Host-focused immunity, metabolism, and diagnostic innovation for precision control of tuberculosis globally

Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), remains one of the deadliest infectious diseases worldwide. Despite advances in treatment and diagnostics, challenges such as multidrug resistance, inadequate vaccines, diagnostic gaps and health inequities continue to impede global control efforts. This review explores emerging insights into host-pathogen interactions, with emphasis on host-directed interventions, trained innate immunity, and immunometabolic reprogramming of TB as complementary approaches. We highlighted advances in rapid and point-of-care diagnostics, including nucleic acid amplification, transcriptomic, proteomic and metabolomic biomarkers, breath-omics, and smartphone-integrated monitoring tools. Furthermore, we discussed multi-omics integration and artificial intelligence (AI) approaches that offer transformative potential for biomarker discovery, patient stratification, and personalized therapy. By shifting the focus from pathogen elimination to host resilience, we emphasized the importance of interdisciplinary collaboration and innovation in accelerating TB elimination globally. Our findings call for a host-inclusive framework to strengthen global TB control, enhance equity, and translate cutting-edge science into field-ready applications.