The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has expanded into a global pandemic, with more than 220 million affected persons and almost 4.6 million deaths by 8 September 2021. In particular, Europe and the Americas have been heavily affected by high infection and death rates. In contrast, much lower infection rates and mortality have been reported generally in Africa, particularly in the sub-Saharan region (with the exception of the Southern Africa region). There are different hypotheses for this African paradox, including less testing, the young age of the population, genetic disposition, and behavioral and epidemiological factors. In the present review, we address different immunological factors and their correlation with genetic factors, pre-existing immune status, and differences in cytokine induction patterns. We also focus on epidemiological factors, such as specific medication coverage, helminth distribution, and malaria endemics in the sub-Saharan region. An analysis combining different factors is presented that highlights the central role of the NF-κB signaling pathway in the African paradox. Importantly, insights into the interplay of different factors with the underlying immune pathological mechanisms for COVID-19 can provide a better understanding of the disease and the development of new targets for more efficient treatment strategies.
【저자키워드】 COVID-19, SARS-CoV-2, Cytokine storm, chemokine, NF-κB, African paradox, Duffy antigen receptor for chemokines (DARC), malaria incidence, helminth infection, macrophage polarization, 【초록키워드】 coronavirus, Europe, Mortality, Genetic, Infection, cytokine, immune, malaria, global pandemic, Coverage, African, Factors, death, pathway, target, age, epidemiological, infection rate, respiratory, correlation, medication, distribution, Immune status, Analysis, genetic factors, focus, death rates, acute respiratory syndrome, Factor, Treatment strategies, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, America, Americas, NF-κB signaling, immunological, pathological mechanism, highlight, affected, reported, the disease, less, hypothese, much lower, endemics, induction patterns, 【제목키워드】 African, Model, NF-κB, paradox, role,