Tag: Tuberculosis

  • WHO releases an investment case for TB screening and preventive treatment

    WHO releases an investment case for TB screening and preventive treatment

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    Ahead of World Tuberculosis (TB) Day, which is marked on 24 March, WHO has released an investment case for TB screening and preventive treatment. A modeling study developed with Governments of four countries – Brazil, Georgia, Kenya and South Africa – highlights the impact to be achieved from expanding TB screening and preventive treatment.

    The analysis shows that modest investments could lead to significant health and economic benefits in all four countries, with a return on investment up to US$ 39 gained for every dollar invested. The investment case has been released to support countries in advocating for and allocating increased resources to scale-up TB screening and preventive treatment towards reaching new targets committed by Heads of State at the 2023 UN High-Level Meeting on TB.

    While global efforts to combat TB have saved an estimated 75 million lives since the year 2000, TB causes 1.3 million deaths each year and affects millions more, with enormous impacts on families and communities.

    The investment case outlines the health and economic rationale for investing in evidence-based, WHO-recommended interventions on TB screening and prevention that can contribute to advancing universal health coverage. Today, we have the knowledge, tools and political commitment that can end this millennia-old disease that remains one of the world’s top infectious killers”.


    Dr. Tedros Adhanom Ghebreyesus, WHO Director-General

    According to the investment report, implementing TB screening plus preventive treatment can substantially reduce TB incidence and mortality. It argues that these crucial public health investments are essential for addressing the needs of vulnerable populations and achieving the End TB targets.

    In 2022, WHO reported a significant worldwide recovery in the scale-up of access to TB diagnosis and treatment services, with the highest figure recorded since WHO began global TB monitoring in 1995.

    However, the scale-up of access to TB preventive treatment has been slow. Preventing TB infection and stopping progression from infection to disease are critical for reducing TB incidence to the levels envisaged by the WHO’s End TB Strategy. To do this, it is vital to offer TB preventive treatment to those with HIV, household contacts of TB patients, and other high-risk groups.

    The global number of people living with HIV and household contacts of people with TB who were provided with TB preventive treatment increased to 3.8 million in 2022 or about 60% of those targeted that year in line with the commitments made at the UN High-Level Meeting of 2018.

    Multidrug-resistant TB (MDR-TB) remains a public health crisis. While an estimated 410 000 people developed multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) in 2022, only about 2 in 5 people accessed treatment. Progress in the development of new TB diagnostics, drugs and vaccines remains constrained by the overall level of investment in these areas. It is clear much more efforts are needed to combat TB, which remains one of the world’s leading infectious killers.

    2024 World Tuberculosis Day is being commemorated under the theme ‘Yes! We can end TB!’ conveying a message of hope that getting back-on-track to turn the tide against the TB epidemic is possible through high level leadership, increased investments and faster uptake of new WHO recommendations.

    Following the commitments made by Heads of State at the UN High-Level Meeting in 2023 to accelerate progress to end TB, this year’s focus shifts to turning these commitments into tangible actions. This includes implementing the WHO Director-General’s flagship initiative on TB for 2023-2027.

    “The next five years will be critical for ensuring that the political momentum we have now is translated into concrete actions towards reaching global TB targets,” said Dr Tereza Kasaeva, Director of WHO’s Global Tuberculosis Programme. “WHO will continue to provide global leadership for the TB response, working with all stakeholders until we reach and save every person, family and community impacted by this deadly disease”.

    The global targets approved at the 2023 UN High-Level Meeting on TB include: reaching 90% of people in need with TB prevention and care services; using a WHO-recommended rapid test as the first method of diagnosing TB; providing a health and social benefit package to all people with TB; ensuring the availability of at least one new TB vaccine that is safe and effective; and closing funding gaps for TB implementation and research by 2027.

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  • Global leaders set ambitious targets to end tuberculosis epidemic

    Global leaders set ambitious targets to end tuberculosis epidemic

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    World leaders at the United Nations General Assembly’s High-Level Meeting on Tuberculosis have approved a Political Declaration with ambitious new targets for the next five years to advance the global efforts towards ending the TB epidemic.

    The targets include reaching 90% of people with TB prevention and care services, using a WHO-recommended rapid test as the first method of diagnosing TB; providing social benefit packages to all people with TB; licensing at least one new TB vaccine; and closing funding gaps for TB implementation and research by 2027. 

    For millennia, our ancestors have suffered and died with tuberculosis, without knowing what it was, what caused it, or how to stop it. Today, we have knowledge and tools they could only have dreamed of. The political declaration countries approved today, and the targets they have set, are a commitment to use those tools, and develop new ones, to write the final chapter in the story of TB.”


    Dr, Tedros Adhanom Ghebreyesus

    Progress made towards 2018 targets

    Taking stock of progress towards targets set in 2018 for a five-year period, WHO reported that while global efforts to combat TB have saved over 75 million lives since the year 2000, they fell short of reaching the targets, mainly due to severe disruptions to TB services caused by the COVID-19 pandemic and ongoing conflicts. Only 34 million people of the intended 40 million people with TB were reached with treatment between 2018 and 2022. For TB preventive treatment, the situation was even more grim, with only 15.5 million of the 30 million people targeted to be reached with preventive treatment accessing it.

    Funding for TB services in low- and middle-income countries fell from US$ 6.4 billion in 2018 to US$ 5.8 billion in in 2022, representing a 50% financing gap in implementing the required TB programmes. Annual funding for TB research ranged from US$ 0.9 billion to US$ 1.0 billion between 2018 and 2022, which is just half of the target set in 2018.

    This has placed an even heavier burden on those affected, especially the most vulnerable. Today, TB remains one of the world’s top infectious killers: annually more than 10 million people fall sick, and over 1 million lose their lives to this preventable and curable disease. Drug-resistant TB continues to be a major contributor to antimicrobial resistance with close to half a million people developing drug-resistant TB every year.

    “Uniting around the TB response by world leaders, for a second time, provides an opportunity to accelerate action and strengthen health systems capable of not only addressing the TB epidemic, but also protecting the broader health and well‑being of communities, strengthening pandemic preparedness and building on lessons learnt during the COVID-19 pandemic,” said Dr Tereza Kasaeva, Director of the WHO Global TB Programme. “Averting TB-related financial hardship and preventing the development of the disease in vulnerable groups will help diminish inequities within and between countries, contributing to the achievement of the Sustainable Development Goals.”

    TB incidence and deaths have risen between 2020 and 2021 but coordinated efforts by countries, WHO and partners are resulting in a recovery of essential services.

    Launch of the TB vaccine accelerator council

    In the lead-up to this historic meeting, WHO Director-General, Dr Tedros Adhanom Ghebreyesus, officially launched the TB vaccine accelerator council to facilitate the development, licensing and use of new TB vaccines. The Council, supported by the WHO secretariat, will be led by a ministerial board, consisting of nine members who will serve on a rotating basis, for a term of two years. The Council will also have subsidiary bodies to support its interaction and engagement with different sectors and stakeholders broadly, including the private sector, scientists, philanthropy, and civil society.

    BCG is currently the only licensed TB vaccine. While it provides moderate efficacy in preventing severe forms of TB in infants and young children, it does not adequately protect adolescents and adults, who account for the majority (>90%) of TB transmission globally.

