Tuberculosis

Purpose: Central nervous system tuberculosis (CNS TB) presenting with vasculitis or arachnoiditis causes significant morbidity and mortality. The purpose of this study was to characterise the clinical spectrum and outcomes of patients diagnosed with TB arachnoiditis and TB-associated CNS vasculitis Methods A retrospective study was conducted between October 2020 and September 2023, screening patients admitted with suspected CNS TB to a tertiary care hospital. Patients diagnosed with proliferative arachnoiditis, and TB-associated CNS vasculitis were recruited. Their clinical details, follow-up records, and outcomes were assessed. Results Among 318 patients admitted with suspected CNS TB, 87 patients had complications, with follow-up data available for 69 patients. Vasculitis, spinal arachnoiditis (SA), and optochiasmatic arachnoiditis (OCA) was diagnosed in 66 (76%), 41 (47%), and 26 (30%) patients respectively. Median duration of follow-up was 490 days. Median mRS at discharge was 4. 18 (69%) OCA patients and 14 (35%) SA patients received pulse methylprednisolone. Intrathecal hyaluronidase was administered in 14 patients and thalidomide was given to 9 patients. 30 (46%) patients with vasculitis were treated with aspirin. 69 patients completed follow-up, 49% died. Among the remaining, 88.6% had improvement with treatment with a median mRS of 2 (1-3). Among patients with OCA, 3(23.1%) showed complete improvement with a median improvement of 3 points on Likert scale. In the SA patients, 19 (55.9%, 34) patients were alive on follow-up, with a median mRS of 1. Aspirin use was not associated with better mRS or survival in patients with vasculitis. A multivariable Cox proportional model showed age at diagnosis to be the only predictor of mortality (HR 1.04, 95% CI (1.01- 1.08), p =0.012). Conclusions TB arachnoiditis and CNS vasculitis are severe complications of CNS TB, and management remains a challenge. The poor therapeutic response to intrathecal hyaluronidase, thalidomide, and aspirin highlights need for further larger prospective trials and search for alternative agents.

Recognition of infected macrophages by CD4+ T cells is essential to immune protection against Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis (TB). However, not all infected macrophage subsets successfully elicit T cell activation. We recently discovered that M2-like macrophages fail to efficiently activate memory CD4+ T cells when infected with Mtb, yet successfully elicit T cell activation when loaded with peptides, {gamma}-irradiated bacteria, or Mtb whole cell lysate. Since the mechanisms underlying CD4+ T cell evasion by infected M2 but not M1-like macrophages remain underexplored, we sought to determine the genes and pathways unique to Mtb infection of M2-like cells, including alveolar macrophages. RNA sequencing of human macrophages infected with virulent Mtb identified enrichment of IL-10 and type I interferon (IFN) signaling genes, including IL10RA and HERC5, respectively, in infected M2-like monocyte-derived and alveolar macrophages. However, genes involved in MHC-II trafficking, such as AP1M2, were higher in infected M1-like macrophages. In complementary experiments using fluorescence microscopy and flow cytometry, we observed impaired trafficking of newly synthesized MHC-II to the plasma membrane of Mtb-infected M2-like macrophages despite high total surface MHC-II levels. Neutralization of IL-10 or knockdown of HERC5 restored MHC-II trafficking to the cell surface among infected M2-like macrophages and significantly enhanced activation of memory CD4+ T cells in an MHC-II-dependent manner. These findings identify coordinated IL-10 and type I IFN signaling as key mechanisms that restrict MHC-II trafficking to the plasma membrane in Mtb-infected M2-like macrophages, thereby limiting antigen presentation and CD4+ T cell activation. We propose that host-directed therapies targeting these pathways in infected alveolar macrophages will facilitate T cell recognition for the prevention or treatment of active TB. Author SummaryRecognition of infected macrophages by CD4+ T cells is essential to immune protection against Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis (TB). However, not all infected macrophage subsets successfully elicit T cell activation. We recently discovered that M2-like macrophages fail to efficiently activate memory CD4+ T cells when infected with Mtb, yet they successfully elicit T cell activation when treated with peptides, {gamma}-irradiated bacteria, or Mtb whole cell lysate. In this study, we identified genes and pathways uniquely upregulated in Mtb-infected M2-like macrophages that are linked to inefficient CD4+ T cell activation, including IL-10 signaling and type I interferon (IFN) pathways. These pathways were linked to reduced MHC-II trafficking to the plasma membrane in Mtb-infected M2-like macrophages. Neutralization of IL-10 or knockdown of HERC5 restored MHC-II trafficking and augmented memory CD4+ T cell activation. Our study demonstrates that IL-10 signaling and type I IFN pathways play detrimental roles in macrophages during Mtb infection, impairing MHC-II trafficking and CD4+ T cell activation. Since lung-resident alveolar macrophages express a dominant M2-like phenotype, these findings suggest that targeting IL-10 and type I IFN signaling may offer a strategy to enhance CD4+ T cell-mediated immunity and improve TB outcomes.

