Decoding drug resistance in Mycobacterium tuberculosis complex: genetic insights and future challenges

Area of Science:

• Microbiology
• Genetics
• Public Health

Background:

• Tuberculosis (TB), including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), remains a critical global health concern.
• The increasing complexity of drug resistance in *Mycobacterium tuberculosis* (MTB) hinders eradication efforts despite treatment and diagnostic advancements.

Purpose of the Study:

• To review the complexities of anti-TB drug resistance, including its genetic mechanisms.
• To explore advanced diagnostic techniques and their impact on managing drug-resistant TB.
• To discuss current treatment strategies, challenges, global disparities, and future research directions.

Main Methods:

• Review of genetic underpinnings of resistance to first- and second-line anti-TB drugs.
• Exploration of advanced diagnostic techniques like Whole-Genome Sequencing (WGS) and CRISPR-based diagnostics.
• Discussion of artificial intelligence applications, treatment strategies, and global health disparities.

Main Results:

• Mutations in key genes are central to the genetic basis of anti-TB drug resistance.
• Advanced diagnostics, including WGS and CRISPR, offer improved identification and management of drug-resistant TB.
• AI applications and personalized medicine approaches show potential for revolutionizing TB management.

Conclusions:

• An integrated approach combining advanced diagnostics, novel therapeutics, and global collaboration is essential for combating anti-TB drug resistance.
• Future research should focus on polygenic resistance and personalized medicine.
• Equitable access to diagnosis and treatment, alongside robust funding, is crucial for effective TB control.