Chez les patients traités par un régime posologique, La concentration sérique moyenne et l'écart type de la concentration SMX était 161,01 ± 69,154 mg/L et de 5,788 ± 2,74 mg/L pour le TMP. La concentration minimale inhibitrice 90% (CMI 90) était de 10 mg/L pour le cotrimoxazole et la sulfadiazine contre Mycobacterium tuberculosis. Toutes les mycobactéries étaient inhibées par 20 mg/L de cotrimoxazole et de sulfadiazine. Les CMI de l'ivermectine contre 13 souches complexe M. tuberculosis ont varié entre 10 et 40 mg/L. En outre, tous isoler M. tuberculosis étaient résistants à la squalamine avec CMI > 100 mg/L. Dans une autre partie nous avons montré que tous les isolats du complexe Mycobacterium avium étaient résistants au triméthoprime avec une CMI > 200 mg/mL. Le cotrimoxazole, le sulfaméthoxazole et la sulfadiazine ont montré une CMI respectivement de 10 mg/L, 25 mg/L et 20 mg/L, à l'exception de Mycobacterium chimaera qui présentait une CMI de 10 mg/L pour ces molécules. La comparaison de la séquence du gène de la dihydroptéroate synthase de M. intracellulare et M. chimaera a montré seulement quatre changements d'acides aminés. / Firstly, we measured the serum concentration of Sulfamethoxazole (SMX)-Trimethoprim (TMP) in patients treated with high dosage regimen. The mean values and standard deviation for SMX concentration was 161.01± 69.154 mg/L and of 5.788 ± 2.74 mg/L for TMP. Susceptibility testing yielded a minimum inhibitory concentration 90% (MIC90) of 10 mg/L for cotrimoxazole and sulfadiazine. All M. tuberculosis complex mycobacteria (MTC) were inhibited by 20 mg/L cotrimoxazole and sulfadiazine. Also, the MICs of ivermectin varied between 10 and 40 mg/L, against 13 MTC mycobacteria. Moreover, all M. tuberculosis isolate were resistant to squalamine with MIC > 100 mg/L. Also, all Mycobacterium avium complex (MAC) isolates were resistant to trimethoprim with MIC > 200 mg/L. Cotrimoxazole, sulfamethoxazole and sulfadiazine exhibited MIC of 10 mg/L, 25 mg/L and 20 mg/L, respectively against all tested MAC isolates except for Mycobacterium chimaera which exhibited MICs of 10 mg/L for these molecules. Comparing the DHPS gene sequence in M. intracellulare and M. chimaera type strains and clinical isolates yielded only four amino acid changes.

Pour l’amélioration de la lutte contre la tuberculose à Madagascar, nous avons décidé de mener des études sur l’analyse de la diversité et la distribution des génotypes de BK y circulant au cours du temps et dans l’espace afin de connaitre le mode de transmission de la TB et les sources potentielles de la TB malgache. Plus spécifiquement il s’agit premièrement, d’étudier la diversité génétique et la distribution des génotypes des BK dans le pays pour évaluer le niveau de transmission de la maladie et d’essayer de retracer les sources potentielles d’importation de la TB malgache ; deuxièmement, étudier la diversité de la souche endémique de Madagascar, le SIT109, afin de voir le niveau de transmission d’une souche à l’intérieur de l’île ainsi que son niveau d’évolution ; et troisièmement, identifier les zones de transmission de la TB par combinaison d’analyse spatiale et de génotypage en commençant par une étude pilote dans la capitale.Pour réaliser cela, 1014 souches représentatives de Madagascar isolés de 2005 à 2007 ont été typés par le spoligotypage. Les génotypes définis ont servi pour l’estimation de la transmission de la TB et l’identification des sources potentielles de la TB ; ensuite, 156 BK endémiques de Madagascar portant l’identité SIT109 ont été typés par la méthode des MIRU-VNTR (« Mycobacterial Interspersed Repetitive Units – Variable Number of Tandem Repeat ») afin d’étudier leur diversité, leur niveau d’évolution et le niveau de distribution de la TB au niveau d’une seule souche et enfin, 523 patients ont été recrutés à Antananarivo en 2013 afin de typer par le spoligotypage leur BK, d’identifier à partir de leur génotype ceux qui sont potentiellement associés à des cas de transmission récente et d’analyser leur clusterisation spatiale par la méthode de Kulldorff.Les résultats nous ont montré une grande diversité génétique des BK circulant dans le pays avec une prédomination de deux lignées de BK qui sont les souches « East african Indian » et « Tuscan » ; une distribution particulière des BK dans la capitale par rapport aux autres provinces ; des similitudes particulières des BK circulant avec des pays comme les USA, la France, l’Italie, le Danemark, l’Arabie Saoudite ou encore le Pays Bas ; une grande diversité des souches SIT109 ainsi que leur distribution dans tout le pays ; ainsi que quatre clusters spatiaux de cas de TB associé à la transmission récente dans la capitale.Cette étude nous a permis de déterminer que la transmission de la TB à Madagascar est toujours très active et se fait à très grande échelle, une petite part de la TB à Madagascar a pu être importée par les populations d’origines mais la majorité des cas actuels provient d’importation assez récente de BK de plusieurs régions du monde. Douze Fokontany de la capitale correspondent à des zones à risque de transmission de la TB et méritent une attention particulière aux responsables de la lutte contre la TB à Madagascar et enfin la méthode combinant génotypage et analyse spatiale permet la détection de ces zones à risque et pourrait servir pour le « Programme National de Lutte contre la Tuberculose » d’outil d’aide à la décision pour les stratégies de lutte contre la TB dans tout Madagascar. / For improving the fight against tuberculosis in Madagascar, we decided to conduct studies on the analysis of the diversity and spatio-temporally distribution of BK genotypes circulating in Madagascar for analyzing the TB transmission mode and the potential origins of Malagasy TB. More specifically, It is to study the genetic diversity and distribution of genotypes of M. tuberculosis strains in the country to assess the transmission level of the disease and to identify the potential sources of Malagasy TB; secondly, to study the diversity of the endemic strain of Madagascar, SIT109, in order to assess the transmission level of the strain inside the island and its level of evolution; and third, to identify TB transmission areas by combining spatial analysis and genotyping, starting with a pilot study in the capital.To achieve this, 1014 BK representative of Madagascar isolated in 2005 to 2007 were typed by the spoligotyping. Defined genotypes were used to estimate the TB transmission level and the identification of potential sources of malagasy TB; after, 156 endemic BK from Madagascar bearing the identity SIT109 were typed by the MIRU-VNTR (Mycobacterial Interspersed Repetitive Units – Variable Interspersed Repeatitive Units) method to study their diversity, their evolution level and the level of TB transmission at a single strain; and finally, 523 patients were recruited in