Personalised Medicine for Tuberculosis and Non-Tuberculous Mycobacterial Pulmonary Disease

Abstract

Personalised medicine, in which clinical management is individualised to the genotypic and phenotypic data of patients, offers a promising means by which to enhance outcomes in the management of mycobacterial pulmonary infections. In this review, we provide an overview of how personalised medicine approaches may be utilised to identify patients at risk of developing tuberculosis (TB) or non-tuberculous mycobacterial pulmonary disease (NTM-PD), diagnose these conditions and guide effective treatment strategies. Despite recent technological and therapeutic advances, TB and NTM-PD remain challenging conditions to diagnose and treat. Studies have identified a range of genetic and immune factors that predispose patients to pulmonary mycobacterial infections. Molecular tests such as nucleic acid amplification assays and next generation sequencing provide a rapid means by which to identify mycobacterial isolates and their antibiotic resistance profiles, thus guiding selection of appropriate antimicrobials. Host-directed therapies and therapeutic drug monitoring offer ways of tailoring management to the clinical needs of patients at an individualised level. Biomarkers may hold promise in differentiating between latent and active TB, as well as in predicting mycobacterial disease progression and response to treatment.

Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management

“…Alongside culture-based techniques, speciation can be achieved using line probe assays, matrix-assisted laser desorption ionization–time-of-flight mass spectrometry or gene sequencing. 15 , 16 , 17 , 18 …”

Xenophagy receptors Optn and p62 and autophagy modulator Dram1 independently promote the zebrafish host defense against Mycobacterium marinum

“…Despite considerable efforts on controlling the disease, the emergence of antibiotic-resistant mycobacterial strains and limited success in vaccine development continue to pose threats to the world’s health security. This emphasizes the need for exploring novel therapeutic strategies, such as immunotherapy to boost the host immune response against mycobacterial infection ( Kilinç et al., 2021 ; Kiran et al., 2016 ; Kumar and Kon, 2021 ). However, insufficient understanding of the early pathogenesis of infection is a limiting factor for the identification of novel therapeutic targets ( Bussi and Gutierrez, 2019 ).…”

Mycobacteriophages in diagnosis and alternative treatment of mycobacterial infections

“…Opportunistic mycobacterial infections are caused by NTM, which include other mycobacterial species, other than Mycobacterium leprae and MTB ( Kumar and Kon, 2021 ). The most common human NTM pathogens are the slow growing Mycobacterium avium complex (MAC), Mycobacterium xenopi , Mycobacterium fortuitum complex, Mycobacterium kansasii , and the rapidly growing Mycobacterium abscessus group (MABS) ( Ratnatunga et al, 2020 ).…”