Transmission between hosts is crucial for the success and survival of the obligate human pathogen and aetiological agent of tuberculosis (TB), Mycobacterium tuberculosis (Mtb). Despite this, little is known about how and when Mtb is aerosolized nor the key metabolic and morphological determinants driving successful transmission. To address these knowledge gaps, my doctoral research sought to develop a microscopic method for the detection of aerosolized Mtb following liquidcapture within the respiratory aerosol sampling chamber (RASC). This was achieved through the combination of the mycobacterial cell wall probe, 4-N,Ndimethylamino-1,8-naphthalimide-trehalose (DMN-tre), with the arraying of bioaerosol samples on bespoke nanowell devices amenable to fluorescence microscopy. With this method, a median of 14 live Mtb bacilli (range 0-36) were detected in 90% of confirmed TB patients following 60 minutes of bioaerosol sampling. Three distinct DMN-tre staining patterns were identified among aerosolized Mtb, strongly suggestive of metabolic heterogeneity. Moreover, a low proportion of patients produced Mtb in small clumps. These observations highlight the advantages of using microscopy over conventional culture- or molecular-based techniques for probing the metabolic and morphological characteristics of aerosolized Mtb. Applying this method in a second study, we sought to understand how and when Mtb is aerosolized. To this end, we aimed to compare the aerosolization of Mtb and total particulate matter from patients with TB during three respiratory manoeuvres: tidal breathing (TiBr), forced vital capacity (FVC), and cough. Although total particle counts were 4.8-fold greater in cough samples than either TiBr or FVC, all three manoeuvres returned similar rates of positivity for Mtb. No correlation was observed between total particle production and Mtb count. Instead, for total Mtb counts, the variability between individuals was greater than the variability between sampling manoeuvres. Finally, when modelled using 24-hour breath and cough frequencies, our data indicate that TiBr might contribute more than 90% of the daily aerosolized Mtb among symptomatic TB patients. Assuming the number of viable Mtb organisms detected provides a proxy measure of patient infectiousness, this method suggests that TiBr is a significant contributor to TB transmission. In developing a novel platform for the detection of aerosolized Mtb, this work has suggested the need to re-examine old assumptions about Mtb transmission.

The serious threat of tuberculosis, especially XDR-TB, is a reality in Southern Africa particularly in individuals with HIV/AIDS. Therefore the importance of development of new or improved anti-TB treatment must now be emphasized more than ever. In this study, a model was created to target isoniazid (toxophore) specifically to a cholesterol rich environment where mycobacteria reside in macrophages, by making use of a sterol binding drug, Amphotericin B (haptophore). Isoniazid was covalently linked to Amphotericin B via a Schiff base to a linker molecule, terephthalaldehyde. Although this molecule showed a loss of biological activity, a discovery was made by serendipity that could have great impact in understanding how Mycobacterium tuberculosis enters and survives in the host macrophage. During the testing of the compound, it was discovered that Amphotericin B bound to mycolic acids at least as well as it binds to cholesterol, its natural ligand. This could provide proof of the structural similarity between mycolic acids and cholesterol but many more controls need to be investigated. As cholesterol was previously shown in literature to be critical for entry and survival of Mycobacterium tuberculosis in macrophages, the indication of a structural mimicry between the cell wall mycolic acids and cholesterol and the attraction of these two chemical entities to one another seems to be highly relevant. This characteristic can now be further explored to improve the understanding of the process of entry and survival of Mycobacterium tuberculosis in the macrophage host. Copyright 2006, University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. Please cite as follows: Benadie, Y 2006, Amphotericin B as a mycolic acid specific targeting agent in tuberculosis, MSc dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd-04212008-151642 / > / Dissertation (MSc (Biochemistry))--University of Pretoria, 2008. / Biochemistry / unrestricted

Despite effective antibiotics, Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis, still infects nearly one-third of the world's population. While key immune factors including CD4+ T cells and IFNg production have been identified, there are still many antimicrobial mechanisms yet to be explored. Here we characterized the role of invariant natural killer T (iNKT) cells and GM-CSF during Mtb infection.