    The Council aims to identify innovative sustainable financing, market solutions and partnerships across public, private, and philanthropic sectors. It will leverage platforms like the African Union, Association of Southeast Asian Nations (ASEAN), BRICS countries (Brazil, Russian Federation, India, China and South Africa), G20, G7 and others to strengthen commitment and actions for novel TB vaccine development and access.

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  • Global fight against TB misses 2020 WHO milestones, despite progress in certain age groups

    Global fight against TB misses 2020 WHO milestones, despite progress in certain age groups

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    In a recent study published in The Lancet Infectious Diseases, researchers assessed the global, national, and regional burden and trends in tuberculosis.

    Study: Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. Image Credit: SewCreamStudio/Shutterstock.comStudy: Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. Image Credit: SewCreamStudio/Shutterstock.com

    Background

    Tuberculosis is a significant contributor to the global disease burden despite being a preventable and curable disease. It accounts for over a million deaths each year, and in 2019, it was the leading cause of death due to a single infectious agent. Global initiatives to address tuberculosis have been prominent since the 1990s.

    The World Health Organization (WHO) End TB Strategy aims to accelerate progress by reducing tuberculosis incidence and deaths by 90% and 95% between 2015 and 2035.

    Therefore, evaluations of the trends in the global tuberculosis burden are necessary to assess progress in achieving these targets.

    About the study

    In the present study, researchers examined the levels and trends in global tuberculosis burden and age-specific achievement of incidence and mortality milestones. They used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021.

    The team included data on vital registration, mortality surveillance, and minimally invasive tissue sample diagnoses for tuberculosis mortality in those without human immunodeficiency virus (HIV) coinfection.

    The cause-of-death ensemble modeling generated mortality estimates in those without HIV coinfection by age, sex, location, and year. Further, a population-attributable fraction approach was used to estimate age-specific deaths among those with HIV.

    In parallel, age-specific tuberculosis prevalence, incidence, and mortality were modeled using disease-model Bayesian meta-regression. Tuberculosis deaths attributable to risk factors were computed.

    Further, the impact of the coronavirus disease 2019 (COVID-19) pandemic on mortality was evaluated for countries with at least 10 tuberculosis deaths in 2019 for each age group.

    Tuberculosis incidence and mortality estimates were aggregated by HIV status, and all-form tuberculosis burden estimates were presented for five age groups – < 5, 5–14, 15–49, 50–69, and ≥ 70 years. Incidence- and mortality-specific annualized rates of change (ARCs) were reported.

    Findings

    Overall, 9.4 and 1.35 million tuberculosis cases and deaths occurred in 2021, respectively. Of these, tuberculosis and HIV coinfection cases accounted for a million cases and 205,000 deaths. The age-standardized incidence and mortality rates were 115 and 16.2 per 100,000 population, respectively. These rates declined by 37% and 61.1% between 1990 and 2021.

    In 2021, 3.8% of incident cases and 4.5% of deaths were reported in those under five years, and 4.7% of cases and 1.5% of deaths occurred in the 5–14 age group. Most cases (54.9%) and deaths (36.4%) in 2021 occurred in the 15–49 age group.

    In 2021, incidence rates exceeded 100 per 100,000 individuals in those aged five or younger across 34 countries and 5–14 across 14 countries.

    Further, incidence rates surpassed 500 per 100,000 individuals in the 15–49, 50–69, and ≥ 70 age groups in nine, 33, and 50 countries, respectively.

    Mortality rates were greater than 25 per 100,000 individuals in the < 5, 5–14, and 15–49 age groups in 20, 1, and 37 countries, respectively. Notably, mortality rates exceeding 300 per 100,000 individuals were observed in the 50–69 and ≥ 70 age groups in eight and 44 countries, respectively.

    ARCs in tuberculosis incidence were the largest in those aged <5 and 5–14 between 2020 and 2021, reducing by 4.1% and 3.7%, respectively, whereas reductions in adult age groups were around 2%.

    Moreover, the largest ARCs for mortality rates were observed in the same age groups. Central Asia and Central and Eastern Europe had the largest age-standardized ARCs between 2010 and 2021.

    Globally, all-age incidence rates reduced by 6.26% between 2015 and 2020, with a 4.9% decline in males and 7.9% in females. In the same period, global deaths due to tuberculosis declined by 11.9%, with a greater change in females (13.8%). Global tuberculosis deaths decreased to one million after removing the cumulative effects of risk factors (diabetes, smoking, and alcohol use).

    Forty-one countries were included in the analysis of the impact of COVID-19. Accordingly, 50,900 deaths due to tuberculosis were expected in 2020 compared to 45,500 deaths observed, corresponding to 5,340 fewer deaths than expected.

    Twenty countries continued to report data through 2021. In these countries, 39,600 deaths were expected compared to 39,000 observed.

    Conclusions

    The first WHO End TB interim milestones were not achieved in 2020, with only 6% and 12% reductions in incidence and mortality rates between 2015 and 2020, respectively.

    There was differential progress across age groups; people under 15 showed the sharpest decreases, whereas the older groups had minimal declines.

    The End TB incidence and mortality milestones were reached in 2020 by only 15 and 17 countries, respectively.

    As such, control programs should evaluate these countries to explore the drivers of their progress. Moreover, the impact of the COVID-19 pandemic was heterogeneous and uncertain, warranting additional data.

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  • Experts advocate three-pronged approach to identifying missing tuberculosis cases

    Experts advocate three-pronged approach to identifying missing tuberculosis cases

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    In the journey towards a world free of Tuberculosis (TB), the crucial first step begins with identifying individuals affected by the disease.

    Globally, around 1.3 million people died from TB in 2022, making it the second leading infectious killer after COVID-19, according to the World Health Organization (WHO).

    However, many people with the disease, which is particularly prevalent in the Asia Pacific region and Africa, do not even get properly diagnosed.

    Public health experts say the task of tracing these missing cases requires a three-pronged approach, involving community engagement, scaling-up the use of available technologies, and effective program management.

    “By putting communities at the core, you ensure that they are fully involved in the process of making their villages TB-free,” said Prabodh Bhambal, executive director of the Union South East Asia (USEA) Trust, at a webinar organized by Citizen News Service (CNS) this week (19 March).

    The USEA Trust is an independent trust hosted by the International Union Against Tuberculosis and Lung Disease (The Union) in New Delhi, with a flagship project that aims to transform 1,000 villages into TB-free villages with support from the JSW Foundation, the social development arm of JSW Group, an Indian conglomerate whose businesses include steel, cement, automotive and paints.

    The WHO estimates that India grapples with the world’s most extensive tuberculosis epidemic. In 2022, the country reported an incidence rate of 199 cases per 100,000 individuals in its population.

    In Uganda, where there was a similar incidence rate of 198 cases per 100,000, the government is using mobile vans to conduct screenings in local communities as part of an awareness, testing and prevention campaign.

    At the core of the campaign is the acknowledgment that relying solely on communities to visit health facilities doesn’t ensure uptake of services or effectively control TB at the community or household level.

