Early transcriptional signature in chikungunya predicts chronic arthralgia and reveals deficient antiviral response

ObjectiveLong-term sequelae following viral infections, such as Chikungunya and SARS-CoV-2, are associated with persistent symptoms, with a notably higher prevalence in women. This study investigated the early determinants of progression to chronic chikungunya (CC) and examined the specific role of biological sex on disease outcomes. MethodsWe analysed peripheral blood mononuclear cells (PBMCs) sampled within seven days of disease onset, recruited between 2016 and 2020. The study compared patients who eventually recovered (RC, n = 11) with those who progressed to develop CC (n = 24). We analysed gene signatures through transcriptomics and validated the results using qRT-PCR and flow cytometry ResultsTen genes were differentially expressed between the cohorts. Specifically, the study identified an upregulation of IKZF2 (encoding Helios) in CC patients, which was confirmed by qRT-PCR. Conversely, ACKR3 (encoding a CXCL12 scavenger in the ACKR3/CXCR4/CXCL12 axis) was upregulated in RC patients and validated by flow cytometry. Furthermore, CC cases demonstrated higher viral loads and downregulation of IFN- and IFN-{gamma} pathways. We also found that immune profiles differed between men and women; specifically, interferon /{gamma} and TNF signalling pathways were upregulated in women with CC but downregulated in men with CC relative to recovered individuals. DiscussionImmune profiles differed significantly between men and women within both the CC and RC groups. These findings suggest that progression to chronic disease is influenced by an impaired early antiviral response combined with sex-specific immune regulation. Furthermore, ACKR3 and IKZF2 are identified as potential prognostic biomarkers for chronic chikungunya.