Tuberculosis (TB) has been a leading cause of death from a single infectious agent for decades. Bacille Calmette-Guerin (BCG) remains both the primary TB vaccine strategy and the oldest vaccine in circulation, with severe limitations in adult populations. Recently, live attenuated vaccine strategies, or generating safe strains of Mycobacterium tuberculosis (Mtb) through genetic engineering, have shown considerable promise. We previously developed an attenuated strain of Mtb lacking the nucleoid-associated protein Lsr2 ({Delta}lsr2) which is also phthiocerol dimycocerosates (PDIM) deficient and induces an immune response that represents an intermediate stage between the parental Mtb strain and BCG. In this study we examined the immune response of {Delta}lsr2 vaccinated mice in comparison to BCG and found a substantially stronger CD4 and CD8 T cell responses from {Delta}lsr2 vaccinated mice. Complementary, we conducted Mtb protection studies in {Delta}lsr2 and BCG vaccinated mice and guinea pigs, where we found that {Delta}lsr2 provided superior protection in both animals. This improved protection is shown with reduced bacterial burden and improved organ pathology in the lungs and spleen. Taken together, our work shows {Delta}lsr2 serves as a promising vaccine candidate for continued preclinical development.

Contagious bovine pleuropneumonia (CBPP), caused by Mycoplasma mycoides subsp. mycoides (Mmm), remains a major burden to cattle health and the agricultural industry. Mmm is an atypical bacterial pathogen that appears to lack classical virulence factors that cause direct tissue injury (i.e. toxins), and little is known about the mechanisms driving its pathogenicity. The host immune response is believed to be implicated in CBPP pathology, though the molecular mechanisms underlying lesion initiation, progression and chronicity are poorly defined. Classical pathology describes a continuum of lung lesions starting from early inflammation to more mature necrotic lesions and formation of fibrotic sequestra. However, the host transcriptional response driving this potentially immunopathological progression during Mmm infection has never been resolved in vivo. Here, we performed lesion-stage-resolved transcriptomic profiling of pathological lung tissue collected from experimentally infected animals and compared to healthy lung tissue collected from unchallenged controls. Differential gene expression and functional enrichment analyses were used to identify biological pathways relevant to Mmm infection and pathological lesion formation. Early infection was dominated by interferon-stimulated genes and cytokine-responsive pathways, creating a primarily antiviral-like response environment despite the bacterial etiology. Red hepatization showed strong induction of neutrophil chemoattractants, epithelial remodeling markers, and early matrix-remodeling enzymes. Consolidation, spanning red and grey stages, was enriched for innate immune activation, leukocyte adhesion, extracellular matrix organization, and persistent interferon signaling. Grey hepatization reflected late-stage consolidation with heightened neutrophil effector activity, oxidative and proteolytic injury, and macrophage and fibroblast-linked collagen processing. Necrosis/Sequestra lesions showed reduced inflammatory signaling, robust extracellular matrix organization, adhesion, and morphogenetic pathways consistent with encapsulation and sequestrum formation. Our data indicate that the dynamic continuum of CBPP lung pathology is initiated by interferon-primed myeloid recruitment and amplified by neutrophil-driven injury and macrophage- and fibroblast-mediated matrix remodeling. These data further substantiate the role of dysregulated immunity in the development of disease during Mmm infection.