    The campaign emphasises the need for a collective desire for change, inspiring individuals to take action and voluntarily seek healthcare services. The aim is to enhance case-finding, address missing TB cases within communities, tackle treatment defaulting, and improve the use of prevention measures.

    Stavia Turyahabwe, assistant commissioner for TB and Leprosy at Uganda’s Ministry of Health, says this approach has been highly effective. In 2022, more than 94,000 Ugandans were diagnosed with TB through the initiative, significantly contributing to improved disease detection rates, she told a two-day summit on TB and leprosy in Kampala this week (19-20 March).

    However, she added that the ministry had yet to assess its impact on TB prevalence.

    Harnessing technology, AI

    Bhambal suggests that, by effectively harnessing current technologies for TB screening and diagnosis, a substantial portion of the undetected TB cases can be identified.

    “In the small population of 5,000 people that we have screened so far under our project, we screened based on symptoms, used portable X-rays, and utilised an AI app.”

    “Through this comprehensive approach, we have successfully detected cases of TB that would have otherwise been missed if we had relied solely on symptoms,” explained Bhambal, adding: “Technology plays a crucial role in finding these cases; we just need to find the right mix.”

    Charles Olaro, director of clinical services at Uganda’s Ministry of Health, highlighted various innovations being employed in the country’s fight against TB, including GeneXpert technology, which rapidly diagnoses TB disease and drug resistance.

    “We are not solely dependent on the microscope,” he said. “For any slides that test positive, we analyze them for drug resistance using the GeneXpert.”

    Sriram Natarajan, co-founder of Indian diagnostics company Molbio Diagnostics, highlighted the limitations of microscopy in terms of detection.

    However, he added that over the last decade, the WHO has approved molecular diagnostic tools capable of being deployed even in the doctor’s surgery.

    He said these molecular tools boast sensitivity rates of up to 98 per cent, meaning that patients can be diagnosed at an early stage. However, despite these tools being available for about a decade, only about 25 to 30 per cent of TB cases globally are being diagnosed using them, according to Natarajan.

    “We now have at least two available tools, but the uptake remains a major concern,” he told the CNS webinar.

    “Both countries and their programs need to commit to implementing these tools at the primary level to ensure that everyone receives a molecular test as a confirmatory tool.”

    Investment ‘crucial’

    Natarajan says more commitment is needed from global funding agencies to focus on making these tools affordable and accessible to all.

    “If we truly want to end TB by the target year of 2030, these interventions need to be scaled up and accelerated,” he added. “It’s crucial that these efforts are taken seriously.”

    Lucica Ditiu, executive director of the Stop TB Partnership, told the CNS webinar: “It is possible to end TB. We see high-burden countries finding and treating TB.”

    High-burden countries include India, Indonesia, Bangladesh, Nigeria, South Africa and Ethiopia.

    “I want to say that, in many countries, private sector engagement is crucial to finding and treating all TB patients,” Ditiu added.

    Guy Marks, respiratory medicine expert at the University of New South Wales and president and interim executive director of The Union, says TB must be treated as a public health problem, not merely an individual patient care issue.

    “We must be brave and recognize that the current strategy to end TB in high-burden countries is not achieving the results we hope for,” he said.

    “We need to change our approach if we are to win the fight against this infectious disease.”

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  • New classification of tuberculosis aims to improve focus on the early stages of disease

    New classification of tuberculosis aims to improve focus on the early stages of disease

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    A new way to classify tuberculosis (TB) that aims to improve focus on the early stages of the disease has been presented by an international team involving researchers at UCL.

    The new framework, published in The Lancet Respiratory Medicine, seeks to replace the approach of the last half century of defining TB as either active (i.e., causing illness and potentially infectious to others) or latent (being infected with the bacterium that causes TB [M tuberculosis] but feeling well and not infectious to others) – an approach researchers say is limiting progress in eradicating the disease.

    Of note, large surveys conducted in over 20 countries recently have shown than many people with infectious TB feel well.

    Under the new classification, there are four disease states: clinical (with symptoms) and subclinical (without symptoms), with each of these classed as either infectious or non-infectious. The fifth state is M. tuberculosis infection that has not progressed to disease – that is, M tuberculosis may be present in the body and alive, but there are no signs of the disease that are visible to the naked eye, for example with imaging.

    The researchers say they hope the International Consensus for Early TB (ICE-TB) framework, developed by a diverse group of 64 experts, will help lead to better diagnosis and treatment of the early stages of TB which have historically been overlooked in research.

    TB remains the world’s most deadly infectious disease currently and has caused over one billion deaths in the last 200 years. An estimated three million cases a year are not reported to health systems and more than half of these cases will be asymptomatic.

    The international team was led by researchers at UCL, London School of Hygiene & Tropical Medicine, The Walter and Eliza Hall Institute (WEHI), University of Cape Town, Imperial College London and the South African Medical Research Council.

    The binary paradigm of active disease versus latent infection has resulted in a one-size-fits-all antibiotic treatment for disease, but designed for those with the most severe form of disease. This leads to potential over-treatment of individuals with subclinical TB.


    A key research priority now is to identify the best combination, dosage and duration of antibiotics to treat each TB state, as well as the benefits of treating the subclinical states.”


    Dr Hanif Esmail, co-lead author at the UCL Institute for Global Health and MRC Clinical Trials Unit at UCL

    Professor Rein Houben (London School of Hygiene and Tropical Medicine), co-lead author of the paper, said: “While providing treatment to people who become very sick with TB has saved millions of lives we are not stopping transmission of the disease.”

    “To prevent transmission of TB, we need to move away from focusing just on the very sick and look at earlier disease states, identifying people who may be infectious for months or years before they develop TB symptoms. 

    “Our consensus framework replaces the old binary concept of ‘active’ versus ‘latent’ TB with a more detailed classification system that we hope, if widely adopted, could help to improve treatment for those with early-stage TB and drive forward efforts to eradicate the disease.”

    The framework was developed via a Delphi process designed to reach a consensus among a diverse group. The process began with a scoping review of papers and online surveys of experts and culminated in a two-day meeting in Cape Town, South Africa, of researchers from a range of disciplines as well as policymakers, clinicians, and TB survivors.

    Dr Anna Coussens, co-lead author from WEHI, said: “One key finding in the consensus is moving the disease threshold and acknowledging that disease does not just start with symptoms or transmission, but when tissue is damaged.

    “In time we hope our framework can contribute to TB elimination by leading to improved early diagnosis and treatment, optimizing patient outcomes and minimizing transmission.”

    The researchers noted that the disease process was non-linear – that people may fluctuate between infectious and non-infectious states, and between the presence and absence of symptoms or signs.

    They also said that better diagnostic tools were needed to identify many of the TB states. For instance, there is currently no test to detect a viable M tuberculosis infection (i.e., one where the bacteria are physiologically active), as opposed to a non-viable infection or recent infection that has cleared.

    The international team involved stakeholders from 19 countries including International Union Against TB and Lung Disease, The StopTB partnership, World Health Organization, FIND, National TB Programmes, TB Proof, and researchers from a number of universities and medical research institutes.

    The work was supported by Wellcome, the National Institutes of Health/RePORT RSA, the Bill and Melinda Gates Foundation, the Medical Research Council, the European Research Council, and the National Health and Medical Research Council.