Antananarivo in 2013 in order to type by spoligotyping their BK, to identify from their genotype those that are potentially associated with recent transmission cases and to analyze their spatial clustering by the Kulldorff method.The results showed a high genetic diversity of BK circulating in the country with a predominance of two strains, “East African Indian and “Tuscan”; a particular distribution of BK genotypes in the capital compared to the other provinces and particular similarities of the BK circulating with countries such as the USA, France, Italy, Denmark, Saudi Arabia or the Netherlands; a high variety of SIT109 strains and their distribution throughout the country; as well as four TB cases associated with recent transmission spatial clusters in the capital.This study allowed us to determine that the TB transmission in Madagascar is still very active and it is done on a very large scale, a small part of TB in Madagascar could be imported by the origin populations but the majority of cases is due to relatively recent importations of BK from several regions of the world. Twelve Fokontany in the capital corresponds to TB high risk transmission areas and need special attention to those responsible for the control of TB in Madagascar and finally the method combining genotyping and spatial analysis allows the detection of these high risk areas and could be used for the “Programme National de Lutte contre la TB” as a decision tool for orientation of the TB fight strategies throughout Madagascar

Molecular-epidemiological analysis of Mycobacterium tuberculosis strains isolated in the West-Bohemian Region of the Czech Republic including detailed characterisation of anti-tuberculosis drugs - resistant strains MUDr. Jana Amlerová Abstract Tuberculosis is contagious infectious disease that embodies significant epidemiological and clinical problem worldwide. Tuberculosis incidence differs considerably in various regions of the world but even the countries with low incidence engage strongly in epidemiology of tuberculosis. Tuberculosis belongs to one of the priorities of WHO, cooperation in this matter takes place on a global scale. Tuberculosis is a social illness; accordingly, the countries with high occurrence of tuberculosis are classified as developing countries. Mainly in Africa, there is the situation being complicated by coexistence of HIV. Generally, Europe represents a region with low incidence of tuberculosis. The Czech Republic is a country with the lowest incidence in the world with less than five new cases per 100 000 inhabitants every year. This situation is among others result of high-level tuberculosis surveillance and effective application of epidemiological arrangements based in legislation. This dissertation thesis examines several fields of tuberculosis, mainly focused on modern...

Le microbiote désigne l'ensemble des microorganismes (bactéries, virus, champignons) vivant dans un environnement spécifique, en particulier chez un hôte (humain, animal ou végétal). La relation symbiotique existant entre le microbiote et son hôte a été mise en évidence dans de nombreux contextes. Le rôle protecteur du microbiote a été démontré chez l'homme, dans diverses pathologies, dont des infections bactériennes. Le microbiote colonise l'ensemble des muqueuses, dont l'intestin, où il est le plus abondant. Bien que le rôle du microbiote intestinal ait été beaucoup décrit, l'existence de bactéries commensales dans les poumons a été mise en évidence plus récemment. D'abord sujette à controverse, l'existence d'un microbiote pulmonaire, dont la composition est distincte de celle de l'intestin, et qui peut être altérée en conditions pathologiques, est maintenant bien établie. Il est également établi que le microbiote d'un organe peut agir sur la physiologie d'autres organes ; ainsi on parle par exemple d'un axe " intestin-poumons " pour désigner l'action de composés solubles produits par le microbiote intestinal, ainsi que de cellules immunitaires ou cytokines de l'intestin, véhiculés par le sang ou la lymphe, sur la physiologie du poumon. Les poumons sont une cible majeure pour la colonisation par des pathogènes. La tuberculose (TB), une inflammation chronique pulmonaire causée par la bactérie Mycobacterium tuberculosis, est encore aujourd'hui la pathologie respiratoire due à un agent étiologique unique la plus meurtrière. A ce jour la complexité des mécanismes mis en jeu pour expliquer la différence de susceptibilité à la TB entre les individus n'est pas encore complètement comprise. Il est proposé que la balance entre virulence de la souche de M. tuberculosis, et statut immunitaire de l'hôte pourrait expliquer l'inégalité entre les individus face au développement de la maladie. Ici nous avons émis l'hypothèse que le microbiote de l'hôte serait un facteur influençant l'interaction hôte-pathogène dans la TB via i) la modulation de l'immunité antituberculeuse et/ou ii) la physiologie (métabolisme, virulence) du pathogène. Mon travail de thèse a permis de montrer que l'élimination du microbiote par un traitement antibiotique à large spectre conduit à une colonisation plus importante des poumons par M.[...] / The microbiota refers to all microorganisms (bacteria, viruses, fungi) living in a specific environment, especially in a host (human, animal or plant). The symbiotic relationship existing between the microbiota and its host has been demonstrated in many contexts. In particular, it is now well-established that the microbiota plays a protective role during different human pathologies, including bacterial infections. The microbiota colonizes all the mucosal membranes of the body; particularly the intestine where it is more abundant. While role of the gut microbiota has already been widely studied, the existence of bacteria in the lungs has been described more recently. Even if at first controversial, the existence of a pulmonary microbiota, whose composition is distinct from that of the intestine, and which can be altered in pathological conditions, is now well established. It is also well-established that the microbiota of an organ can act on the physiology of other organs; for instance, a "gut-lungs" axis is used to designate the action of soluble compounds produced by the intestinal microbiota, as well as immunes cells or cytokines from the gut, carried by the blood or the lymph, on the physiology of the lung. The lungs are one of the major colonization site for different pathogens. Tuberculosis (TB), a chronic pulmonary inflammation caused by the bacteria Mycobacterium tuberculosis, is still today the most lethal respiratory disease due to a single etiological agent. To date, the complexity of the mechanisms explaining the difference in susceptibility to TB between individuals has not been fully understood yet. It has been suggested that the balance between virulence of the strain of M. [...]