Infection by Mycobacterium tuberculosis (Mtb) is characterized by pathogen persistence in lung cells derived from blood monocytes. Since monocyte-derived lung subsets differ in their ability to restrict the growth of intracellular Mtb in mice, understanding the ontogeny of these subsets can inform development of host-directed therapies. Circulating monocytes are proposed to be heterogeneous, arising from distinct bone marrow or spleen progenitors that direct local differentiation. However, the role of the Mtb-infected lung environment in this process has not been addressed. We found that infected and uninfected mice had similar bone marrow monopoiesis, resulting in equivalent monocyte differentiation within the infected lung. While pulmonary Mtb infection also induced splenic monopoiesis, we found no impact on lung monocyte differentiation in splenectomized mice. However, when wildtype monocytes were transferred into Mtb-infected Sp140-/- recipients, in which excess Type I interferons and neutrophils alter the lung environment, we observed that donor-derived lung subsets resembled recipient-derived cells. In the lungs of Mtb-infected mice, we identified monocyte-derived lung subsets with unique gene expression, associated with specific spatial distributions and cell neighborhoods. These findings suggest that the local lung environment has a larger influence on the phenotypic diversity of monocyte-derived lung cells than does the peripheral environment.

Naturally occurring variation in the bovine mannose receptor C-type 1 gene (MRC1) may shape macrophage responses to Mycobacterium (M.) bovis, a key driver of bovine tuberculosis (bTB). We identified four coding region SNPs in MRC1 across Bos taurus (Holstein Friesian, Brown Swiss) and Bos indicus (Boran, Sahiwal) cattle breeds, including a non-synonymous variant, rs380943118 (c.2963G>A; Ser988Asn) in C-type lectin-like domain (CTLD) 6, most prevalent in Sahiwal cattle. Structural modelling suggested that the S988N substitution, which is spatially separated from the monosaccharide binding site of CTLD4, might indirectly affect glycan binding, perhaps through a conformational change in the receptor. Monocyte-derived macrophages upregulated MR expression during differentiation, with heterozygous (G/A) animals showing higher MR expression and increased uptake of GFP-M. bovis BCG, although differences were not statistically significant. Anti-CD206 blockade did not inhibit BCG internalization, either indicating that this specific antibody did not bind to a CTLD involved in ligand binding or that MR is not the sole entry receptor. These results highlight naturally occurring MRC1 polymorphisms that may influence MR structure and macrophage function, providing a foundation for future studies to assess their role in bTB susceptibility.

Lipoarabinomannan (LAM) is a useful biomarker for detection of M. tuberculosis infection and disease. Related antigens can be detected in urine samples of TB patients by combinations of monoclonal antibodies (mAbs) directed against specific epitopes expressed in LAM. While sensitive for samples from patients with active TB disease who have HIV-1 co-infections, these assays are less effective for other populations, and there is therefore a need for more sensitive antibodies that can improve the sensitivity of these assays. Here we characterize the antigen and epitope specificities, sequence diversity and isotype dependencies of eight LAM-specific human mAbs that target five distinct arabinose- and mannose-dependent epitopes present in LAM and lipoarabinomannan (LM). Whereas all of the mAbs recognized ManLAM, only a few, including A194-01, consistently detected antigens in TB+ urine samples. Converting A194-01 from the IgG1 to the IgM isotype resulted in broader recognition of poly-Ara glycan epitopes, and increased sensitivity for clinical antigens when combined with several capture reagents, including RU95-C1, a novel antibody targeting the mannan domain of LAM. These results define novel epitopes that are differentially expressed in bacterial and urinary forms of LAM, and identify novel antibody combinations which possess enhanced diagnostic utility for clinical forms of LAM.