    Source:

    Journal reference:

    Coussens, A. K., et al. (2024) Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise. The Lancet Respiratory Medicine. doi.org/10.1016/S2213-2600(24)00028-6.

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  • More than 80% of patients with tuberculosis do not have persistent cough, study shows

    More than 80% of patients with tuberculosis do not have persistent cough, study shows

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    More than 80% of patients with tuberculosis, the world’s most deadly infection, do not have a persistent cough, despite this being seen as a key symptom of the disease. The infection is predominantly transmitted by coughing, but probably also through simply breathing. Research, led by Amsterdam UMC and the Amsterdam Institute for Global Heath and Development, analyzed data on more than 600,000 individuals in Africa and Asia and found that 82.8% of those with tuberculosis had no persistent cough and 62.5% had no cough at all. These results are published today in the Lancet Infectious Diseases. 

    Our results indicate the probable reason why, despite huge efforts to diagnose and treat the disease, the tuberculosis (TB) burden across Africa and Asia is hardly declining. We already knew that there was a giant gap between the 10.6 million who get ill with tuberculosis and the 7.5 million cases that were registered by health authorities in 2022.”


    Frank Cobelens, Professor of Global Health at Amsterdam UMC and Senior Fellow at the AIGHD

    “A persistent cough is often the entry point for a diagnosis, but if 80% of those with TB don’t have one, then it means that a diagnosis will happen later, possibly after the infection has already been transmitted to many others, or not at all,” he adds. 

    The study analyzed the results of national monitoring schemes in 12 countries, and found that, alongside the lack of a cough, more than a quarter of those with TB had no symptoms at all. With both of these traits being more common in women than in men. Further, the study showed that a quarter of those without cough have high loads of bacteria in their sputum and are probably highly infectious. 

    “When we take all of these factors into account, it becomes clear that we need to really rethink large aspects of how we identify people with TB. It’s clear that current practice, especially in the most resource-poor settings will miss large numbers of patients with TB. We should instead focus on X-ray screening and the development of new inexpensive and easy-to-use tests” says Cobelens.

    Source:

    Journal reference:

    Stuck, L., et al. (2024) Prevalence of subclinical pulmonary tuberculosis in adults in community settings: an individual participant data meta-analysis. The Lancet Infectious Diseases. doi.org/10.1016/S1473-3099(24)00011-2.

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  • Mtb bacteria detected in exhaled breath of 90% of individuals presenting with suspected tuberculosis

    Mtb bacteria detected in exhaled breath of 90% of individuals presenting with suspected tuberculosis

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    Mycobacterium tuberculosis (Mtb), the bacteria that causes a tuberculosis infection, is present in exhaled breath of 90% of those presenting with suspected tuberculosis. This includes those who were negative on conventional sputum testing and not diagnosed with TB. This raises the possibility that those who have tested negative may be unknowingly transmitting the infection. Researchers from the University of Cape Town and Amsterdam UMC analyzed results from over 100 patients who presented themselves to clinics in South Africa. These findings are published today in PNAS

    “If someone carries Mtb in their respiratory tract, this may also mean they can spread it. Therefore, since these results suggest a much broader range of people transmitting TB than previously recognized, there are significant implications for public health interventions designed to interrupt transmission.” says Ben Patterson, external Ph.D. candidate at Amsterdam UMC and the Amsterdam Institute for Global Health and Development. 

    Participants in the study attended two community clinics in the south-west of Cape Town before being either diagnosed with TB, or not. Subsequently, aerosol samples were collected in a community-based dedicated TB aerobiology lab using a novel method optimized to find low concentrations of Mtb. These samples were then used to detect the presence of Mtb, finding it in the samples given by 90% of patients, including those that had tested negative by sputum for tuberculosis. 

    This rather shatters the paradigm on the transmission of tuberculosis. Previously we understood that Mtb was only expelled by those who have the disease, but this study shows that also those with symptoms who test negative do this and probably spread the infection.”


    Frank Cobelens, professor of Global Health at Amsterdam UMC and senior fellow at the AIGHD

    Aerosol samplings were repeated at three separate timepoints over six months for all participants. The presence of Mtb decreased in those on treatment as well, surprisingly, as those not on treatment over this time period. Nevertheless, 20% of all participants continued to test positively for Mtb in aerosol after six months. This suggests that transmission can continue over a period longer than previously thought. Indeed, a recent study from the University of Cape Town suggests that tuberculosis could be present in the lungs for up to four years prior to the onset of symptoms. 

    “Together, our results indicate how complex tuberculosis is, and perhaps also why it is so difficult to eliminate tuberculosis in endemic areas. Even when public health agencies work, according to the current guidelines, effectively against symptomatic TB cases. In this sense, a revaluation of our practices is necessary,” adds Cobelens. 

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  • Breakthrough blood test developed for early detection of sarcoidosis

    Breakthrough blood test developed for early detection of sarcoidosis

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    A research project led by Lobelia Samavati, M.D., professor of internal medicine and molecular medicine and genetics at the Wayne State University School of Medicine, and supported by the National Institutes of Health (NIH), has developed a tool to rapidly and inexpensively diagnose sarcoidosis, a chronic inflammatory disease marked by the growth of tiny lumps called granulomas in the lungs and other organs. The tool, which uses a simple blood test, could allow for selective use of more invasive diagnostic tests often used to identify the disease. The findings were published in the American Journal of Respiratory and Critical Care Medicine

    Currently, diagnosing sarcoidosis isn’t a straightforward process and requires tissue removal and testing with additional screenings to rule out other diseases, such as tuberculosis or lung cancer. Using a blood test will help diagnose faster, particularly in those organs that are more challenging to biopsy and with less harm to the patient.”


    James Kiley, Ph.D., Director of the NIH’s Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI)

    Though the exact cause of sarcoidosis is unknown, researchers suspect it is an immune disorder triggered by a group of specific antigens, which are generally foreign substances that incite an immune response in the body. In the United States, an estimated 8-11 people per 100,000 are affected by sarcoidosis each year, according to previous research. 

    To identify antigens and determine which might be linked to sarcoidosis, scientists collected lung fluid samples and blood cells from patients with pulmonary sarcoidosis, then extracted the genetic material. Using a combination of molecular techniques, the researchers homed in on two newly described disease-specific antigen biomarkers that only bind to the antibodies of sarcoidosis positive patients. 

    They next designed a highly specific blood test, which only requires a small amount of blood, to determine if they could accurately detect sarcoidosis. To verify the test, researchers compared blood samples from 386 people, which included patients with sarcoidosis, patients with tuberculosis, patients with lung cancer and healthy individuals. The researchers confirmed that their test was able to differentiate patients who had sarcoidosis from those with other respiratory diseases. 

    “More testing needs to be completed before this screening method is ready for clinical use, but it’s possible that could be a reality within a few years,” said Samavati.

    “Dr. Samavati’s important work is an excellent example of how scientific research can have promising results that may lead to addressing major health challenges,” said Ezemenari M. Obasi, Ph.D., vice president for research at Wayne State University. “I look forward to the potential impact this research will have on the lives of those inflicted with sarcoidosis.”