Thesis (Ph.D.(Microbiology)) -- University of Limpopo, 2022 / Respiratory tract infections (RTIs) are frequent ailments among humans and are a high burden to public health. One strategy for the development of new therapies against pathogenic bacteria such as Mycobacterium tuberculosis is to target essential biosynthetic pathways of its metabolism. The aim of this study was to evaluate and target the biosynthesis of aromatic amino acids (shikimate pathway) of Mycobacterial spp using medicinal plant extracts. The selection of the plants in this study was based on their ethnopharmacological use for the treatment of tuberculosis infections and related symptoms. The leaves were dried at ambient temperatures and ground to fine powder. The powdered material was extracted with hexane, dichloromethane, acetone, methanol and water. Phytochemical screening was done using standard protocols that tested for tannins, saponins, terpenoids, alkaloids, flavonoids, steroids, anthraquinones, phlobatannins, quinones, and betacynins. Phytochemical fingerprints were established using thin layer chromatography (TLC) where three mobile phases varying in polarity were used to develop the chromatograms. Total Phenolics, flavonoids, flavonols, tannins, alkaloids and proanthocyanidin contents were quantified using UV/Vis spectrometry. Spectrometric quantification of the free radical (DPPH) scavenging activity and ferric (potassium ferricyanide) reducing power were performed. The heat-dependent bovine serum albumin and egg albumin denaturation assays were used to evaluate anti-inflammatory activity. Antimycobacterial activity was screened using bioautography assay in qualitative analysis. Quantitatively, broth microdilution assay was used to determine the minimal inhibitory concentrations. The Clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 interference genetic editing technique was used to evaluate and validate the essentiality of the aromatic amino acids in Mycobacteria to further determine the vulnerability and draggability of the transketolase (tkt) and DAHPs (aroG) genes. Plasmid, PLJR962, was used for the CRISPRi/dCas9 gene knockdown experiments. The integrating CRISPRi plasmid expressed both sgRNA with the targeting region (for tkt or aroG) and the dCas9 handle which is under control of the anhydrotetracycline (ATC) inducible promoters. The spot assay and growth curves were used to for phenotypic characterisation and gene knockdown experiments. RNA microarray (qPCR) was used to evaluate the level of expression inhibition of tkt gene . Mechanism of action of plants extracts bioactive components were predicted based on synergy between gene knockdown, shikimate inhibitors and the plant extracts. To evaluate whether the shikimate intermediates may rescue gene depleted M. smegmatis hypomorphs, the cultures were grown in L-tryptophan, L-phenylalanine, L-tyrosine and shikimic acid and growth curves constructed. Cytotoxicity of the extracts was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on Vero cell lines and phorbol 12-myristate 13-acetate (PMA) differentiated THP-1 macrophages. Phytochemical analysis showed that the various extracts had various polar and non-polar compounds which belonged to phenolics, saponins, steroids, terpenoids, alkaloids, cardiac glycosides and resins. Numerous non-polar compounds from Gardernia volkensii, Senna petersiana, Ficus sur had antimycobacterial activity against M. smegmatis in bioautography. Remarkably, acetone extracts from S. petersiana, Acacia senegal, Carissa bispinosa, P. africanum and C. gratissimus that had moderate to low antimycobacterial activity against wild type M. smegmatis (mc2 155) demonstrated improved inhibitory activity against the tkt PAM1 M. smegmatis CRISPRi mutant. Only the acetone Clerodendrum glabrum, Croton gratissimus, Peltophorum africanum and Gardenia volkensii demonstrated activity against M. tuberculosis H37Rv. These results suggest that the employment of CRISPRi in M. tuberculosis to develop screening models may increase changes of obtaining bioactive chemical species because the tkt gene knockdown was showed to possess the ability to potentiate the antimycobacterial activity of the plant extracts. An added advantage of the plant extracts is their antioxidant and anti-inflammatory activities which may benefit the host immune system during treatment of infection by reducing free radicals and pro-inflammatory agents that perpetuate the infection. Non polar compounds were found to generally have higher anti-inflammatory activity than the polar counterpart for all the plant extracts. These results suggest that the non-polar compounds from the tested extracts may not only confer antimycobacterial effects, but also anti-inflammatory activities. A. senegal, G. volkensii, F. sur, S. petersiana and C. glabrum were found to be toxic to the Vero cell line. However, purification techniques may circumvent their toxic effects. This study demonstrated that the amino acid biosynthesis is a potential antimycobacterial drug target because it was found to be essential, vulnerable and druggable by medicinal plant extracts / University of Limpopo and National Research Foundation (NRF-DAAD In-Country Doctoral Scholarship Programme)

Yes / Human tuberculosis (TB) is caused by members of the Mycobacterium tuberculosis complex (MTBC). The MTBC comprises several human-adapted lineages known as M. tuberculosis sensu stricto, as well as two lineages (L5 and L6) traditionally referred to as Mycobacterium africanum. Strains of L5 and L6 are largely limited to West Africa for reasons unknown, and little is known of their genomic diversity, phylogeography and evolution. Here, we analysed the genomes of 350 L5 and 320 L6 strains, isolated from patients from 21 African countries, plus 5 related genomes that had not been classified into any of the known MTBC lineages. Our population genomic and phylogeographical analyses showed that the unclassified genomes belonged to a new group that we propose to name MTBC lineage 9 (L9). While the most likely ancestral distribution of L9 was predicted to be East Africa, the most likely ancestral distribution for both L5 and L6 was the Eastern part of West Africa. Moreover, we found important differences between L5 and L6 strains with respect to their phylogeographical substructure and genetic diversity. Finally, we could not confirm the previous association of drug-resistance markers with lineage and sublineages. Instead, our results indicate that the association of drug resistance with lineage is most likely driven by sample bias or geography. In conclusion, our study sheds new light onto the genomic diversity and evolutionary history of M. africanum, and highlights the need to consider the particularities of each MTBC lineage for understanding the ecology and epidemiology of TB in Africa and globally.