Tuberculosis (TB) is a disease that the World Health Organisation (WHO) regards as a global pandemic. There is a great need for new drugs to combat this threat. Drug resistant strains of the causative agent, Mycobacterium tuberculosis (Mtb), have increased the urgency of this quest for novel anti-mycobacterial medicines. Publication of the Mtb genome sequence revealed a large number of cytochrome P450 (CYP) enzymes [Cole, S. T. et al. 1998]. These mono-oxygenase enzymes have been studied for many years and are responsible for metabolic functions in every kingdom of life. Research on the Mtb P450s to date has highlighted several of them as having critcal roles within the organism. CYP121 and CYP128 have been implicated as essential through gene knockout studies. It has been demonstrated that CYP125 is not essential for viability. However, it is part of a gene cluster highly important for Mtb infectivity and virulence. Due to the prospective importance of P450s to Mtb, this group of enzymes is under investigation as a source of novel drug targets. CYP142 was discovered as a potential drug target after it was located to a gene cluster involved in cholesterol catabolism during Mtb dormancy. As part of this PhD project, it was demonstrated that CYP142 performs an almost identical role to that reported for CYP125. These enzymes both perform C27 hydroxylation and carboxylation of the cholesterol side chain. However, variations in the level of oxidation have been identified, dependent upon the redox system with which these P450s are associated. A crystal structure of CYP142 showing high similarity in active site architecture to CYP125 supports the physiological role of CYP142 in cholesterol catabolism. Combining this with in vitro data which demonstrates that CYP142 possesses high affinity for a range of azole anti-fungal agents [Ahmad, Z. et al. 2005, 2006] supports the suggestion that it is a candidate target for the next generation of anti-mycobacterial drugs. CYP144 was highlighted as being important during the latent phase of Mtb growth, a phase that is not targeted by any of the current antimycobacterials. Work performed as part of this PhD has shown that many characteristics of CYP144 are highly comparable to those reported for other MtbP450s. CYP144 shows high affinity and specificity towards many azole molecules. Econazole, clotrimazole and miconazole have repeatedly been shown to bind to MtbP450s, including CYP144 and CYP142, with high affinity and are excellent potential candidates as novel anti-mycobacterial agents. An N-terminally truncated form of CYP144, CYP144-T, has been investigated in the pursuit of a CYP144 crystal structure. It is hoped that this will enable the elucidation of a physiological role for CYP144. Both CYP142 and CYP144 have demonstrated biochemical and biophysical characteristics that contribute to our knowledge of P450 enzymes. This PhD has established that CYP142 exhibits an equilibrium between P450 and P420 species in its CO-bound, ferrous form. A conversion from P420, and stabilisation of P450, upon substrate binding was also demonstrated. CYP144 displays unusual azole coordination characteristics when examined by EPR and removal of the CYP144 gene from Mtb increased sensitivity of the strain to clotrimazole. Studies of these enzymes has advanced knowledge of P450 and Mtb redox chemistry, established roles for the MtbP450 cohort and identified the potential of anti-mycobacterial drugs and associated targets.