    Source:

    Journal reference:

    Peng, C., et al. (2024). Discovery of Two Novel Immunoepitopes and Development of Peptide-based Sarcoidosis Immunoassay. American Journal of Respiratory and Critical Care Medicine. doi.org/10.1164/rccm.202306-1054oc

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  • Incomplete transcripts dominate the Mycobacterium tuberculosis transcriptome

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    Bacterial strains and growth conditions

    The Mtb H37Rv strain (obtained from C. Sassetti) was grown at 37 °C in a minimal medium (Difco Middlebrook 7H9 broth (BD, 271310) supplemented with 0.5% (v/v) glycerol, 0.05% (v/v) tyloxapol (Sigma, T8761), 0.2 g l−1 casamino acids (BD, 223050), and 10% (v/v) OADC (oleic acid, albumin, dextrose and catalase; BD, 212351)). The double-auxotrophic Mtb mc26206 strain (H37Rv ΔpanCDΔleuCD)42 (obtained from W. Jacobs Jr) was grown in the minimal medium with an additional 50 mg l−1 l-leucine (Sigma, L8000) and 24 mg l−1 pantothenic acid (Sigma, P5155). The Msm mc2155 strain (obtained from S. Fortune) was grown in the Middlebrook 7H9 medium supplemented with 0.2% (v/v) glycerol, 0.05% (v/v) Tween-80 (VWR, M126), and 10% (v/v) albumin–dextrose–catalase. Liquid Mtb and Msm cultures were grown at 37 °C in Nalgene sterile square PETG medium bottles with constant agitation. The solid Mtb culture was grown on 7H11 agar (Sigma, M0428) supplemented as described above except for tyloxapol.

    CRISPR interference

    Plasmid pIRL58 (Addgene, 166886) bearing the Streptococcus thermophilus CRISPR–dCas9 system (dCas9Sth1)13 was used to modulate the RNA expression level of target genes in Mtb mc26206 cells. Oligonucleotides for single guide RNAs (sgRNAs; Integrated DNA Technologies) were cloned into pIRL58. After verification by Sanger sequencing, pIRL58 and pIRL19 (Addgene, 163634, which supplied the L5 integrase function on a separate suicide vector) were co-transformed into Mtb cells by electroporation using GenePulser (BioRad) at 2,500 V, 700 Ω, and 25 μF. Single colonies were picked from the solid culture plates with 20 μg ml−1 kanamycin (Goldbio, K-120) selection after 14–21 days of culture. Target gene knockdown was induced by adding 100 ng ml−1 ATc (Sigma, 37919). The sgRNA and primer sequences are listed in Supplementary Table 5.

    SEnd-seq

    RNA isolation

    Bacterial cells were quenched by adding 1× vol of GTC buffer (600 g l−1 guanidium thiocyanate, 5 g l−1 N-laurylsarcosine, 7.1 g l−1 sodium citrate, and 0.7% (v/v) β-mercaptoethanol) to the culture medium immediately before collection and placed at room temperature for 15 min. Cell pellets were collected by centrifugation at 4,000g for 10 min at 4 °C, and then thoroughly resuspended in 100 μl TE buffer (10 mM Tris-HCl pH 8.0 and 1 mM EDTA). After the addition of 1 ml TRIzol reagent (Invitrogen, 15596) and 350 mg of glass beads (Sigma, G1145), the cells were immediately lysed in a screw-cap tube by bead beating with the Precellys Evolution homogenizer (Bertin Technologies, 02520-300-RD000) at 10,000 r.p.m. for 4× 45-s cycles with a 60-s interval and chilled with dry ice. After removal of the beads by spinning samples at 12,000 r.p.m. for 5 min at 4 °C, the liquid phase was transferred to a new tube. A 200 μl volume of chloroform was added, and the sample was gently inverted several times until reaching homogeneity. The sample was then incubated for 15 min at room temperature before spinning at 12,000g for 10 min at 4 °C. The upper phase (about 600 μl) was gently collected and mixed at a 1:1 ratio with 100% isopropanol. The sample was incubated for 2 h at −20 °C and then centrifuged at 14,000 r.p.m. for 15 min at 4 °C. The pellet was washed twice with 1 ml of 75% (v/v) ethanol, air dried for 5 min and dissolved in nuclease-free water. RNA integrity was assessed with 1% (m/v) agarose gel and the Agilent 2100 Bioanalyzer System (Agilent Technologies, 5067-4626). For antibiotic treatment conditions, Mtb mc26206 cells were exponentially grown to an optical density at 600 nm (OD600) of about 0.8 followed by treatment with a specific antibiotic (30 μg ml−1 linezolid (Sigma, PZ0014), 40 μg ml−1 clarithromycin (Sigma, C9742), 300 μg ml−1 streptomycin (Sigma, S9137), or 50 μg ml−1 rifampicin (Sigma, R3501)). At each time point following the treatment, 4 ml of cell culture medium was withdrawn and mixed quickly with 4 ml GTC buffer. The cells were then collected, and the RNA was isolated as described above.

    Library preparation for total RNA SEnd-seq

    A 5 μg quantity of total RNA was mixed with pooled spike-in RNAs used in our previous study3 at a mass ratio of 300:1 in a total volume of 12 μl. The RNA sample was incubated with a 5′-adaptor ligation mix (1 μl of 100 μM 5′ adaptor (Supplementary Table 5), 0.5 μl of 50 mM ATP, 2 μl DMSO, 5 μl of 50% PEG8000, 1 μl RNase Inhibitor (New England BioLabs, M0314), and 1 μl of High Concentration T4 RNA Ligase 1 (New England BioLabs, M0437)) at 23 °C for 5 h. The sample was then diluted to 40 μl with nuclease-free water and cleaned twice with 1.5× vol of Agencourt RNAClean XP beads (Beckman Coulter, A63987). Immediately following the 5′ adaptor ligation, the eluted RNA was ligated to the 3′ adaptor (Supplementary Table 5) using the same procedure. After incubation at 23 °C for 5 h, the reaction was diluted to 40 μl with water and cleaned twice with 1.5× vol of Agencourt RNAClean XP beads to remove excess adaptors. The sample was subsequently eluted with 0.1× TE buffer and subjected to ribosomal RNA removal with RiboMinus Transcriptome Isolation Kit (Thermo Fisher, K155004) following the manufacturer’s instructions. After recovery by ethanol precipitation, the RNA was reverse transcribed to cDNA with Eubacterium rectale maturase (recombinantly purified from Eco, obtained from A. M. Pyle)43 and 5′-phosphorylated and biotinylated reverse transcription primer (Supplementary Table 5). After purification, the cDNA was circularized with TS2126 RNA ligase44 (obtained from K. Ryan). Double-stranded DNA was synthesized by DNA PolI (New England BioLabs, M0209S). After enzyme inactivation and DNA purification with 1.5× vol of AMPure beads (Beckman Coulter, A63882), the DNA was subsequently fragmented by dsDNA Fragmentase (New England BioLabs, M0348S) at 37 °C for 15 min. The reaction was stopped by adding 5 μl of 0.5 M EDTA and incubated at 65 °C for 15 min in the presence of 50 mM dithiothreitol (DTT). Next, the DNA was diluted to 40 μl with TE buffer and purified with 1.5× vol of AMPure beads. The eluted DNA was used for sequencing library preparation with NEBNext Ultra II DNA Library Prep Kit (New England BioLabs, E7645). Biotinylated DNA fragments were enriched by 5 μl of Dynabeads M-280 Streptavidin (Thermo Fisher, 11205D) and further amplified for 12 cycles by PCR.