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a significant public health threat in low- and middle-income countries, including Cameroon. This systematic review and meta-analysis aimed to determine the pooled prevalence of MDR-TB and other specific anti-tuberculosis drug resistance patterns, as well as to identify factors associated with drug-resistant tuberculosis in Cameroon. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Embase, Cochrane Library, and African Journals Online. Additional studies were identified through Google Scholar and reference list screening. Observational studies (cross-sectional, cohort, and case-control) reporting drug resistance among bacteriologically confirmed tuberculosis patients in Cameroon were eligible. Joanna Briggs Institute critical appraisal tools were used to critically assessed the study quality. Pooled prevalence estimates were calculated using random-effects meta-analysis. Subgroup analyses and meta-regression explored sources of heterogeneity. A p-value 0.05 was considered statistically significant. Results: Twenty-eight studies conducted between 1995 and 2022 were included. The pooled prevalence of MDR-TB was 5.2% (95% CI: 2.7-9.6; 21 studies; n = 7,515), with significantly higher acquired resistance (11.6%; 95% CI: 6.3-20.3) than initial resistance (2.0%; 95% CI: 1.1-3.5). The highest pooled MDR-TB prevalence was observed in the most recent studies (38.8%; 95% CI: 33.7-44.2), and the lowest in 2015-2019 (2.7%; 95% CI: 0.4-15.2). Any resistance to anti-tuberculosis drugs was 16.0% (95% CI: 10.3-23.9; 28 studies; n = 9,931), and rifampicin resistance was 4.6% (95% CI: 2.4-8.6; 25 studies; n = 8,728). Monoresistance was highest for streptomycin (6.4%; 95% CI: 3.7-10.8) and isoniazid (4.7%; 95% CI: 3.0-7.4). Previous tuberculosis infection was the strongest predictor of drug resistance (OR = 3.9; 95% CI: 1.8-8.4), followed by alcohol consumption (OR = 1.8; 95% CI: 1.2-2.7) and history of incarceration (OR = 1.7; 95% CI: 1.1-2.6). High heterogeneity was observed across most of the pooled estimates. Conclusions: Drug-resistant tuberculosis, particularly MDR-TB, poses a substantial burden in Cameroon, with acquired resistance significantly exceeding initial resistance. Previous tuberculosis infection, alcohol use, and incarceration are key modifiable risk factors. These findings underscore the urgent need to strengthen routine drug susceptibility testing, scale up rapid molecular diagnostics, enhance treatment adherence strategies, and implement targeted interventions for high-risk populations.

Background: Access to accurate tuberculosis (TB) diagnostics remains limited, particularly in high-burden settings. The Pluslife MTB assay is among the first molecular tests specifically designed for swab-based detection of Mycobacterium tuberculosis complex (MTBC) and offers near point-of-care use. Methods: We conducted a prospective diagnostic accuracy study in South Africa to evaluate the performance of the Pluslife assay on tongue swabs (TSs) and sputum swabs (SSs) among symptomatic and asymptomatic adults. Results were compared against liquid culture as the reference standard and Xpert MTB/RIF Ultra (Xpert Ultra) as a comparator. Operational characteristics and ease-of-use were assessed through structured observation and Likert-scale scoring by testing personnel. Results: Of 256 participants enrolled, 92 [36%] were people with HIV (PHIV) and 217 were included in the final analysis. Culture confirmed TB in 41/217 (19%). The Pluslife assay demonstrated sensitivity of 85% (95% CI: 70.8-94.4) on SSs, comparable to Xpert Ultra on sputum (83%, 95% CI: 67.9-92.8), and detected one additional case missed by Xpert Ultra. Sensitivity on TSs was lower (63%, 95% CI: 46.9-77.9), particularly among PHIV. Specificity exceeded 97% across specimen types. Concordance on TSs between Pluslife and Xpert Ultra increased with higher bacterial loads. Operational evaluation showed short hands-on time and high ease-of-use scores, though limitations were noted for patient identifier recording and troubleshooting on the Pluslife MiniDock device. Conclusions: The Pluslife MTB assay on SSs shows comparable performance to existing rapid diagnostics and favorable usability. Tongue swabs remain feasible but less reliable, supporting sputum as the preferred first specimen for TB diagnosis.

Males incur greater risk of tuberculosis (TB) than females, but the contribution of sex-associated immune differences remains unclear. We addressed this using sex-stratified transcriptomic analyses across four independent studies spanning active pulmonary TB, subclinical TB and latent infection, in peripheral blood, bronchoalveolar lavage (BAL) and by using the tuberculin skin test (TST) as a standardised in vivo antigenic challenge. In blood of active TB patients, expression of TNF- and type I interferon-regulated signatures, genome-wide gene expression, and performance of leading host-response biomarkers of TB were comparable between sexes. Similarly, blood transcriptomic biomarkers showed no meaningful sex-related differences for predicting asymptomatic or incident TB. In the TST of people with latent infection, bulk and single-cell RNA sequencing identified only limited differences, largely restricted to sex chromosome-linked transcripts, with no consistent evidence of dimorphism in immune-regulated pathways. Single-cell RNA sequencing of BAL samples identified reduced abundance of B cells in male TB patients, with gene expression differences again largely restricted to sex chromosome-linked transcripts. These findings suggest that canonical immune responses associated with TB are broadly similar between the sexes, and that increased TB risk among males more likely reflects differential exposure rather than intrinsic immunological susceptibility.

