Advances in tuberculosis biomarkers: unravelling risk factors, active disease and treatment success

Tuberculosis (TB) is a major global health threat and demands improved diagnostic and treatment monitoring methods. Conventional diagnostics, such as sputum smear microscopy and culture, are limited by slow results and low sensitivity, particularly in certain patient groups. Recent advances in biomarker research offer promising solutions in three key areas: risk of disease, diagnosis of active disease and monitoring of treatment response. For risk assessment, novel genetic signatures and metabolites show potential in predicting the progression from TB infection to active TB. A 16-gene signature, for example, predicts this progression with significant accuracy. In diagnosing active TB, RNA-based transcriptomic signatures provide higher diagnostic accuracy than traditional methods. These signatures, such as a three-gene RNA sequence, effectively differentiate active TB from other diseases and infections, addressing issues of specificity and sensitivity. Monitoring treatment response is crucial, given the varying response rates in treating TB. Emerging biomarkers focus on bacterial burden and host response. They offer more precise and timely assessments of treatment efficacy, enhance personalised treatment approaches and potentially improve patient outcomes. These advancements in biomarkers for TB risk, diagnosis and treatment response represent significant steps towards more effective TB management and control, aligning with global efforts to decrease the burden of TB. Here we aim to highlight several promising biomarkers used to predict risk of disease progression, active TB disease and treatment success.