    Library preparation for primary RNA SEnd-seq

    A 5 μg quantity of total RNA was used for primary transcript enrichment with our previously published method3. In brief, the 5′-triphosphorylated RNA species was specifically capped with 3′-desthiobiotin-GTP (New England BioLabs, N0761) by the Vaccinia Capping System (New England BioLabs, M2080S). The RNA was subjected to 3′ adaptor ligation using the same procedure as described above and subsequently enriched with Hydrophilic Streptavidin Magnetic Beads (New England BioLabs, S1421). After washing thoroughly, the RNA was eluted and reverse transcribed to cDNA as described above. The remaining steps were the same as those for library preparation for total RNA SEnd-seq, except that the DNA library was amplified for 15 cycles.

    Illumina sequencing

    Following PCR amplification, each amplicon was cleaned by 1× vol of AMPure XP beads twice and quantified with a Qubit 2.0 fluorometer (Invitrogen). The amplicon size and purity were further evaluated on an Agilent 2200 Tape Station (Agilent Technologies, 5067-5576). Equal amounts of amplicon were then multiplexed and sequenced with 2 × 150 cycles on an Illumina NextSeq500 or NovaSeq6000 platform (Rockefeller University Genomics Resource Center).

    SEnd-seq data analysis

    Data processing

    After quality filtering and Illumina sequencing adaptor trimming with FASTX-Toolkit (v0.0.13), the raw paired-end reads were merged to single-end reads by using FLASh software (v1.2.11). The correlated 5′-end and 3′-end sequences were extracted by the custom script (fasta_to_paired.sh) using the SeqKit (v2.4.0) and Cutadapt (v4.1) packages. The inferred full-length reads were generated by Bedtools (v2.31.0) and Samtools (v1.17) after mapping to the reference genome (NC_000913.3 for Eco, NC_008596.1 for Msm and NC_018143.2 for Mtb) with Bowtie 2 (v2.5.1). The full-length reads with an insert length greater than 10,000 nt were discarded. The mapping results were visualized using the IGV genome viewer (v2.4.10). Data analysis and visualization scripts used Python packages including Matplotlib (v3.7.1), Numpy (v1.24.3), Scipy (v1.10.1), bioinfokit (v0.3), and pyCircos (v0.3.0).

    RNA coverage

    Each full-length read was first mapped to the genome in a specific direction. Directional RNA coverage was quantified by summing the number of aligned reads at each mapped nucleotide position. When comparing RNA coverage between samples, data were normalized by the total non-ribosomal RNA amount in each sample. For the samples treated with translation inhibitors, the abundance of spike-in RNAs was used for normalization. Coding TUs and asRNAs with high levels of expression were defined as those with an average RNA coverage of at least 10 for the first 100 nt downstream of the TSS. The circos plot was generated using the Python package pyCircos (github.com/ponnhide/pyCircos, version 0.2.0). The RNA coverage plots were generated using Matplotlib package45 and custom Python scripts.

    TSS identification

    TSSs were identified from the primary RNA SEnd-seq data using a custom Python script. Only positions with more than 10 reads starting at that position, and with an increase of at least 50% in read coverage compared to its upstream neighbouring position (for example, 50 reads at position −1 and 150 reads at position 0), were retained. Candidate TSS positions within 5 nt in the same orientation were grouped together, and the position with the largest amount of read increase was used as the representative TSS position. Motif analysis around the TSS regions (−40 nt to +5 nt) was carried out by MEME (v5.5.2)46.

    TTS identification

    Potential TTSs were identified from the total RNA SEnd-seq data at genomic positions with more than 10 reads ending at that position (outside rRNA genes) and with a reduction of more than 40% in read coverage compared to its upstream neighbouring position (for example, 100 reads at position −1 and 50 reads at position 0).

    TU annotation

    TUs were used in this work to analyse the transcription of coding genes. The genome was first segmented into preliminary TUs that contained annotated genes of the same direction. A preliminary unit was further segmented into multiple units if it contained any internal TSS with a strong activity (>2-fold increase in RNA coverage between downstream and upstream of the site for log-phase cell sample). As such, each TU contains a major TSS (TU start site) and possibly additional minor TSSs (<2-fold increase in RNA coverage). The end site of a TU was set to 10 nt before the start of a following co-directional TU, or the middle position between opposite genes that belong to two convergent TUs. TUs shorter than 700 nt and TUs annotated with only rRNA or tRNA genes were excluded from further analysis.

    Antisense transcript annotation

    asRNAs were called if there existed a strong antisense TSS within a given coding TU or if an opposite-direction TSS was found within the non-annotated 400-nt region downstream of a coding TU. The end site of an asRNA was set to the position where the RNA coverage dropped below 25% of the peak value.

    PF analysis

    Each coding TU was assigned with an upstream zone (from 0 to 200 nt downstream of the TSS) and a downstream zone (from 500 nt downstream of the TSS to the end of the TU). If there was another qualified TSS located within the downstream zone, the region downstream of that TSS was excluded from analysis. The ratio between the average RNA intensity of the downstream zone and that of the upstream zone was calculated as the PF for the corresponding TU. For asRNAs, the upstream and downstream zones were defined as 0–200 nt and 500–700 nt downstream of the TSS, respectively. The lower and upper bounds of PF values were set to be 0.0 and 2.0, respectively.

    Gene ontology analysis

    The Database for Annotation, Visualization, and Integrated Discovery (DAVID; v2023q2; https://david.ncifcrf.gov/)47 was used to carry out gene ontology analysis for Mtb genes with different PF values. The complete list of genes within each set was uploaded to DAVID under the headings of Cellular Compartment, Biological Process, and Molecular Function. Enriched categories with a P value < 0.05 were presented.