Homologous recombination (HR) is a highly conserved cellular process involved in the maintenance of chromosomal integrity and generation of genetic diversity. Biochemical and genetic studies have suggested that HR is crucial for repair of damaged DNA arising from various endogenous or exogenous assaults on the genome of any organism. Further, HR is vital to repair fatal DNA damage during DNA replication. An instructive example of cross-talk between the processes of DNA recombination and replication can be construed in the processing of replication/recombination/repair intermediates. The impediment(s) to the progression of DNA replication fork is one of the underlying causes for increased genome instability and consequently this might compromise the survival of organism. Various processes manifest at stalled replication forks before they can be rendered competent for the replication-restart. One of the mechanisms of replication-restart involves replication fork reversal (RFR), which envisage unwinding of the blocked forks with simultaneous annealing of the parental and daughter strands o generate a Holliday junction intermediate adjacent to DNA double strand end. Genetic evidence shows that in E. coli dnaEts mutant, holD mutant and in helicase defective rep mutant, RFR is catalyzed by RuvAB complex. Classically, HJ intermediates are generated during the terminal stages of the HR pathway. In E. coli, branch migration and resolution of HJ intermediates is promoted by RuvA, RuvB and RuvC proteins, which participate at the late stages of HR. Structural, biochemical and mutational analysis suggest that E. coli RuvA binds Holliday junction DNA with high affinity and specificity. RuvB, a member of the AAA+ (ATPase associated with various cellular activities) family, is recruited to the RuvA-Holliday junction complex and functions as a motor protein. Together, RuvA and RuvB catalyze ATP dependent branch migration of HJ. The resolution of HJ is catalyzed by the RuvC endonuclease, which introduces coordinated cuts at two symmetrical sites across the junction. RuvAB complex, the Holliday junction branch migration apparatus, is ubiquitous in bacteria. Genetic, biochemical and structural studies have not only established the in vivo role of E. coli RuvAB, in context of HR pathway, but have also provided valuable insights into the mechanism of HJ processing by RuvAB complex. However, the paucity of extensive studies examining the biochemical properties of each member of the RuvABC protein complex restricts models in deciphering the functions of the individual components of this tripartite protein complex. Our current understanding of the biochemical function of E. coli RuvA is within the context of its interacting cellular partner, RuvB. Consequently, the inherent activities of RuvA in the context of DNA repair and HR are poorly understood. Moreover, it remains to be ascertained if RuvABC protein complex, its different sub-complexes, or the individual subunits can function differently in the processing of HJ intermediates generated during DNA repair and HR. The information from these studies would be helpful in understanding the mechanistic details of HR pathway in mycobacteria. Additionally, a number of important questions regarding the molecular basis of RuvAB catalyzed fork reversal remain unanswered. Therefore, exploration of biochemical details of the RuvAB mediated RFR would provide mechanistic insights into the dynamics of fork reversal process. Moreover, analysis of RuvAB catalyzed RFR might be helpful in validating the different assumptions of the RFR model that has been proposed on the basis of genetic analysis of certain E. coli replication mutants. Another interesting question that remains to be answered is, how under in vivo conditions, RuvABC protein complex or its individual subunits are regulated to function differently in the context of HR and DNA repair? Mycobacterium tuberculosis is an important intracellular pathogen which is likely to experience substantial DNA damage inside the host and thus may require an efficient DNA recombination and repair machinery for its survival. Our knowledge about the mechanistic aspects of genetic exchange in mycobacteria is rather limited. Therefore, understanding of the processes catalyzed by the components of HR pathway may help in molecular genetic analysis of mycobacteria. Sequence analysis of M. tuberculosis genome, followed by various comparative genomic studies, has revealed the presence of putative homologs of E. coli rec genes but it is not known whether these gene products are able to catalyze the reactions similar to their E. coli counterparts. In M. tuberculosis, the genes encoding for the enzymatic machinery required for branch migration and resolution of HJ intermediates are present. The ruvA, ruvB and ruvC genes form an operon, and are probably translationally coupled. Further, these ruv genes are DNA damage inducible. The transcript level of ruvC is regulated by both RecA dependent and independent mechanisms whereas ruvA and ruvB are induced only through RecA dependent SOS response. During M. tuberculosis infection of host cells, expression of ruvA and ruvB genes is upregulated. We therefore surmise that their gene product might be required for DNA replication, recombination or repair, and would be physiologically relevant under in vivo conditions. However, the details of reactions involved in the processing of HR intermediates and rescue of stalled replication forks in M. tuberculosis remains unknown. In the initial part of this study, we have investigated the function of M. tuberculosis RuvA protein using Holliday junctions containing either homologous or heterologous core. In the later part, we have explored the ability of M. tuberculosis RuvA and RuvB proteins to catalyze in vitro replication fork reversal. M. tuberculosis ruvA gene was isolated by PCR amplification and cloned in an expression vector to generate the pMTRA construct. Genetic complementation assays, using the pMTRA construct transformed into E. coli ΔruvA mutant, indicated that M. tuberculosis ruvA is functional in E. coli and suggested that it can substitute for E. coli RuvA in conferring resistance to MMS and survival following UV irradiation. Having established the functionality of M.tuberculosis ruvA, a method was developed for heterologous over-expression and purification of M. tuberculosis RuvA protein (MtRuvA). MtRuvA was purified to homogeneity and the identity of purified protein was verified using western blot analysis using the anti-MtRuvA antibodies. Purified MtRuvA was free of any contaminating endo- or exo-nuclease activity. Biochemical functions of MtRuvA were defined by performing detailed investigations of DNA-binding and Holliday junction processing activities. Substrate specificity of purified MtRuvA was examined,through DNA binding assays, by using oligonucleotide substrates mimicking differentintermediates involved in the pathway of recombinational DNA repair. Purified M. tuberculosis RuvA exhibited high affinity for HJ substrate but also formed stable complex with replication fork and flap substrate. DNase I footprinting of MtRuvA-homologous Holliday junction complex confirmed that MtRuvA bound at the junction center. The DNase I protection conferred by MtRuvA, on homologous HJ, was two-fold symmetric; the continuous footprint was 10 bp longon one pair of symmetrical arms and 7 bp on the opposite pair of arms. In parallel, DNase footprinting of MtRuvA-heterologous Holliday junction complex generated a footprint that encompassed 16 nucleotide residues on each strand of the Holliday junction. Different crystallographic studies have envisaged an important role for RuvA in base pair rearrangement atthe center of the junction. Also, in crystal structure of tetramer of EcRuvA-HJ complex twobases at the junction center were unpaired. To explore if RuvA binding leads to helical distortionof Holliday junction, MtRuvA-HJ complexes were subjected to chemical probing with KMnO4.In case of heterologous HJ, binding of MtRuvA resulted in appearance of sensitive T residues at the junction crossover. By contrast, binding of MtRuvA to homologous HJ rendered the T residues at the junction center and within the homologous core sensitive to oxidation by KMnO4.Taken together, these observations suggested that binding of MtRuvA distorts two base pairs at the junction crossover in heterologous HJ, whereas in case of homologous