Insights on Mpox virus infection immunopathogenesis

Abstract

An immunocompromised status has been associated with more odds of being infected with Mpox virus (MPXV) and progressing to severe disease. This aligns with the importance of immune competence for MPXV control and clearance. We and others have previously reviewed parallels between MPXV and other viruses belonging to the Poxviridae in affecting the immune system. This article reviews studies providing direct evidence of the MPXV-immune interactions. The wideranging effects of MPXV on the immune system, from stimulation to modulation to memory, are broadly categorised, followed by a detailing of these effects on the immune cells and molecules, including natural killer cells, macrophages, neutrophils, lymphocytes, cytokines, interferons, chemokines, and complement. K E Y W O R D Simmune system, Mpox virus, MPXV | INTRODUCTIONAfter about 80 years of its presence in endemic regions, the Mpox virus (MPXV) will be a cause of the outbreak in non-endemic regions in 2022. 1 From May 2022, when the MPXV outbreak occurred, until 23 December 2022, when writing this piece, more than 83,000 cases have been reported to the CDC, with 72 deaths corresponding to the death rate of about 0.09%. 2 However, since 1970 when MPXV first occurred in humans, the cumulative death rate has been calculated at about 11%. Also, mortality remains higher in Africa; according to the last weekly report of the World Health Organization (WHO), the case fatality rate (CFR) of MPXV was estimated at about 2% for the week of 29 August-4 September 2022, in multiple African countries. 3 Totally, high MPXV transmission, despite its globally low mortality rate in the 2022 outbreak, has warned researchers and practitioners that it is time for implementation, while they had just begun learning lessons on the coronavirus disease (COVID-19) pandemic.As expected, 2022 has subsequently witnessed a surge in MPXV literature. Because it takes late for original research to be planned, conducted, and released, many efforts took place to review the current knowledge of MPX-related features in history, epidemiology, and clinical infection, as reviewed elsewhere. 4,5 They led to important messages. MPXV, previously isolated in endemic regions, is of two clades: clade I, Central African, also known as Congo Basin; clade II, West African, which, in turn, has two clades: IIa and IIb. Clade I is endemic in the Democratic Republic of the Congo (DRC) and South Sudan, with a fatality rate of about 11%. MPXV we today are experiencing is of the West African clade IIb. This clade is endemic in Nigeria and associated with a CFR of about 4%. However, compared to previous times, 2022 0 MPXV has been different in its presentation.Meta-analysis confirms this changing epidemiology that between

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