Tongue swabs (TSs) are a non invasive specimen type for the detection of Mycobacterium tuberculosis complex (MTBC) and can expand access to testing for individuals unable to produce sputum. This study evaluated the diagnostic performance and user acceptability of self collected and health worker (HW) collected tongue swabs using the Xpert MTB/RIF Ultra (Ultra) assay and assessed participant perspectives on self collection. In this prospective, cross sectional study, symptomatic and asymptomatic adults under investigation for TB were enrolled from a high HIV prevalence setting. Each participant provided both a self collected and a HW collected TS, which were tested using Ultra. Ultra TS results were compared to liquid culture as the reference standard and sputum Ultra as a comparator. Participant perspectives on self collection were captured via questionnaires. Sensitivity on Ultra for both self and HW collected TSs was 68% (95% CI:51.9 to 81.9), compared to liquid culture. This sensitivity was significantly higher than that of sputum smear microscopy (46%, 95% CI: 30.7 to 62.6; McNemar's p = 0.003). Tongue swab sensitivity was lower than sputum Ultra (80.5%; p<0.001) and decreased with low bacillary loads. Importantly, TSs enabled MTBC detection in six participants unable to produce sputum. Most participants (>90%) found self collection instructions easy to follow, reporting high confidence and comfort, and trust in results from self collected TSs. This study demonstrates that self collected TSs perform comparably to those collected by health workers for TB detection using Ultra and are both feasible and acceptable in a high TB/HIV burden setting. To maximize impact, clear training instructions and robust linkage to care remain critical priorities.

Tuberculosis (TB) remains a leading global cause of infectious mortality due, in part, to the limited efficacy of the Mycobacterium bovis BCG vaccine against pulmonary TB. Previous studies in mice have shown that stimulating type I interferon (IFN) signaling during BCG vaccination can bolster protection against Mycobacterium tuberculosis, yet clinically feasible delivery strategies for this approach are lacking. Adenoviral vectors, which induce potent type I IFN responses and are utilized in approved vaccine platforms, represent a promising adjuvant strategy. To evaluate the host immune response to this combination, bone marrow-derived murine macrophages were co-infected with replication-deficient adenovirus and BCG. Adenovirus-infected macrophages elicited a robust type I IFN response via the cGAS/STING pathway. Compared to BCG infection alone, co-infected macrophages exhibited additive expression of genes with known host-protective roles against M. tuberculosis. Conversely, co-infection with BCG suppressed adenovirus-induced type I IFN signaling and diminished the production of IFN-stimulated genes compared to adenovirus infection alone. Together, these findings reveal a complex regulatory interplay during adenovirus and BCG co-infection. While BCG partially restricts adenoviral IFN induction, the co-infection still drives an enhanced host-protective gene profile, suggesting that adenoviral vectors could serve as a viable platform to modulate innate immunity and improve BCG vaccine efficacy. IMPORTANCETuberculosis (TB) remains the leading cause of death by a single infectious organism with approximately 1.25 million deaths annually. M. bovis BCG remains the only approved vaccine for TB; however, its efficacy against the contagious and most common pulmonary form of the disease is limited. There have been numerous attempts to improve BCG efficacy, but these approaches have not resulted in any clinically approved vaccine. We propose that BCG combined with a replication-deficient adenovirus presents a way to bolster vaccine-conferred protection as the combination may elicit a robust innate immune response and drive a more protective T cell response. Moreover, BCG and replication-deficient adenoviruses have well-assessed safety profiles and decades of studies regarding their use in patients. The significance of our work is in leveraging their complementary immunology to function as a combined vaccine platform. This approach presents a novel and clinically feasible approach to improve the BCG vaccine.