HJ base pairs distortion extends into the arms of the junction. These observations with KMnO4 probing were independently validated, in real time, by using sensitive to 2-aminopurine fluorescence spectroscopy measurements of MtRuvA-HJ complexes. To follow structural distortions upon interaction with MtRuvA, HJ variants carrying 2-AP substitution were generated for both homologous and heterologous HJ substrate. In each junction species, the 2-AP residue was uniquely present either at the junction center, adjacent to the center or away from the center. Incase of heterologous HJ, binding of MtRuvA resulted in increase of fluorescence emission of2-AP residues located at the junction crossover but not those of 2-AP residues that were present1-2 base pairs away from the junction center. Binding of MtRuvA to homologous HJ resulted in increase of fluorescence emission of 2-AP residues located at the junction crossover. Further, increase in fluorescence emission was also observed for 2-AP residues present within the homologous core or adjacent to the homologous core in a pair of symmetrically related arms. Thus, 2-AP fluorescence results suggested that binding of MtRuvA to homologous HJ causes base pair distortion within and adjacent to the homologous core whereas in case of heterologous HJ the base pair distortion is restricted to the junction center. Together, these results suggest thatMtRuvA causes two distinct types of base pair distortions between homologous and heterologous HJ substrates. To explore the relationship between binding of MtRuvA and alterations in global structure of the junction DNA, we employed the established technique of comparative gel electrophoresis. Analysis of data from comparative gel electrophoresis revealed that MtRuvA, upon binding to the Holliday junctions, converts the stacked-X structure of HJ to square-planar form and stabilizes the same for loading of RuvB rings and subsequent branch migration by RuvAB complex. Our results underline the possible existence of distinct pathways for RuvA function, which presumably depend on the structure and the nature of the DNA repair or HR intermediates. In summary, our results show that binding of MtRuvA to the HJ induced changes in the local conformation of junction, which might augment RuvB catalyzed branch migration. An unexpected finding is the observation that MtRuvA causes two distinct types of structural distortions, depending on whether the Holliday junction contains homologous or heterologous core. These observations support models wherein RuvA facilitates, in a manner independent of RuvB, base pair rearrangements at the crossover point of both homologous and heterologous Holliday junctions. Although the genetic basis of ruvA ruvB catalyzed RFR in E. coli has been understood in some detail but less is known about the genetic and molecular mechanism of fork reversal in mycobacteria or other organisms. Specifically, to examine if the E. coli paradigm can be generalized to other RuvAB orthologs, we explored the RFR activity of M. tuberculosis RuvAB using a series of oligonucleotides and plasmid-based substrates that mimic stalled replication fork intermediates. This approach might be useful in genetic analysis of factors involved in processing of stalled forks in M. tuberculosis wherein technical difficulties associated with the isolation and characterization of appropriate mutants have limited our understanding of DNA metabolism. Importantly, we have asked the questions as to how the structure at fork junction, extent of reversal and presence of sequence heterology might determine the outcome of RuvAB mediated RFR. The results from this study will be helpful in consolidating the proposed in vivo role for RuvAB complex in fork reversal. The open reading frame corresponding to M. tuberculosis ruvB gene was PCR amplified and cloned in an expression vector to generate the pMTRB construct. Genetic complementation assays were performed to assess the functionality of M. tuberculosis ruvB in E. coli ΔruvB mutant. The data from these assays suggested that M. tuberculosis ruvB is active in E. coli and it is able to make functional contacts with E. coli RuvA. Moreover, the efficient alleviation of MMS toxicity in E. coli ΔruvB mutant suggested that M. tuberculosis ruvB might have a role in relieving replication stress generated under specific in vivo conditions. For biochemical analysis, M. tuberculosis RuvB protein (MtRuvB) was over-expressed in a heterologous system and purified to homogeneity. The identity of purified MtRuvB was verified using western blot analysis using the anti-MtRuvB antibodies. Purified MtRuvB was free of any contaminating endo- or exo- nuclease activity. The DNA-binding properties of MtRuvB were analyzed, in conjunction with its cognate RuvA, by using different substrates that are most likely to occur as intermediates during the processes of DNA replication and/or recombination. MtRuvAB bound HJ, three-way junction and heterologous replication fork with high affinity but with relatively weaker affinity to flap and flayed duplex substrates. MtRuvB displayed very weak affinity for linear duplex and failed to bind linear single-stranded DNA. The high affinity of MtRuvB for HJ substrate, in presence of its cognate RuvA, is indicative of direct and functional interaction between RuvA and RuvB. To further test this idea, the catalytic activity of MtRuvB was assayed in the in vitro HJ branch migration assay. In this assay,MtRuvB, in association with its cognate RuvA, promoted efficient branch migration of homologous HJ over heterologous HJ. To decipher the role of MtRuvAB in processing of stalled replication fork we performed in vitro replication fork reversal (RFR) assay using both oligonucleotide and plasmid based model replication fork substrates. Initially, binding of MtRuvAB to different homologous fork (HomFork) substrates was analyzed using the electrophoretic mobility shift assays. MtRuvAB exhibited similar binding affinity towards different HomFork substrates bearing different spatial orientation of nascent leading and lagging strands. To gain insight into the role of MtRuvAB in processing of replication forks, in vitro RFR reactions were carried out using an array of synthetic homologous fork substrates. In all these reactions, MtRuvAB catalyzed efficient fork reversal leading to generation of both parental duplex and daughter duplex. In the kinetics of fork reversal reaction, for all the fork substrates,the accumulation of daughter duplex increased with time whereas the increase in parental or nascent strand DNA was negligible. Taken together, our results suggest that MtRuvAB can efficiently catalyze in vitro replication fork reversal reaction to generate a Holliday junction intermediate thus implicating that RuvAB mediated fork reversal involves concerted unwinding and annealing of nascent leading and lagging strands. Equally important, we demonstrate the reversal of forks carrying hemi-replicated DNA, thus indicating that MtRuvAB mediated fork reversal is independent of symmetry at the fork junction. For understanding the role of RuvAB mediated processing of stalled forks at chromosome level, the fork reversal assays were performed using plasmid derived model “RF” substrate. Fork reversal was monitored by restriction enzyme digestion mediated release of 5’ end labeled fragments of specific size from the fourth arm extruded at the branch point of fork junction. In these reactions MtRuvAB complex was proficient at generating the reversed arm de novo from the RF substrate. Further, MtRuvAB complex catalyzed extensive fork reversal as analyzed by release of linear duplex of2.9 kb from a JM substrate. Use of non hydrolysable analogs of ATP and analysis of restriction digestion mediated release of duplex fragments from the reversed arm suggested that MtRuvAB catalyzed RFR reaction is ATP hydrolysis dependent progressive and processive reaction. MtRuvAB complex catalyzed fork reversal on plasmid substrate that had been linearized thus indicating that MtRuvAB mediated RFR is uncoupled from DNA supercoils in the substrate. Notably, MtRuvAB promoted reversal of forks in a substrate containing short stretch of heterologous sequences, indicating that sequence heterology failed to impede fork reversal activity of MtRuvAB complex. These results are discussed in the context of recognition and processing of varied types of replication fork structures by RuvAB enzyme complex.

