Transcriptional biomarkers for predicting development of tuberculosis: progress and clinical considerations

[摘要] Achieving the ambitious targets for global tuberculosis (TB) control, will require an increased emphasis on preventing development of active disease in those with latent TB infection (LTBI) by preventative treatment or vaccination [1]. New shortened regimens of 1–3 months duration potentially allow much wider and more effective use of preventive therapy [2, 3]. A significant barrier is the limited ability to reliably identify those at high risk of disease progression, leading to high numbers needed to treat (NNT) to prevent a case of TB [4]. Hence, there is an interest in developing new diagnostic tests that better predict TB disease to allow more targeted preventive treatment and lower NNT [5]. These are often referred to as tests for incipient TB, stemming from the notion that TB prediction with low NNT most likely reflects detection of an early inflammatory response to multiplying Mycobacterium tuberculosis [6]. There are a number of promising biomarkers in development and undergoing evaluation as incipient TB tests [7]. Although it will be a few years before validated and approved diagnostics are ready for use in clinic, there is the potential for such tests to transform the TB management paradigm and provide a fresh approach to TB control. However, how such tests fit into future TB management and control algorithms is not fully defined and there remain limitations in their potential utility as well as a number of research gaps in this area.

[学科分类] 呼吸医学