    NET-SEnd-seq

    Cell collection, lysis, and elongation complex pulldown protocols were adapted from a published study16 with modifications. Briefly, an ATc-inducible pIRL58 backbone plasmid bearing Mtb rpoC–6×His was transformed into Mtb mc2 6206 cells and the genome-integrated expression strain was picked as described above. For each pulldown sample, 55 ml of cell culture was prepared. When the cell culture reached the mid-log phase (OD600 = 0.5), 100 ng ml−1 ATc or an equivalent volume of solvent methanol was added to the medium, and the cells were cultured for another 12 h. After removing 4 ml of cell culture for total RNA extraction, the remaining cell culture was mixed with an equal volume of frozen 2× crush buffer (20 mM Tris-HCl pH 7.8, 10 mM EDTA, 100 mM NaCl, 1 M urea, 25 mM NaN3, 2 mM β-mercaptoethanol, 10% ethanol, 0.4% NP40, and 1 mM phenylmethylsulfonyl fluoride). The cells were subsequently precipitated by centrifugation at 4,000g for 10 min at 4 °C, immediately frozen in liquid nitrogen, and stored at −80 °C for at least 1 day. After thawing on ice, the cells were washed twice with 25 ml of cold PBS pH 7.4 and once with 5 ml of cold lysis buffer (20 mM KOH-HEPES pH 7.9, 50 mM KCl, 0.5 mM DTT, 5 mM CaCl2, 10% glycerol, 0.3 mM MgCl2, and 2.5 mM imidazole). The cells were then resuspended in 2 ml of lysis buffer, transferred to two 2-ml lysing matrix B tubes (MP Biomedicals, 116911050), and immediately lysed by bead beating with the Precellys Evolution homogenizer at 10,000 r.p.m. for 4× 45-s cycles with 60-s interval and chilled with dry ice. After centrifugation at 13,000g for 5 min, the supernatant was collected into a new 15-ml RNase-free tube. Each lysing matrix B tube was subjected to an additional round of bead beating with 1 ml of fresh lysis buffer and the supernatants were combined. Next, the collected sample was treated with 1 μl TURBO DNase (Life Technologies, AM2238) and incubated at room temperature for 10 min. After centrifugation at 4,000g for 10 min at 4 °C, the supernatant was transferred to a new 15-ml tube and incubated with 40 μl pre-washed Ni-NTA beads (Qiagen, 30230) for 1 h at 4 °C with continuous shaking at 100 r.p.m. After immobilization, the beads were washed four times with 5 ml of wash buffer (20 mM Tris-HCl pH 7.8, 1 M betaine, 5% glycerol, 2 mM β-mercaptoethanol, and 2.5 mM imidazole) and five times with 5 ml of pre-elution buffer (20 mM Tris-HCl pH 7.8, 40 mM KCl, 5% glycerol, 2 mM β-mercaptoethanol, and 2.5 mM imidazole). The immobilized complex was subsequently eluted with 300 μl of the pre-elution buffer containing 0.3 M imidazole. The nucleic acids in the eluates were extracted once with 200 μl phenol/chloroform/isoamyl alcohol (25:24:1, v/v/v) and once with 200 µl chloroform. The top aqueous phase was collected and precipitated by 3× volumes of ethanol, 0.1× vol of 3 M sodium acetate pH 5.2, and 2 μl glycogen (Thermo Fisher, AM9510). After precipitation at −20 °C overnight and maximum-speed centrifugation for 20 min, the pellet was washed twice with 300 µl of 75% ethanol. The pellet was then dissolved in 50 µl nuclease-free water and treated with 0.5 U Turbo DNase at 37 °C for 15 min. The residual RNA was extracted by phenol/chloroform/isoamyl alcohol, precipitated by ethanol and recovered in 11.5 µl of nuclease-free water. A 1 µl volume of spike-in RNA was added to each RNA sample, and the RNAs were ligated to a 3′ adaptor. The remaining steps were the same as those described above for total RNA SEnd-seq. The DNA library was amplified for 16 cycles by PCR.

    ChIP–seq

    A 50 ml volume of mid-log phase Mtb cells (OD600 = 0.8–1.0) were treated with 1% formaldehyde while the culture was agitated at room temperature for 30 min. Crosslinking was quenched by adding glycine to a final concentration of 250 mM for another 30 min while stirring at room temperature. The cells were pelleted by centrifugation at 4,000g for 10 min at 4 °C and washed three times with 20 ml of cold PBS and 0.1× protease inhibitor (Sigma, P8465). The cell pellet was stored at −80 °C for at least one day. After thawing on ice, the cells were washed once with 5 ml of IP lysis buffer (20 mM KOH-HEPES pH 7.9, 50 mM KCl, 0.5 mM DTT, 5 mM CaCl2, and 10% glycerol) and resuspended in 2 ml of IP lysis buffer. The cells were then transferred to two 2-ml lysing matrix B tubes (MP Biomedicals, 116911050) and immediately lysed by bead beating with the Precellys Evolution homogenizer at 10,000 r.p.m. for 4× 45-s cycles with a 60-s interval and chilled with dry ice. After centrifugation at 13,000g for 5 min, the supernatant was collected into a new 15-ml RNase-free tube. Each lysing matrix B tube was subjected to an additional round of bead beating after adding 1 ml of fresh IP lysis buffer. After centrifugation at 4,000g for 10 min at 4 °C and sampling for input control, 4 ml of supernatant was transferred to a new 15-ml tube and incubated with 0.75 µl of micrococcal nuclease (New England BioLabs, M0247S) at 37 °C for 15 min with continuous shaking. The reaction was stopped by adding EDTA at a final concentration of 25 mM, and the supernatant was transferred to a new 15-ml tube after centrifugation at 4,000g for 10 min at 4 °C. A 3 µl volume of anti-Eco σ70-factor antibody (BioLegend, 663208; 1:1,333 dilution) or 5 µl of anti-Eco RNAP β-subunit antibody (BioLegend, 663903; 1:800 dilution) was used to immunoprecipitate Mtb σA-factor and Mtb RNAP, respectively. After overnight incubation, 40 µl of pre-washed protein A/G agarose beads (Thermo Fisher, 26159) were added and incubated for 2 h at 4 °C and for another 30 min at room temperature. The beads were then washed ten times with 5 ml IPP150 buffer (10 mM Tris-HCl pH 8.0, 150 mM NaCl, and 0.1% NP40) and once with 5 ml TE buffer. Next, the DNA was eluted with 150 µl of elution buffer (50 mM Tris-HCl pH 8.0, 10 mM EDTA, and 1% SDS) followed by 100 µl TE buffer with 1% SDS. After thoroughly removing the beads by centrifugation at 2,000g for 5 min at 4 °C, the combined supernatants were incubated with 1 mg ml−1 Pronase (Sigma, 537088) at 42 °C for 2 h and then at 65 °C for 9 h. The sample was cleaned twice with 200 µl of phenol/chloroform/isoamyl alcohol (25:24:1, v/v/v) and recovered by ethanol precipitation. Finally, the sequencing libraries for immunoprecipitated DNA and input control were prepared using the NEBNext Ultra II DNA Library Prep Kit. After sequencing and quality filtering, the reads were mapped to the Mtb genome using Bowtie 2. The ChIP–seq signals were extracted and plotted using custom Python scripts.

    Analysis of deposited RNA-seq data

    The RNA-seq datasets SRR5689224 and SRR5689225 (BioProject PRJNA390669)12 from log-phase Mtb cells cultured in dextrose-containing medium were used to compare the RNA coverage between SEnd-seq and RNA-seq. The RNA-seq datasets SRR5061507, SRR5061514, SRR5061706 and SRR5061510 (BioProject PRJNA354066)18 from Mtb cells with Rho depletion were used to compare to the rho-knockdown SEnd-seq datasets. The deposited datasets were downloaded from the National Center for Biotechnology Information. After read extraction and quality filtering, the reads were mapped to the Mtb genome using Bowtie 2 (v2.5.1). The RNA intensities were extracted and plotted using custom Python scripts.