Tuberculosis, caused by the infection with Mycobacterium tuberculosis remained as a major global health challenge with one third of world population being infected by this pathogen. M. tuberculosis can persist for decades in infected individuals in the latent state as an asymptomatic disease and can emerge to cause active disease at a later stage. Thus, pathways and the mechanisms that are involved in the maintenance of genome integrity appear to be important for M. tuberculosis survival, persistence and pathogenesis. Helicases are ubiquitous enzymes known to play a key role in DNA replication, repair and recombination. However, role of helicases in providing selective advantage for M. tuberculosis survival and genome maintenance is obscure. Therefore, understanding the role of various helicases could provide insights into the M. tuberculosis survival, persistence and pathogenesis in humans. This information could be useful in considering helicases as a novel therapeutic target as well as developing effective vaccines. The research focus of my thesis has been to understand the role of helicases in safeguarding the M. tuberculosis genome from various genotoxic stresses. The major focus of the current study has been addressed towards understanding the role of M. tuberculosis RecG (MtRecG) helicase in recombinational repair and in remodeling stalled replication forks. This study highlights the importance of RecG helicase in the maintenance of genome integrity via DNA repair, recombination and in remodeling the stalled replication forks in M. tuberculosis. The thesis has been divided into following sections as follows: Chapter I: General introduction that describes the causes and consequences of replication stress and DNA repair pathways in M. tuberculosis The genome is susceptible to various types of damage induced by exogenous as well as endogenous DNA damaging agents. Unrepaired or misrepaired DNA lesions can lead to gross chromosomal rearrangements and ultimately cell death. Thus, organisms have evolved with efficient DNA damage response machinery to cope up with deleterious effects of genotoxic agents. Accurate transmission of genetic information requires error-free duplication of chromosomal DNA during every round of cell division. Defects associated with replication are considered as a major source of genome instability in all organisms. Normal DNA replication is hampered when the fork encounters road blocks that have the potential to stall or collapse a replication fork. The types of lesions that potentially block replication fork include lesions on the template DNA, various secondary structures, R-loops, or DNA bound proteins. To understand the DNA damage induced replication stress and the role of fork remodeling enzymes in the repair of stalled replication forks and its restart, chapter I of the thesis has been distributed into multiple sections as follows: Briefly, initial portion of the chapter describes overall replication process in prokaryotes highlighting the importance of coordinated replisome assembly and disassembly during initiation and termination. Later section discusses about various types of exogenous and endogenous DNA damages leading to replication fork stalling. Subsequent section of chapter I provide detailed description and mechanism of various repair pathways cell operates to repair such damages. Chapter I further summarizes causes of stalled replication forks majorly including template lesions, natural impediments like DNA secondary structures and DNA-protein cross links. Subsequent section discusses various pathways of replication restart that include essential role of primosomal proteins in reloading replisome machinery at stalled replication forks. Subsequent section of chapter I provide a comprehensive description of replication fork reversal (RFR) and mechanism of replication restart. RFR involves unwinding of blocked forks via simultaneous unwinding and annealing of parental and daughter strands to generate Holliday junction (HJ) intermediate. Genetic and biochemical studies highlighted the importance of RecG, RuvAB and RecA proteins in driving RFR reaction in E. coli. Hence, in the subsequent chapter, the functional role of RecG, RuvAB and RecA in replication-recombination processes has been discussed. Last section of the chapter devotes completely to M. tuberculosis, its genome dynamics and the various pathways of mycobacterial DNA repair. M. tuberculosis experiences substantial DNA damage inside host macrophages owing to the acidic environment, reactive oxygen species (ROS) and reactive nitrogen intermediates (RNI) which are sufficient enough to cause replication stress. To gain insights into the role of M. tuberculosis RecG helicase in DNA repair, recombination and in remodeling the stalled replication forks the following objectives were laid for my PhD thesis: 1 To understand the functional role of M. tuberculosis RecG (MtRecG) in DNA repair and recombination. 2 To investigate the distinct role(s) of MtRecG, MtRuvAB and MtRecA in remodeling the stalled replication forks. Chapter II: Evidence for the role of Mycobacterium tuberculosis RecG helicase in DNA repair and recombination In order to survive and replicate in a variety of stressful conditions during its life cycle, M. tuberculosis must possess mechanisms to safeguard the integrity of the genome. Although DNA repair and recombination related genes are thought to play key roles in the repair of damaged DNA in all organisms, so far only a few of them have been functionally characterized in the tubercle bacillus. Helicases are one such ubiquitous enzyme involved in all DNA metabolic transaction pathways for maintenance of genome stability. To understand the role of M. tuberculosis RecG (MtRecG) helicase in recombination and repair, we carried out functional and biochemical studies. In our study, we show that M. tuberculosis RecG expression was induced in response to different genotoxic agents. Strikingly, expression of M. tuberculosis RecG in Escherichia coli ∆recG mutant strain provided protection against MMC, MMS and UV-induced cell death. Purified M. tuberculosis RecG exhibited higher binding affinity for the Holliday junction (HJ) as compared to a number of canonical recombinational DNA repair intermediates. Notably, although MtRecG binds at the core of the mobile and immobile HJs, and with higher binding affinity for the immobile junction, branch migration and resolution was evident only in the case of the mobile junction. Furthermore, immobile HJs stimulate MtRecG ATPase activity less efficiently as compared to the mobile HJs. In addition to HJ substrates, MtRecG exhibited binding affinity for a variety of branched DNA structures including three-way junctions, replication forks, flap structures, forked duplex and a D-loop structures, but demonstrated strong unwinding activity on replication fork and flap DNA structures. Altogether, these results support that MtRecG plays an important role in processes related to DNA metabolism under normal as well as in stress conditions. Chapter III: Mycobacterium tuberculosis RecG but not RuvAB or RecA is efficient at remodeling the stalled replication forks: Implications for multiple mechanisms of replication restart in mycobacteria Aberrant DNA replication, defects in the protection and restart of stalled replication forks are a major cause of genome instability in all organisms. Replication fork reversal is emerging as an evolutionarily conserved physiological response for restart of stalled forks. Escherichia coli RecG, RuvAB and RecA proteins have been shown to reverse the model replication fork structures in vitro. However, the pathways and the mechanisms by which Mycobacterium tuberculosis, a slow growing human pathogen responds to different types of replication stress and DNA damage is unclear. In our study, we show that M. tuberculosis RecG rescues E. coli ∆recG cells from replicative stress. The purified M. tuberculosis RecG (MtRecG) and RuvAB (MtRuvAB) proteins catalyze fork reversal of model replication fork structures with and without leading strand ssDNA gap. Interestingly, SSB suppresses the MtRecG and MtRuvAB mediated fork reversal with substrates that contain lagging strand gap. Notably, our comparative studies with fork structures containing template damage and template switching mechanism of lesion bypass reveal that MtRecG but not MtRuvAB or MtRecA is proficient in driving the fork reversal. Finally, unlike MtRuvAB, we find that MtRecG drives efficient reversal of forks when fork structures are tightly bound by protein. These results provide direct evidence and valuable insights into the underlying mechanism of MtRecG catalyzed replication fork remodeling and restart pathways in vivo.