A tuberculose (Tb) é uma doença infecciosa crônica ocasionada pelo bacilo Mycobacterium tuberculosis (Mtb). No espaço alveolar, o bacilo entra em contato com células do sistema imune inato como as células dendríticas (DCs), assim como células epiteliais (AEC). Na Tb, o fator de transcrição HIF-1? (Fator Induzido por Hipóxia 1 alfa) se encontra elevado em macrófagos infectados e células epiteliais alveolares adjacentes. Por isso, o objetivo deste trabalho foi investigar o papel de HIF-1? na resposta pró- inflamatória de AEC do tipo II (AEC-II) e na modulação da função de DCs em contato com AEC-II durante a infecção por Mtb. Células MLE-15 foram infectadas com Mtb H37Rv (MOI10) para avaliação da permissividade à infecção (microscopia eletrônica), crescimento dos bacilos (CFU) e ativação através da análise de citocinas (ELISA), nitrito (ensaio de Griess), TLR2, TLR9 e HIF-1? (qPCR e/ou Western blotting). A modulação DCs derivadas da medula óssea (BMDCs) por AEC-II, foi analisada de forma direta (contato) ou indireta (meio condicionado - CM) de MLE-15 não infectadas (CM - NIC) ou infectadas (CM - IC). Foram determinadas citocinas (ELISA), nitrito (Ensaio de Griess), expressão de HIF-1?, enzimas glicolíticas, moléculas co-estimuladoras e CCR7 (citometria de fluxo). Ensaio de migração foi realizando em câmera de boyden. A proliferação de células T CD4+ naive em co-cultura com BMDCs e a manutenção da Th17 foram avaliadas por citometria de fluxo. Eventualmente, BMDCs foram previamente infectadas com Mtb (MOI2) e, em seguida, estimuladas com CM-NIC ou CM-IC. Células MLE-15 mostraram-se permissivas à infecção, não conseguindo controlar o crescimento dos bacilos. A infecção induziu aumento da produção de IL-6, NO2-,CCL5, S100A9 e IFN- ?. Apesar do acúmulo inicial de HIF-1?, a expressão gênica caiu com o passar do tempo. A expressão gênica de TLR2 e TLR9 também estava aumentada. A regulação positiva10 de HIF-1? em células epiteliais induziu uma redução de IL-6 e NO, sem, no entanto, interferir significativamente no número de CFU. BMDCs estimuladas com CM - IC mostraram maior produção de IL-1?, IL-12, IL-6 e IL-10, maior expressão gênica de GLUT1 e HK2, além do acúmulo inicial de HIF-1?, que foi degradado em 24 horas, acompanhado de baixa expressão de iNOS. A expressão MHC-II, CD80, CD86 e CCR7 estava aumentada em BMDCs submetidas ao CM - IC, enquanto a indução do acúmulo de HIF-1? através do seu estabilizador, DMOG, foi capaz de reverter negativamente essa resposta. A maior maturação de BMDCs ocasionou maior proliferação de células TCD4+ naive, desfavorecendo a indução de células T CD4+ IFN?+. Entretanto, as citocinas produzidas favorecerem a manutenção de células TCD4+ produtoras de IL-17. No entanto, o fenótipo de maior maturação foi perdido em BMDCs infectadas estimuladas com CM - IC, aliado à baixa produção de TNF e alta produção de IL-10. Em conclusão, HIF-1? mostrou uma função anti-inflamatória, reduzindo a produção de moléculas pró- inflamatórias por AEC-II e regulando negativamente a maturação e a migração de DCs. Além disso, apesar de AEC-II infectadas por Mtb favorecerem a maturação e migração de DCs, o Mtb é capaz de subverter essa resposta / Tuberculosis (Tb) is a chronic infectious disease caused by the bacillus Mycobacterium tuberculosis (Mtb). In the alveolar space, the bacillus contacts cells from the immune system, such as dendritic cells (DCs), as well as alveolar epithelial cells (AEC). In Tb, the transcription factor HIF-1? (Hypoxia-inducible factor 1- alpha) is accumulated in infected macrophages and adjacent alveolar epithelial cells. Therefore, the aim of this work was to investigate the role of HIF-1? in the proinflammatory response of type II AEC (AEC-II) and modulation of DCs function upon contact with AEC-II during Mtb infection. MLE-15 cells were infected with Mtb H37Rv (MOI10) to evaluate the permissiveness to infection (electron microscopy), killing ability (CFU) and cell activation through cytokine analysis (ELISA), nitrite (Griess assay), TLR2, TLR9 and HIF-1? (qPCR and / or Western blotting). Bone marrow derived DCs (BMDCs) modulation by AEC-II, were analyzed directly (contact) or indirectly (conditioned medium - CM) of uninfected (CM-NIC) or infected (CMIC) MLE-15. We determined cytokines (ELISA), nitrite (Griess Assay), HIF-1? expression, glycolytic enzymes, co-stimulatory molecules and CCR7 (flow cytometry). Chemotaxie assay was performed on Boyden camera. Proliferation of