Macrolides are key agents for treating infections caused by non-tuberculous mycobacteria (NTM). Nevertheless, chromosomal erm genes conferring inducible macrolide resistance are described in some NTM species, such as Mycobacterium abscessus and M. fortuitum, whereas M. chelonae had long been considered as lacking a functional erm. Recent descriptions from the USA and Japan of a new plasmid-borne erm(55) (erm(55)P) in M. chelonae and other rapidly growing mycobacteria (RGM) have challenged this assumption. We investigated erm(55)P occurrence in clinical RGM referred to the French National Reference Centre for Mycobacteria between 2012 and 2026 by genome screening and erm(55)P specific real-time PCR. Positive isolates underwent long-read whole genome sequencing (GridIon, Oxford Nanopore Technologies). Clarithromycin (CLR) minimum inhibitory concentration (MIC) was determined by broth microdilution (RAPMYCO and FRATMYC, Thermo Fisher) and read up to 14 days. Five clinical isolates showing inducible CLR resistance (MIC range <0.25-64 mg/L on day 3-4 and 128 - >128 mg/L on day 14) were positive for erm(55)P: one M. chelonae, three M. neoaurum, and one M. parafortuitum. erm(55)P-positive M. chelonae genomes from this and previous descriptions did not cluster together in the phylogenetic analysis of 263 genomes. The assembled plasmids showed high similarity to previously reported erm(55)-carrying plasmids, especially within the erm(55)P region. The upstream sequence of erm(55)P showed a secondary structure compatible with a possible translation attenuation mechanism. These findings document the first report of a plasmid-borne erm(55) in Europe in M. chelonae and other RGM and raise concern about the emergence of plasmid macrolide resistance in NTM.

BACKGROUND Nontuberculous mycobacterial lung disease (NTM-LD) is highly heterogenous, geographically and etiologically, hindering effective timely identification. Prior CT radiomics studies require manual segmentation of pathology. We developed a whole-lung CT radiomics-based machine learning approach and identified common features across two geographically distinct NTM-LD cohorts. STUDY DESIGN AND METHODS 1,300 chest CT scans from China (871 TB; 429 NTM, Dataset 1) and 173 independent NTM cohort from UAB, US. Whole-lung regions were automatically segmented on each scan, and 85 quantitative radiomic features were extracted using a standardized image-processing pipeline. We evaluated two frameworks to assess model performance and generalizability: (1) training on Dataset 1 with external validation on Dataset 2, and (2) training on the combined cohort. Linear discriminant analysis (LDA) was used as the primary classification method. Cross-cohort concordance analysis was performed to evaluate the reproducibility of radiomic features across datasets. RESULTS In Scenario 1, the LDA classifier trained on Dataset 1 achieved an AUC of 0.79 (95% CI, 0.73-0.84) with high specificity (0.91). On the external UAB cohort, the model achieved an AUC of 0.94 (95% CI, 0.90-0.97). In Scenario 2, the combined cohort model achieved an AUC of 0.81 (95% CI, 0.76-0.85) with improved sensitivity (0.61) and precision (0.82). Feature importance analysis identified 16 features consistently ranked among the top 20 in both scenarios, predominantly texture-based descriptors reflecting distinct parenchymal patterns between mycobacterial species. CONCLUSION Whole-lung CT radiomics enables interpretable NTM-LD classification across geographically distinct populations without manual annotation. Suggesting population-independent parenchymal signatures of NTM-LD.

Mycobacterium avium pulmonary disease is an emerging global health challenge for which drug development remains limited by preclinical models that rely on laboratory strains and invasive endpoint analyses. Here, we compared recent clinical M. avium isolates with the reference strain ATCC 700898 across macrophage, Galleria mellonella, and murine infection models and evaluated longitudinal micro-computed tomography ({micro}CT) as a non-invasive tool to monitor disease progression and treatment response. While extracellular growth rates were comparable, clinical isolates demonstrated enhanced host-associated fitness and induced higher bacterial burdens and more severe pulmonary pathology in mice than the reference strain. These strain-dependent differences were detected by quantitative {micro}CT imaging. Using the hypervirulent isolate MYC_0069, we further show that clarithromycin monotherapy and standard-of-care triple therapy significantly reduced bacterial burden and lung pathology. Together, these findings establish a clinically relevant chronic M. avium model that combines clinical isolates with longitudinal imaging to enable preclinical anti-mycobacterial drug evaluation in vivo.