Thesis (MSc (Biomedical Sciences. Molecular Biology and Human Genetics))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Varying levels of Rifampicin (RIF) resistance in closely related clinical Mycobacterium tuberculosis isolates and in vitro generated mutants question the dogma that non-synonymous single nucleotide polymorphisms in the rpoB gene are the only mechanism explaining RIF resistance. This study aimed to identify biological mechanisms that define the level of RIF resistance in two closely related clinical M. tuberculosis isolates using proteomic, transcriptomic and genomic approaches. Two dimensional electrophoresis revealed an increase in the abundance of numerous membrane proteins in response to RIF at the critical concentration of 2g/ml. Fourty-one of these proteins were identified by mass spectrometry and could be grouped according to their cellular function (Energy metabolism, degradation, biosynthesis of cofactors, metabolic groups and carriers, lipid biosynthesis, central intermediate metabolism, synthesis and modification of macromolecules, chaperone/heat shock proteins). The identification of proteins responsible for ATP synthesis (atpA and atpH) suggests an ATP requirement to combat the toxic effect of RIF. These proteins are components of the FoF1 ATP synthase an enzyme which is involved in the oxidative phosphorylation pathway that generates ATP in the cell. QRT-PCR confirmed the up regulation of the transcription of the atpA and atpH genes in response to RIF, while DNA sequencing failed to identify mutations that could define the rate of transcription. To explain our findings we proposed that RIF induces a toxic response leading to the up regulation of a number of genes. The induction of metabolic enzymes, such as the FoF1 ATP synthase provides energy to activate ATP dependant mechanisms, including membrane ABC transporters. These ABC transporters actively pump RIF out of the cell thereby lowering the intracellular concentration of RIF to below its binding concentration with the rpoB protein leading to RIF resistance. Inhibition of efflux by the efflux pump inhibitors reserpine and verapamil leads to an accumulation of RIF within the cell and concurrent binding of RIF to rpoB, leading to inhibition of transcription and cell death (ongoing research in our laboratory). Similarly, we propose that the recently identified diarylquinoline compound (TMC207) inhibit ATP synthesis, thereby depleting the energy source necessary for active efflux. This will lead to an accumulation of anti-TB drug within the cell and subsequent cell death. In summary, this study provides the first evidence to suggest that the evolution of RIF resistance is a dynamic process involving a cascade of adaptive events which leads to a bacterial growth state where hydrophobic compounds are actively extruded from the cell. This has important ramifications for the treatment of RIF resistant TB and supports the need for the development of anti-TB drugs that target both efflux and ATP synthesis to improve the treatment outcome of MDR-TB and XDR-TB. / AFRIKAANSE OPSOMMING: Verskillende vlakke van Rifampisien (RIF) weerstandigheid, in naby verwante Mycobacterium tuberculosis kliniese isolate en in vitro mutante, bevraagteken die dogma dat nie-sinonieme enkel nukleotied polimorfismes in die rpoB geen die enigste verklaarbare meganisme vir RIF weerstandigheid is. Die doel van hierdie studie was om deur 'n proteomiese, transkriptomiese en genomiese benadering, biologiese meganismes te identifiseer wat die vlakke van RIF weerstandigheid in twee naby verwante kliniese M. tuberculosis isolate bepaal. Twee dimensionele elektroferese het gevind dat daar 'n verhoging in die hoeveelheid van verskeie proteïne is wanneer die isolate aan RIF by die 'n kritiese konsentrasie van 2μg/ml blootgestel is. Massa spektrometrie het 41 van hierdie proteine geïdentifiseer en die proteïne kan gegroepeer word in verskeie sellulêre funksies (Energie metabolism, degradering, biosintese van kofaktore, metaboliese groepe en draers, lipied biosintese, sentrale intemediêre metabolisme, sintese en modifisering van makromolekules, en “chaperone/heat shock” proteine). Die identifisering van proteïne verantwoordlik vir ATP sintese (atpA en atpH) stel voor dat ATP belangrik is om die toksiese effek van RIF te ontwyk. Hierdie proteïne is komponente van die FoF1 ATP sintase ensiem wat betrokke is in die oksidatiewe fosforilerings pad en wat lei tot die generering van ATP in die sel. Kwantitatiewe QRT-PCR het bevestig dat hierdie gene, atpA en atpH, opgereguleer word nadat die bakterium aan RIF blootgestel is. In teen deel kon DNA volgorde bepaling nie mutasies identifiseer wat die verandering in geen transkripsie kon verklaar nie. Om ons bevindings te verduidelik, stel ons voor dat RIF 'n toksiese effek in die sel induseer wat lei tot die opregulering van verskeie gene. Die indusering van metaboliese ensieme, soos die FoF1 ATP sintase, voorsien energie om ATP afhanklike meganismes, insluitende membraan ABC transporters, te aktiveer. Hierdie ABC transporters pomp RIF aktief uit die sel, wat daarvolgens die intrasellulêre konsentrasie van RIF verlaag tot 'n konsentrasie laer as die bindings konsentrasie met die rpoB protein en gevolglik lei tot weerstandigheid. Die onderdrukking van membraan pompe wat RIF uit die sel pomp deur middels soos reserpine en verapamil sal aanleiding gee lei tot akkumulering van RIF in die sel. Die verhoogde RIF in die sel versoorsaak dat RIF aan die rpoB protein gebind bly sodat dit transkripsie inhibeer, wat dan aanleiding gee tot seldood. (voortgesette navorsing in ons laboratorium). Soortgelyk, stel ons voor dat die onlangs geïdentifiseerde dairylquinoline verbinding (TMC207) ATP sintese inhibeer en daarvolgens die energie bron uitput wat noodsaaklik is vir aktiewe uitpomp van RIF. Dit sal aanleiding gee tot die ophoping van RIF in die sel en gevolglik lei tot seldood. In opsomming, hierdie studie voorsien die eerste bewys wat voorstel dat die evolusie van RIF weerstandighied 'n dinamiese proses is. Dit sluit 'n kaskade van aanpasbare gebeurtenisse in wat lei tot 'n bakteriële groei fase waar hidrofobiese verbindings aktief uit die sel gedryf word. Dit het rampspoedige gevolge vir die behandeling van RIF weerstandige TB en ondersteun die noodsaaklikheid om teen-TB middels te ontwikkel wat beide effluks pompe en ATP sintese teiken om die uikoms van behandeling vir MDR-TB en XDR-TB te verbeter.