naive CD4 + T cells in co-culture with BMDCs and maintenance of Th17 were assessed by flow cytometry. Eventually, BMDCs were previously infected with Mtb (MOI2) and then stimulated with CM-NIC or CM-IC. MLE-15 cells were permissive to infection, failing to control the bacilli growth. Infection induced increased production of IL-6, NO2-, CCL5, S100A9 and IFN-?. Despite the initial accumulation of HIF-1?, gene expression dropped over time. The gene expression of TLR2 and TLR9 was also increased. Positive regulation of HIF-1? in epithelial cells induced a reduction of IL-6 and NO, but did not significantly interfere with the number of CFU. BMDCs stimulated with CM-IC showed higher production of IL-1?, IL-12, IL-6, and IL-10, greater GLUT1 and HK2 gene expression, in addition to the initial12 accumulation of HIF-1?, which was degraded within 24 hours, accompanied by low iNOS expression. The expression of MHC-II, CD80, CD86 and CCR7 was increased in BMDCs undergoing CM-IC, while the induction of HIF-1? accumulation through its stabilizer, DMOG, was able to negatively revert this response. The higher maturation of BMDCs resulted in a greater proliferation of naive CD4 + T cells, but hampered induction of CD4 + IFN? + T cells. However, cytokines produced favor the maintenance of IL-17 producing CD4 + cells. The phenotype of higher maturation was lost in Mtb-infected BMDC, accompanied by low TNF production and high IL-10 production. In conclusion, HIF-1? showed an anti-inflammatory function, reducing the production of proinflammatory molecules by AEC-II and negatively regulating the maturation and migration of DCs. In addition, although Mtb-infected AEC-II favor maturation and migration of DCs, Mtbinfection of DCs is capable of subverting this response

This Master's thesis is focused on technical preparation of the MTB front wheel hub and application of SinuTrain 4.7 computer software. The thesis is divided into four thematic parts. The first part introduces the SinuTrain software and briefly describes the MTB wheel hub. The next section contains the hub design and selection of the suitable material for this component. The third part describes production technologies and selection of the turning machine with suitable tools. The last chapter deals with SinuTrain 4.7 software usage and also presents the results of the production simulations.

Yes / Background: The Xpert MTB/RIF (Xpert) assay is used globally to rapidly diagnose tuberculosis and resistance to rifampicin. We investigated the frequency and predictors of false-positive findings of rifampicin resistance with Xpert. Methods: We did a prospective, observational study of individuals who were enrolled in a Rwandan nationwide diagnostic cohort study (DIAMA trial; NCT03303963). We included patients identified to have rifampicin resistance on initial Xpert testing. We did a repeat Xpert assay and used rpoB Sanger and deep sequencing alongside phenotypic drug susceptibility testing (pDST) to ascertain final rifampicin susceptibility status, with any (hetero)resistant result overriding. We used multivariable logistic regression to assess predictors of false rifampicin resistance on initial Xpert testing, adjusted for HIV status, tuberculosis treatment history, initial Xpert semi-quantitative bacillary load, and initial Xpert probe. Findings: Between May 4, 2017, and April 30, 2019, 175 people were identified with rifampicin resistance at initial Xpert testing, of whom 154 (88%) underwent repeat Xpert assay. 54 (35%) patients were confirmed as rifampicin resistant on repeat testing and 100 (65%) were not confirmed with resistance. After further testing and sequencing, 121 (79%) of 154 patients had a final confirmed status for rifampicin susceptibility. 57 (47%) of 121 patients were confirmed to have a false rifampicin resistance result and 64 (53%) had true rifampicin resistance. A high pretest probability of rifampicin resistance did not decrease the odds of false rifampicin resistance (adjusted odds ratio [aOR] 6·0, 95% CI 1·0–35·0, for new tuberculosis patients vs patients who needed retreatment). Ten (16%) of the 64 patients with true rifampicin resistance did not have confirmed rifampicin resistance on repeat Xpert testing, of whom four had heteroresistance. Of 63 patients with a very low bacillary load on Xpert testing, 54 (86%) were falsely diagnosed with rifampicin-resistant tuberculosis. Having a very low bacillary load on Xpert testing was strongly