<60 or ≥60 years) among males than among females. Parallel genome-wide screening of inbreeding depression in SCOURGE also showed an effect of homozygosity in COVID-19 hospitalization and severity and this effect was stronger among older males. In summary, new candidate genes for COVID-19 severity and evidence supporting genetic disparities among sexes are provided. © The Author(s) 2022. Published by Oxford University Press. 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