Thesis (PhD)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: New agents for the diagnosis, prevention and treatment of tuberculosis are urgently required. Yet, despite extensive tuberculosis research over recent years, no new drugs, vaccines or diagnostics have been identified to date. It is widely speculated that the major obstacle to the identification of new therapies is the lack of understanding of the hostpathogen interaction. This study has investigated whether patterns of antigen expression correlate with molecular epidemiological data and strain virulence through the analysis of protein expression and antigen recognition profiles of different M tuberculosis clinical isolates. Using polyacrylamide gel electrophoresis, enzyme-linked immunosorbent assay, and Western blotting, protein expression and antigen recognition by two genotypically different clinical strains that differed in their frequency in the study population have been compared. In addition to differences in protein expression and antigen recognition between the clinical strains and the reference strain H37Rv, protein expression differences between the clinical strains themselves were observed which may relate to strain frequency and virulence. Differential protein expression by M tuberculosis strains, may explain the heterogeneous host humoral immune response and why no fully effective serodiagnostic test has been developed to date. To explore this hypothesis, the potential of serodiagnosis in this community, where patients are infected with a wide variety of genotypically distinct strains, was investigated. IgG levels to three mycobacterial antigens showed that serodiagnosis of TB is possible in this community, despite infection by a wide variety of genotypically different M tuberculosis strains. Disease episode affected antibody levels, suggesting that care should be taken when evaluating serological diagnosis for repeat episode patients. This study has shown that M tuberculosis protein expression is dynamic and that the bacillus presents a hypervariabie array of antigens to the host immune system. It is likely that different antigens become immunodominant as antituberculosis chemotherapy progresses, and that these differentially expressed antigens may be tracked as predictors of treatment outcome. This hypothesis was tested by correlating Ag85-specific IgG with treatment response, as assessed by sputum smear conversion after two months of antimycobacterial chemotherapy. No significant correlation between antibody levels and treatment responses was observed, suggesting that antibodies may not be useful surrogate markers or that the incorrect antibody type or mycobacterial antigen were selected. Results were consistent with previous findings where patient-to-patient variation dictated the host humoral response. The results obtained in this study have demonstrated that although bacteriological factors may influence strain prevalence due to antigen variation and immune evasion, both bacteriological and host factors affect humoral immunity. Differential protein expression by M tuberculosis strains has potentially important implications for serodiagnosis and the development of subunit or DNA vaccines, by suggesting that multi-antigen cocktails should be used. Differential protein expression may also explain why patients do not develop adequate protective immunity and are susceptible to reinfection. / AFRIKAANSE OPSOMMING: Daar is 'n dringende behoefte vir nuwe middels vir die diagnosering, voorkoming en behandeling van tuberkulose. Ondanks intense tuberkulose navorsing gedurende die afgelope paar jaar, is daar geen nuwe tuberkulose medikasie, vaksines of diagnostiese metodes geïdentifiseer nie. Daar word gespekuleer dat die hoof struikelblok vir die identifisering van nuwe medikasie die onkunde oor die tuberkulose patogeen is. Deur die analise van proteien-uitdrukking en antigeen-erkenning profiele van verskillende M. tuberculosis kliniese isolate is daar tydens hierdie studie ondersoek ingestel of die patroon van antigeen uitdrukking korreleer met molekulêre epidemiologiese data and stam-virulensie. Proteien-uitdrukking en antigeen-erkenning deur twee genotipies verskillende kliniese stamme wat verskil in hul frekwensie in die bestudeerde populasie, is vergelyk deur middel van poli-akrielamied gel elektroforese, ensiem-gekoppelde immuunabsorberende analise en Westelike oordrag. Addisoneel tot die verskille in proteienuitdrukking en antigeen-ekenning tussen kliniese stamme en die verwysingstam H37Rv, is daar ook verskille aangedui tussen die kliniese stamme self wat kan dui op stam frekwensie en virulensie. Differensiële proteien-uitdrukking deur M. tuberculosis stamme, kan moontlik die heterogene gasheer se humorale immuunreaksie verduidelik en daarmee saam die rede waarom daar nie tot op hede 'n effektiewe sero-diagnostiese toets ontwikkel is nie. Daar is dus ondersoek ingestel na die potensiaal van sero-diagnose in 'n gemeenskap waar pasiënte geïnfekteer is met 'n wye verskeidenheid genotipiese stamme. Die IgG vlakke van drie mikobakteriële antigene het aangedui dat sero-diagnose van tuberkulose moontlik is in hierdie gemeenskap, ten spyte van infektering deur 'n wye verskeidenheid genotipies-verskillende M. tuberculosis stamme. Die tussenspel van die siekte het teenliggaampie-vlakke beïnvloed wat daarop dui dat daar versigtig moet gelet word tydens die evaluering van serologiese diagnose van geïnfekteerde pasiënte wat voorheen siek was. Hierdie studie toon dat M. tuberculosis proteïen-uitdrukking dinamies is en dat die bacillus 'n groot variëteit van antigene tot die immuun sisteem bied. Dit is moontlik dat verskillende antigene immuun dominant kan word soos wat antituberkulose chemoterapie toeneem, en dat hierdie verskillend-uitgedrukte antigene as 'n gevolg daarvan gebruik kan word as voorspellers vir behandeling. Hierdie hipotese is getoets deur die korrelering van Ag85-spesifieke IgG met die reaksie op behandeling soos geëvalueer deur speeksel-monster verandering na twee maande se anti-mikobakteriële chemoterapie. Daar was geen noemenswaardige korrelasie tussen teenliggaampie vlakke en die reaksie op behandeling nie, wat daarop dui dat die teenliggaampies nie toepaslike surrogaat merkers is nie of dat die verkeerde teenliggaampie-tipe of mikobakteriële antigeen geselekteer is. Hierdie resultate bevestig vorige bevindinge waar pasiënt-tot-pasiënt verskille die gasheer se humorale immuunreaksie gedikteer het. Die resultate wat uit hierdie studie volg dui dat alhoewel bakteriologiese faktore die stam-frekwensie kan beïnvloed as gevolg van antigeen-variasie en immuun-ontduiking, kan beide bakteriologiese en gasheer faktore die humorale immuunreaksie beïnvloed. Differensiële proteiën uitdrukking deur 'n verskeidenheid M. tuberculosis stamme het potensieël belangrike toepassings vir sero-diagnose en die ontwikkeling van subeenheid of DNS vaksines wat impliseer dat multi-antigeen mengsels gebruik moet word. Differensiële proteiën uitdrukking mag ook verduidelik waarom pasiënte nie 'n voldoende beskermende immuniteit opbou nie en sodoende ontvanklik is vir her-infeksie.