associated with false rifampicin resistance at the initial Xpert assay (aOR 63·6, 95% CI 9·9–410·4). Interpretation: The Xpert testing algorithm should include an assessment of bacillary load and retesting in case rifampicin resistance is detected on a paucibacillary sputum sample. Only when rifampicin resistance has been confirmed on repeat testing should multidrug-resistant tuberculosis treatment be started. When rifampicin resistance has not been confirmed on repeat testing, we propose that patients should be given first-line anti-tuberculosis drugs and monitored closely during treatment, including by baseline culture, pDST, and further Xpert testing. / The European & Developing Countries Clinical Trials Partnership 2 programme, and Belgian Directorate General for Development Cooperation.

Mycobacterium tuberculosis (Mtb), a pathogenic bacterium, is the causative agent in the vast majority of human tuberculosis (TB) cases. Nearly one-third of the world’s population has been affected by TB and annually two million deaths result from the disease. Because of the high cost of medication for a long term treatment with multiple drugs and the increase of multidrug-resistant Mtb strains, faster-acting drugs and more effective vaccines are urgently demanded. Several metabolic pathways of Mtb are attractive for identifying novel drug targets against TB. Hence, a high quality genome-scale metabolic network of Mtb (HQMtb) was reconstructed to investigate its whole metabolism and explore for new drug targets. The HQMtb metabolic network was constructed using an unbiased approach by extracting gene annotation information from various databases and consolidating the data with information from literature. The HQMtb consists of 686 genes, 607 intracellular reactions, 734 metabolites and 471 E.C. numbers, 27 of which are incomplete. The HQMtb was compared with two recently published Mtb metabolic models, GSMN-TB by Beste et al. and iNJ661 model by Jamshidi and Palsson. Due to the different reconstruction methods used, the three models have different characteristics. The 68 new genes and 80 new E.C. numbers were found only in the HQMtb and resulting in approximately 52 new metabolic reactions located in various metabolic pathways, for example biosynthesis of steroid, fatty acid metabolism, and TCA cycle. Through a comparison of HQMtb with a previously published human metabolic network (EHMN) in terms of protein signatures, 42 Mtb metabolic genes were proposed as new drug targets based on two criteria: (a) their protein functional sites do not match with any human protein functional sites; (b) they are essential genes. Interestingly, 13 of them are found in a list of current validated drug targets. Among all proposed drug targets, Rv0189c, Rv3001c and Rv3607c are of interest to be tested in the laboratory because they were also proposed as drug target candidates from two research groups using different methods.

Despite many studies describing the physiological characteristics of professional road cyclists and recent work describing the demands of competition, there is a paucity of similar information regarding elite mountain bike (MTB) cyclists. The aim of the present work was to describe the physiological characteristics and the demands of competition for successful MTB cyclists relative to successful road cyclists. Internationally competitive cyclists from both disciplines (seven MTB and seven road) completed the following laboratory tests: anthropometric measurements, an incremental cycle ergometer test and a 30 minute laboratory time trial. In addition, the power output profile obtained in the field from a world-class MTB cyclist riding a simulated race were compared to successful road cycling performances (placing top 3) in flat (FLAT), semi-mountainous (SEMO), high-mountainous (HIMO), individual time trial (ITT) and criterium (CRIT) road races. Due to conversion problems, 6 sentences have been omitted. For full abstract, see 01front.pdf. These results indicate that success in international MTB racing requires high power-to-weight characteristics complemented by a light and lean physique. MTB racing is associated with greater torque at the pedal crank, a more constant effort with less time at lower power outputs and a higher frequency of highintensity surges than road racing. Therefore coaches should take into account these unique MTB racing characteristics when devising training programs for elite athletes.