Background The World Health Organization (WHO) recommends 4-month treatment for children with non-severe pulmonary tuberculosis, outlining eligibility criteria for settings with and without chest X-ray (CXR). We evaluated the diagnostic accuracy of the WHO eligibility criteria in settings without CXR (WHO-criteria) and developed clinical scores to support disease classification. Methods Using data from an individual participant dataset (IPD; Decide TB) of children with confirmed/unconfirmed tuberculosis from four diagnostic studies (RaPaed-TB, Umoya, TB-Speed HIV, TB-Speed Decentralisation), we assessed the diagnostic accuracy of the WHO-criteria (with/without bacteriological testing) using expert CXR interpretation as a reference. We developed two multivariable logistic regression models with (Score 1) and without (Score 2) bacteriological testing, converted coefficients into integer scores with a threshold of >10 corresponding to a sensitivity [&ge;]70%. Results Of 2,383 children in the Decide TB-IPD, 633 (26.6%) met the eligibility criteria for a 4-month regimen, of whom 116 (18.3%) had radiologically severe disease. With and without bacteriological testing, the WHO-criteria had sensitivities of 30.1% (95%CI: 20.3%-40.2%) and 21.7% (95%CI: 10.4%-34.5%), and specificities of 83.4% (95%CI: 80.2%-86.4%) and 81.9% (95%CI: 78.8%-84.9%), respectively. Score 1 and Score 2 had sensitivities of 41.1% (95%CI: 32.4%-49.5%) and 30.9% (95%CI: 22.6%-40.4%), and specificities of 77.3% (95%CI: 73.6%-80.8%) and 83.0% (95%CI: 79.5%-86.3%) respectively. Using WHO-criteria, 91/116 (78.4%) and 105/116 (90.5%) of children were at risk of undertreatment, compared to 68/116 (58.6%) and 80/116 (68.9%) when using developed scores. Conclusions Developed scores demonstrated better sensitivity than WHO-criteria, however, performance remains suboptimal. Implementing shorter antituberculosis regimens without CXR remains challenging in children.

The phenotypic plasticity, slow replication, and complex, hydrophobic cell envelope of Mycobacterium tuberculosis contribute to its successful survival as a pathogen and its drug tolerance. Consequently, the global threat of multidrug-resistant Tuberculosis (MDR-TB), coupled with lengthy and highly toxic treatment regimens, necessitates the development of innovative treatment solutions. Mycobacteriophages are natural viruses of mycobacteria that typically encode two endolysins, which cooperatively facilitate host cell lysis at the end of the lytic life cycle: LysA, a peptidoglycan hydrolase, and LysB, a lipolytic enzyme, targeting the mycolylarabinogalactan-peptidoglycan complex. Their precise and efficient lytic activity, along with their low propensity to induce resistance, make them, particularly LysBs, promising candidates for new treatment solutions. In this study, we report MTB-LysB1, a novel LysB enzyme from an F1 sub-cluster mycobacteriophage isolated from our laboratory collection. While studying its structural features by comparing the modelled structure with representative mycobacteriophage LysB homologues, we found that the /{beta}-hydrolase fold and key motifs are conserved. Also, we identified putative membrane-interaction motifs that may play a role in LysB1s cell permeation. Significantly, we found MTB-LysB1 to be active against both drug-susceptible and multidrug-resistant (MDR) M. tuberculosis strains at nanomolar concentrations, comparable to the well-characterised D29 LysB reference enzyme. Beyond its standalone activity, MTB-LysB1 exhibits an additive effect when combined with the TB drugs rifampicin and moxifloxacin, and co-administration reduces the drugs minimum inhibitory concentrations (MICs), which holds clinical significance. By structurally damaging the mycobacterial cell wall, the enzyme appears to act as a permeability enhancer for the chemotherapeutic drugs, thereby improving antibiotic efficacy. Collectively, our findings position the enzyme not only as a novel antimycobacterial agent but also provide a structural framework for its rational engineering as a promising next-generation adjunct to TB drug regimens. HighlightsO_LIA novel F1 sub-cluster phage-derived LysB is discovered and characterised using integrated computational, biochemical and microbiological methods. C_LIO_LIAlphaFold2 modelling, molecular dynamics simulations and comparative structural analyses revealed an /{beta}-hydrolase fold with conserved catalytic and membrane-interaction features. C_LIO_LIThe enzyme exhibited high esterase activity, thermal stability and potent lytic activity against Mycobacterium tuberculosis. C_LIO_LIAn additive effect with TB drugs rifampicin and moxifloxacin highlights MTB-LysB1s potential as an adjunct therapeutic. C_LI

