Closing the Translational Gap in Tuberculosis Lipidomics for Resource-Constrained Settings

Tuberculosis (TB) host lipidomics research has produced a technically sophisticated evidence base that remains structurally unprepared for clinical translation. Discovery-phase, cross-sectional studies dominate the field; longitudinal and independently validated studies remain scarce; and no study has yet linked a host plasma lipid signature to a direct aerobiological measure of infectiousness, such as Cough Aerosol Culture (CAC) positivity. We argue that closing this gap requires a deliberate reorientation of the field: from single-time-point diagnostic discovery toward prospective, longitudinal cohort designs; from reliance on systemic blood-based matrices alone toward non-invasive, point-of-care-compatible specimens such as urine and exhaled breath; and from fragmented, idiosyncratic reporting toward standardized frameworks that allow findings to be pooled and compared across studies. We further argue that low- and middle-income countries (LMICs), which host the majority of the existing TB lipidomics evidence base and carry the greatest burden of disease, are well positioned to lead this next phase rather than wait for it to be imported. This Perspective sets out the case for that reorientation and proposes a concrete translational agenda built around three pillars: longitudinal validation, a point-of-care specimen shift, and reporting standardization.