Introdução: O teste Xpert MTB / RIF está sendo cada vez mais utilizado em muitos países como diagnóstico inicial para a tuberculose (TB). Poucos estudos avaliaram o impacto do Xpert no diagnóstico em rotinas de programas de controle de TB no Brasil. O objetivo do presente estudo foi avaliar o impacto da introdução do Xpert MTB / RIF no diagnóstico de TB em uma cidade com alta incidência de TB no Brasil. Métodos: Incluímos pacientes avaliados com testes diagnósticos convencionais durante um ano antes da introdução do Xpert (grupo pré-Xpert) e pacientes avaliados usando Xpert durante um ano após a introdução do teste (grupo pós-Xpert). Resultados: 620 pacientes preencheram os critérios de inclusão (208 no grupo pré-Xpert e 412 no grupo pós-Xpert) e foram incluídos na análise. O tempo até o diagnóstico de TB foi menor no grupo pós-Xpert (0,7 dias, IQR: 0,5-1,0 dias) do que no grupo pré-Xpert (2,0 dias, IQR: 2,0-2,0 dias) (p <0,0001). Características atípicas da doença, como menor perda de peso, febre, dispneia, sudorese noturna e hemoptise; baciloscopia de escarro negativa; cultura negativa e radiografia de tórax atípica de TB foram mais comuns no grupo pós-Xpert do que no grupo pré-Xpert (p <0,0001 para todos). Conclusões: Observamos que a implementação do ensaio Xpert MTB / RIF, em rotinas de programas de controle de TB, melhora e facilita o diagnóstico de tuberculose, especialmente nos casos com manifestações da doença atípica. Esses resultados podem provavelmente ser generalizados para locais com incidência de TB similar. / Introduction: The receptor for advanced glycation end products (RAGE) is expressed in normal lungs and is upregulated during inflammation and infection. The interaction between AGEs and RAGE on the plasma membrane causes oxidative stress and apoptosis in lung cells. The objective of this study is to evaluate plasma levels of AGEs and its soluble receptor (sRAGE) in patients with active TB and healthy controls, and to investigate their relationship with food intake and nutritional status. Methods: Case-control study. AGE (carboxymethil lysine, CML) and RAGE were measured by Elisa. Nutritional assessment was performed by body mass index, triceps skin-fold thickness, mid-arm circumference, mid-arm muscle circumference, bioelectrical impedance analysis, and food frequency questionnaire. Results: 35 TB patients and 35 controls were included in the study. The mean S-RAGE levels were higher in TB patients than in controls (68.5 ± 28.1 vs 57.5 ± 24.0, p=0.046). Among cases that were current smokers, lower S-RAGE levels were associated with mortality (S-RAGE levels= 58.0 ± 36.5 [non-survivors] vs 71.3 ± 25.6 [survivors], p=0.006), and with weight loss (S-RAGE levels= 65.6 ± 27.4 [weight loss] vs 98.6 ± 16.7 [no weight loss], p=0.034). There was no statistically significant difference in CML levels and diet CML content between cases and controls. Malnutrition was more frequent in cases than in controls, but there was no correlation between nutritional parameters and CML or S-RAGE levels. Conclusions: TB patients had higher S-RAGE levels than controls. S-RAGE may play a role in disease manifestations and outcomes, being associated with weight loss and mortality.