Neurocysticercosis (NCC), the infection of the central nervous system by Taenia solium larvae, is a leading cause of acquired epilepsy in endemic regions. While viable cysticerci can persist asymptomatically for extended periods, their spontaneous or drug-induced degradation triggers marked perilesional inflammation and severe neurological symptoms. Despite well-documented histopathological characterisation of these lesion states, the host transcriptional programmes associated with viable parasite persistence and early post-treatment lesion disruption remain poorly understood. To address this gap, we performed the first bulk RNA sequencing of pericystic brain tissue using a physiologically relevant porcine model of NCC. Comparing uninfected controls (n = 3), infected untreated pigs with intact viable cysts (n = 6), and antiparasitic-treated pigs with disrupted cysts (n = 3), we identified distinct transcriptional signatures associated with each disease state. Viable infection was associated with broad transcriptional changes (461 upregulated and 175 downregulated genes), characterised by local immune activation alongside suppression of blood-brain barrier (BBB) remodelling, vascular, and neuronal signalling molecular signatures. The post-treatment state with confirmed BBB disruption was associated with a smaller but directionally distinct response (160 upregulated and 57 downregulated genes), marked by inflammatory signalling and increased expression of genes associated with endothelial activation, vascular regulation, and BBB-associated remodelling. Together, these findings suggest that, while immune engagement is a feature shared across both lesion states, the BBB-associated transcriptional axis shifts substantially following treatment. These results provide an exploratory transcriptomic framework for understanding parasite persistence, treatment-induced neuroinflammation, and neurovascular remodelling in NCC, and highlight candidate pathways and genes for future mechanistic investigation.

Background: This study aimed to elucidate B cell subset pathology in COPD, a poorly characterized area, with a focus on its similarities to and differences from classical autoimmune disorders. Methods: Single-cell RNA-sequencing (scRNA-seq) data from COPD and autoimmune diseases were obtained from the Gene Expression Omnibus (GEO) for comparative analyses of B cell subsets and functions via differentially expressed genes (DEGs), KEGG, protein-protein interaction (PPI), and cell-cell communication analyses. Serum IgG4 was measured by ELISA and correlated with clinical parameters. Peripheral blood B cells were sorted by flow cytometry for single-cell B cell receptor (BCR) sequencing. A v-Abl-Bcl2 pro-B cell line was stimulated with cigarette smoke extract (CSE) to assess abnormal development in vitro. Results: In lung tissue, IgG4 plasma cells were enriched and expressed BCR activation and inflammatory genes and TNF-NF-kB-MAPK pathways. Serum IgG4 concentrations correlated negatively with pre- and post-bronchodilator FEV1-FVC. B cells interacted with monocytes, macrophages, fibroblasts, and endothelial cells via IL-1B-IL-6, integrin, and chemokine signaling, contributing to chronic inflammation and remodeling. In peripheral blood, transitional T1 B cells were increased, accompanied by lambda-chain enrichment and increased IGLV1-47 usage, as well as enrichment of autoimmune pathways. In the bone marrow, the numbers of pre-B I cells were increased while those of small pre-B III cells were reduced, with altered expression of BCR development genes. CSE stimulation of the pro-B cell line reduced lambda expression in a concentration-dependent manner. Conclusions: The autoimmune abnormalities in COPD appear more restricted, although IgG4 antibody generation may contribute to immune-mediated lung damage.

Cryptococcus neoformans is the predominant causative agent of cryptococcal meningitis in immunocompromised individuals. Conversely in immunocompetent individuals, C. neoformans establishes a latent pulmonary infection characterized by a paucity of clinical symptoms. Using a mouse inhalation model of latent C. neoformans infection, we previously showed that CD4 T-cells are necessary for preventing fungal proliferation in the lungs. In the current study, we performed single cell RNA sequencing (scRNAseq) and found that the CD4 T-cell response was both highly heterogenous and dichotomous during pulmonary C. neoformans infection, with concomitant expression of genes related to Th1 polarization (Tbx21, Ifng) and immune regulation (Ctla4). First, we demonstrated that cells with Th1-like phenotypes are necessary and sufficient to control latent infection via adoptive transfer of T-bet positive cells into infection-matched CD4-depleted recipient mice. Second, scRNAseq analysis revealed the subpopulation of effector CD4 T-cells that co-expressed Ctla4 and Gata3 was significantly higher than a subpopulation that co-expressed Ctla4 and Tbx21. Furthermore, our data suggested that CTLA-4 upregulation is beneficial against C. neoformans infection, as CTLA-4 blockade promoted fungal proliferation. Thus, we propose a model wherein Th1 control of latent C. neoformans infection is supported by CTLA-4 suppression of detrimental Th2 activation.