Host-pathogen relationship in retreated tuberculosis with major rifampicin resistance-conferring mutations

Nguyen Thi Le Hang; Minako Hijikata; Shinji Maeda; Pham Huu Thuong; Hoang Van Huan; Nguyen Phuong Hoang; Do Bang Tam; Pham Thu Anh; Nguyen Thu Huyen; Vu Cao Cuong; Nobuyuki Kobayashi; Keiko Wakabayashi; Akiko Miyabayashi; Shintaro Seto; Naoto Keicho

doi:10.3389/fmicb.2023.1187390

Host-pathogen relationship in retreated tuberculosis with major rifampicin resistance-conferring mutations

Front Microbiol. 2023 Jul 4:14:1187390. doi: 10.3389/fmicb.2023.1187390. eCollection 2023.

Authors

Nguyen Thi Le Hang¹, Minako Hijikata², Shinji Maeda³, Pham Huu Thuong⁴, Hoang Van Huan⁵, Nguyen Phuong Hoang⁶, Do Bang Tam⁷, Pham Thu Anh⁸, Nguyen Thu Huyen^{1

9}, Vu Cao Cuong¹⁰, Nobuyuki Kobayashi¹¹, Keiko Wakabayashi², Akiko Miyabayashi², Shintaro Seto², Naoto Keicho^{12

13}

Affiliations

¹ NCGM-BMH Medical Collaboration Center, Hanoi, Vietnam.
² Department of Pathophysiology and Host Defense, The Research Institute of Tuberculosis, JATA, Tokyo, Japan.
³ Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo, Hokkaido, Japan.
⁴ My Duc District General Hospital, Hanoi, Vietnam.
⁵ Hanoi Lung Hospital, Hanoi, Vietnam.
⁶ Department of Microbiology, Hanoi Lung Hospital, Hanoi, Vietnam.
⁷ Department of Biochemistry, Hematology and Blood Transfusion, Hanoi Lung Hospital, Hanoi, Vietnam.
⁸ Tuberculosis Network Management Office, Hanoi Lung Hospital, Hanoi, Vietnam.
⁹ Department of Health Policy and Economics, Hanoi University of Public Health, Hanoi, Vietnam.
¹⁰ Hanoi Department of Health, Hanoi, Vietnam.
¹¹ Department of Internal Medicine, Fureai Machida Hospital, Tokyo, Japan.
¹² The Research Institute of Tuberculosis, JATA, Tokyo, Japan.
¹³ National Center for Global Health and Medicine, Tokyo, Japan.

Abstract

Introduction: It is assumed that host defense systems eliminating the pathogen and regulating tissue damage make a strong impact on the outcome of tuberculosis (TB) disease and that these processes are affected by rifampicin (RIF) resistance-conferring mutations of Mycobacterium tuberculosis (Mtb). However, the host responses to the pathogen harboring different mutations have not been studied comprehensively in clinical settings. We analyzed clinico-epidemiological factors and blood transcriptomic signatures associated with major rpoB mutations conferring RIF resistance in a cohort study.

Methods: Demographic data were collected from 295 active pulmonary TB patients with treatment history in Hanoi, Vietnam. When recruited, drug resistance-conferring mutations and lineage-specific variations were identified using whole-genome sequencing of clinical Mtb isolates. Before starting retreatment, total RNA was extracted from the whole blood of HIV-negative patients infected with Mtb that carried either the rpoB H445Y or rpoB S450L mutation, and the total RNA was subjected to RNA sequencing after age-gender matching. The individual RNA expression levels in the blood sample set were also measured using real-time RT-PCR. Logistic and linear regression models were used to assess possible associations.

Results: In our cohort, rpoB S450L and rpoB H445Y were major RIF resistance-conferring mutations [32/87 (36.8%) and 15/87 (17.2%), respectively]. H445Y was enriched in the ancient Beijing genotype and was associated with nonsynonymous mutations of Rv1830 that has been reported to regulate antibiotic resilience. H445Y was also more frequently observed in genetically clustered strains and in samples from patients who had received more than one TB treatment episode. According to the RNA sequencing, gene sets involved in the interferon-γ and-α pathways were downregulated in H445Y compared with S450L. The qRT-PCR analysis also confirmed the low expression levels of interferon-inducible genes, including BATF2 and SERPING1, in the H445Y group, particularly in patients with extensive lesions on chest X-ray.

Discussion: Our study results showed that rpoB mutations as well as Mtb sublineage with additional genetic variants may have significant effects on host response. These findings strengthen the rationale for investigation of host-pathogen interactions to develop countermeasures against epidemics of drug-resistant TB.

Keywords: Mycobacterium tuberculosis; blood transcriptomic signatures; interferon-inducible genes; recurrence; rifampicin resistance; rpoB variants; whole genome sequencing.