Nanopore-based targeted sequencing (NTS) for drug-resistant tuberculosis: an integrated tool for personalized treatment strategies and guidance for new drug development.

Background: Drug-resistant tuberculosis has emerged as a major public health issue that requires immediate attention. NTS is an innovative method that allows for the direct detection of clinical samples without the need for culture. It could provide more accurate, reliable, and comprehensive information on drug resistance.

Methods: We collected clinical data retrospectively from patients suspected of having drug-resistant tuberculosis who visited the tuberculosis department at the Second Hospital of Nanjing in Jiangsu Province, China, from December 2023 to December 2024. The diagnostic efficiency of NTS for different types of drug-resistant tuberculosis and antimicrobial resistance was calculated. The relationship between resistance genes, mutated amino acids, and mutation sites was demonstrated.

Results: In this study, a total of 107 patients with drug-resistant tuberculosis were included, comprising 43 cases of mono-drug resistant tuberculosis, 20 patients with poly-drug resistant tuberculosis, 22 cases of multidrug-resistant tuberculosis, 21 cases of pre-extensively drug-resistant tuberculosis and 1 case of extensively drug-resistant tuberculosis. The accuracy of NTS in diagnosing drug-resistant tuberculosis ranged from 42.9 to 93.0%. Except for second-line injectable drugs, NTS achieved a sensitivity of over 70% for other anti-tuberculosis drugs. Serine was identified as the most frequently mutated amino acid in both the rpoB gene (66.2%, 49/74) and the katG gene (86.3%, 44/51). Additionally, the most frequently mutated amino acids in the embB gene, rpsL gene, and gyrA gene were methionine (94.7%, 44/51), lysine (100%, 28/28), and aspartic acid (66.7%, 20/30), respectively.

Conclusion: NTS could effectively and precisely deliver comprehensive drug resistance results, assisting medical professionals to create more personalized treatment plans. Besides, it would encourage the development of new anti-tuberculosis drugs to broaden clinical treatment options for drug-resistant tuberculosis.