    Analysis of deposited Ribo-seq data

    Mtb Ribo-seq data were downloaded from the EMBL-EBI database (E-MTAB-8835)21. After read extraction and quality filtering, the reads were mapped to the Mtb genome using Bowtie 2. The directional ribosome binding signals were extracted and plotted using a custom Python script.

    Immunoblot

    Mtb cells were lysed with TRIzol reagent as described above, and protein samples were extracted following a TRIzol-based protein extraction protocol provided by the manufacturer. Immunoblotting was carried out as described previously48. Antibodies against His-tag (Santa Cruz, sc-8036; 1:1,000 dilution), Mtb Rho (obtained from D. Schnappinger; 1:200 dilution), and Eco RpoB (BioLegend, 663903; 1:1,000 dilution) were used.

    qPCR

    A 1–10 μg amount of total RNA was treated with 0.5 μl of TURBO DNase (Life Technologies, AM2238) at 37 °C for 30 min to remove the genomic DNA. The sample was diluted to 100 μl with RNase-free water and then cleaned three times with 100 μl of H2O-saturated phenol/chloroform/isoamyl alcohol (25:24:1, v/v/v). After ethanol precipitation, 1 μg of RNA was reverse transcribed to cDNA with the High-Capacity cDNA Reverse Transcription Kit (Thermo Fisher, 4368814) following the manufacturer’s instructions. qPCR was conducted using synthesized primers and the SYBR green master mix (Thermo Fisher, 4309155) on a QuantStudio5 Real-Time PCR System (Thermo Fisher). The relative RNA abundance was presented as the signal ratio between the target transcript and the reference 16S rRNA from the same sample using the formula: 2Ct(16S) − Ct(target), in which Ct denotes the cycle threshold.

    Inducible lacZ transcription in Mtb

    Plasmid pIRL58 was modified by removing the sgRNA expression cassette and replacing the dCas9Sth1 gene body with the Eco lacZ coding region, allowing the synthesis of lacZ RNA under the control of ATc-inducible promoter Ptet. The modified plasmid was co-transformed into Mtb mc26206 cells with pIRL19 as described above. Cells from a single colony of Mtb Ptet-lacZ after selection were exponentially grown to an OD600 of about 0.8 followed by the addition of 100 ng ml−1 ATc to induce lacZ transcription. After induction, 4 ml of cell culture was withdrawn at indicated time points and mixed with 4 ml GTC buffer in a new tube as sample t (St). One extra sample taken immediately before ATc addition was referred to as S0. After RNA isolation and TURBO DNase treatment as described above, 1 µg of total RNA was used to synthesize the cDNA for qPCR. The relative lacZ mRNA abundance at each time point is defined as 2Ct(S0) − Ct(St), in which Ct denotes the cycle threshold.

    In vitro transcription

    DNA fragments were amplified by PCR from Mtb genomic DNA with primer sets listed in Supplementary Table 5. An AP3 promoter sequence was inserted into one end of the fragment and an intrinsic terminator (derived from TsynB in pIRL58) was placed at the other end. The DNA fragment was then incorporated into the pUC19 plasmid. The plasmid templates were prepared from Eco DH5α cells and subsequently treated with 2 µl RNase A (Thermo Fisher, EN0531) for 30 min and 2 µl Proteinase K (New England BioLabs, P8107S) for 1 h. The plasmid templates were cleaned three times with phenol/chloroform/isoamyl alcohol (25:24:1, v/v/v) and recovered by ethanol precipitation.

    To prepare templates with a preformed bubble, the DNA fragment containing the intrinsic terminator was amplified from the plasmid DNA described above by PCR. The product was cleaned with QIAQuick PCR purification kit (Qiagen, 28104) and phenol/chloroform/isoamyl alcohol (25:24:1, v/v/v). The bubble template was constructed by ligating a DNA adaptor (NEBNext adaptor for Illumina) to each end of the DNA fragment using NEBNext Ultra II DNA Library Prep Kit. After XbaI digestion (cut site immediately after the terminator), the DNA template was purified using AMPure XP beads.

    Purified Mtb RNAP, σA-factor, NusA, and NusG were prepared as described previously38,49,50. The in vitro transcription mixture contained 2 μl of 10× transcription buffer (200 mM Tris-acetate pH 7.9, 0.5 M potassium acetate, 100 mM magnesium acetate, 10 mM DTT, and 50 µg ml−1 BSA), 1 μl RNase inhibitor, 0.5 pmol of DNA template, and 2 pmol of Mtb RNAP holoenzyme (or core RNAP alone) in a 20 μl volume. The mixture was incubated at 37 °C for 15 min before the addition of rNTPs (100 μM each). At indicated time points, the reaction was quenched by adding EDTA at a final concentration of 20 mM and 2 μl of Proteinase K and incubating for 30 min. The reaction was then diluted to 100 μl with RNase-free H2O and cleaned three times with phenol/chloroform/isoamyl alcohol (25:24:1, v/v/v). After ethanol precipitation and resuspension with 30 μl RNase-free H2O, 0.5 μl DNase I (New England BioLabs, M0303S), 3.5 μl of DNase buffer, and 1 μl RNase inhibitor were added. After incubation at 37 °C for 30 min, the RNA product was cleaned three times with phenol/chloroform/isoamyl alcohol (25:24:1, v/v/v) and recovered by ethanol precipitation. Half of the RNA was converted to cDNA with the High-Capacity cDNA Reverse Transcription Kit and evaluated by qPCR as described above. RNA abundances were normalized to a diluted plasmid DNA sample with a concentration of 0.033 ng ml−1.

    Statistics

    Statistical analyses were conducted with Excel (version 16.178.3) or GraphPad Prism (version 10.1.0). GraphPad Prism (version 10.1.0) or the Python Matplotlib package (version 3.7.1) was used for plotting.

    Reporting summary

    Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article.

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  • Study reveals BCG vaccine’s unexpected role in fighting influenza

    Study reveals BCG vaccine’s unexpected role in fighting influenza

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    As Canada’s flu season collides with record strep A cases and ongoing COVID-19 concerns, a new study is shedding light on our understanding of respiratory immune responses. Scholars from the Research Institute of the McGill University Health Centre (RI-MUHC) have discovered a surprising facet about a century-old vaccine for tuberculosis, Bacillus Calmette Guérin (BCG). The study, published in the journal Nature Immunology, uncovered a previously unknown mechanism that extends the vaccine’s shield to combat influenza A virus-;the most prevalent flu strain.

    The immune interactions involved here can ‘train’ the lungs, which are frequently exposed to infectious agents in the environment. If we can map out the protective immune pathways involved in the lungs, this will revolutionize our conceptual and clinical approaches in developing vaccines against infections, including emergent respiratory viruses.”


    Maziar Divangahi, lead author, pulmonary immunologist, senior scientist at the RI-MUHC, and Professor of Medicine at McGill University

    The discovery paves the way for future studies to assess whether BCG could be used to prevent other emergent viruses. Notably, research on the vaccine’s protection against COVID-19 has had promising results.

    Source:

    Journal reference:

    Tran, K. A., et al. (2024). BCG immunization induces CX3CR1hi effector memory T cells to provide cross-protection via IFN-γ-mediated trained immunity. Nature Immunology. doi.org/10.1038/s41590-023-01739-z.

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