Long non-coding RNAs in tuberculosis: Immune regulation and clinical biomarker potential

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains the leading infectious cause of mortality worldwide, with an estimated 1.25 million deaths in 2023. Despite therapeutic advances, the lack of precise early screening tools continues to impede epidemic control. Long non-coding RNAs (lncRNAs) have emerged as essential modulators of host anti-Mtb immunity, and elucidating their functional mechanisms is pivotal for developing effective interventions. This review systematically synthesizes lncRNA-mediated immune regulation during Mtb infection, with emphasis on their roles in modulating immune cell death, extending beyond apoptosis to encompass necrosis and pyroptosis. Importantly, we provide a comprehensive analysis of lncRNAs and related gene polymorphisms as predictive biomarkers for anti-TB drug-induced adverse reactions. Current research gaps and future priorities are also discussed. Together, the dual potential of lncRNAs as molecular diagnostics and candidate targets for host-directed therapy represents a promising frontier in TB management.