Metabolomic Biomarkers for Monitoring Tuberculosis Treatment Response: A Comprehensive Literature Review

Area of Science:

• Biochemistry
• Immunology
• Medical Diagnostics

Background:

• Tuberculosis (TB) poses a significant global health burden, with current diagnostic tools for treatment monitoring being limited.
• Sputum-based methods for TB diagnosis are often insensitive and impractical, especially for extrapulmonary or pediatric cases.

Purpose of the Study:

• To synthesize existing evidence on metabolomic biomarkers for monitoring tuberculosis treatment response.
• To identify key metabolic pathways associated with treatment-associated immunometabolic changes in TB patients.

Main Methods:

• A comprehensive literature review was conducted across PubMed, Scopus, and EMBASE databases.
• Included studies utilized targeted or untargeted metabolomics techniques (NMR, LC-MS, GC-MS, CE-MS).
• Data extraction and risk of bias assessment were performed by two independent reviewers.

Main Results:

• Fifteen studies met the inclusion criteria, revealing recurrent signals in amino acid metabolism (tryptophan-kynurenine pathway), vitamin/cofactor metabolism, lipid remodeling, and bile acid perturbations.
• Plasma studies indicated lipid and bile acid changes, while urine studies highlighted polyamine metabolism and fatty acid oxidation markers.
• Common limitations included confounding factors, small sample sizes, and insufficient external validation in predictive models.

Conclusions:

• Metabolomics demonstrates reproducible, albeit heterogeneous, immunometabolic alterations during TB therapy.
• Key identified pathways include tryptophan-kynurenine, vitamin/cofactor metabolism, lipid remodeling, and urine polyamine pathways.
• Standardization and multicenter validation are crucial for the clinical translation of metabolomic biomarkers in TB management.