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-ĸB 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.

中文翻译：

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COVID-19：非洲悖论的机制模型支持 NF-κB 通路的核心作用

新型严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 已扩大为全球大流行，截至 2021 年 9 月 8 日，受影响人数超过 2.2 亿，近 460 万人死亡。尤其是欧洲和美洲受到严重影响高感染率和死亡率。相比之下，非洲的感染率和死亡率普遍要低得多，特别是撒哈拉以南地区（南部非洲地区除外）。对于这一非洲悖论有不同的假设，包括检测较少、人口年轻化、遗传倾向以及行为和流行病学因素。在本综述中，我们讨论了不同的免疫因素及其与遗传因素、预先存在的免疫状态以及细胞因子诱导模式差异的相关性。我们还关注流行病学因素，例如撒哈拉以南地区的特定药物覆盖范围、蠕虫分布和疟疾流行情况。结合不同因素的分析强调了 NF-ĸB 信号通路在非洲悖论中的核心作用。重要的是，深入了解不同因素与 COVID-19 潜在免疫病理机制之间的相互作用，可以更好地了解该疾病，并制定更有效治疗策略的新靶点。