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Ciobanu, N.

Publications and source records attributed to Ciobanu, N..

5 recordsLinked to original sources

The global phylogeography of rapidly expanding multidrug resistant Ural lineage 4.2 Mycobacterium tuberculosis

Multidrug resistant tuberculosis (MDR-TB) is a leading global health challenge. Recent studies identified a reproductively fit Ural lineage 4.2 MDR M. tuberculosis (Mtb) variant circulating within the Republic of Moldova. We searched a large publicly available dataset of [~]200,000 Mtb whole genome sequences and identified a clade of 1604 drug-resistant Mtb sequences harboring conserved resistance-conferring mutations that are closely related to the MDR Mtb variant circulating in Moldova. We identified the Russian Federation as the most likely country of origin for this clade, and we inferred several independent migration events from Russia and Moldova to other former Soviet Republics and several European countries. Using local branching index, we found that this clade is expanding more rapidly than comparable clades of lineage 4.2. This evolutionarily successful strains presence beyond Moldova poses a threat to MDR-TB control, and enhanced surveillance is necessary to reduce the risk of MDR-TB epidemics in the region. FundingThe authors report funding from the National Institutes of Health (R01AI180209, P01AI159402)

microbiology↗

Minimal immune cell subset differences in a cohort of close contacts of tuberculosis index cases

Understanding the perturbations in immune response across the spectrum of TB infection is still unclear. In this study, we followed a cohort of close contacts of pulmonary TB patients with serial QFT testing at 0, 3, 6, and 12 months, and stratified them into six subgroups: QFT-increasing (low/high), QFT converters (QFT- to QFT+), QFT+ stable, and QFT- individuals. Despite these distinct QFT trajectories, we observed minimal differences in immune cell frequencies, activation profiles, and T helper subset distributions among the QFT subgroups, suggesting limited immunological stratification based on QFT dynamics alone. Ex vivo immune phenotyping, including analysis of CD4, CD8, and NKT cell frequencies, memory T cell subsets, and activated T cells (HLA-DRCD38), failed to distinguish between QFT subgroups. Antigen-specific CD4 T cell responses assessed by the activation-induced marker (AIM) assay were elevated in QFT+ compared to QFT- individuals. These findings suggest that blood-based immune profiling may not capture subtle immunological transitions among QFT converters or individuals with increasing QFT responses. In contrast, individuals with active TB (ATB) showed clear immune perturbations. ATB patients at diagnosis exhibited significantly elevated frequencies of antigen-specific CD4 T cells, increased activated T cells, and higher frequencies of intermediate monocytes and NK cells compared to QFT+/QFT- contacts. Many of these immune features declined with treatment, indicating therapy-associated immune resolution. Additionally, shifts in T helper subsets and effector memory populations were observed over the course of treatment. These results suggest that while ex vivo immune profiling can robustly distinguish active TB from non-diseased states, it lacks the resolution to differentiate QFT subgroups based on QFT dynamics alone. This could reflect either immunological similarity among close contacts regardless of QFT status or limitations of blood-based phenotyping in detecting early or subclinical immune shifts. Our study highlights the challenge of immunologically distinguishing QFT-defined subgroups within close contacts using conventional ex vivo profiling approaches.

immunology↗

Tiled Amplicon Sequencing Enables Culture-free Whole-Genome Sequencing of Pathogenic Bacteria From Clinical Specimens

Pathogen sequencing is an important tool for disease surveillance and demonstrated its high value during the COVID-19 pandemic. Viral sequencing during the pandemic allowed us to track disease spread, quickly identify new variants, and guide the development of vaccines. Tiled amplicon sequencing, in which a panel of primers is used for multiplex amplification of fragments across an entire genome, was the cornerstone of SARS-CoV-2 sequencing. The speed, reliability, and cost-effectiveness of this method led to its implementation in academic and public health laboratories across the world and adaptation to a broad range of viral pathogens. However, similar methods are not available for larger bacterial genomes, for which whole-genome sequencing typically requires in vitro culture. This increases costs, error rates and turnaround times. The need to culture poses particular problems for medically important bacteria such as Mycobacterium tuberculosis, which are slow to grow and challenging to culture. As a proof of concept, we developed two novel whole-genome amplicon panels for M. tuberculosis and Streptococcus pneumoniae. Applying our amplicon panels to clinical samples, we show the ability to classify pathogen subgroups and to reliably identify markers of drug resistance without culturing. Development of this work in clinical settings has the potential to dramatically reduce the time of diagnosis of drug resistance for multiple drugs in parallel, enabling earlier intervention for high priority pathogens.

genomics↗

The appearance of sugI mixed loci in three individuals during treatment for MDR-TB, supports the involvement of sugI in Mycobacterium tuberculosis d-cycloserine resistance in vivo.

To study the adaptation of multi-drug resistant Mycobacterium tuberculosis (MDR-TB) during treatment patients diagnosed with MDR-TB were recruited into an observational study. Clinical data and M. tuberculosis DNA at diagnosis and between seven days and two months of MDR-TB treatment were collected. The drugs prescribed were recorded. Interpretable WGS data from 118 isolates from 54 participants was obtained (11 in Belarus and 43 in Moldova) and screened for the presence of unfixed single nucleotide polymorphisms (mixed SNPs / loci). This study was performed shortly after the publication of the 2019 WHO consolidated guidelines on drug-resistant tuberculosis treatment. Existing drug supplies and procurement in one country after the switch to the all oral MDR-TB regimen in addition to patient factors, influenced the selection of and exposure to drugs. Confidently mixed SNPs were identified in samples from multiple participants in only five genes (gyrA, pncA, Rv1129c, Rv1148c, and sugI). All other genes with confidently mixed SNPs were identified in isolates from only a single individual. A significant proportion of the participants (52 of 54 participants) received d-cycloserine as part of their initial treatment, most participants who initially received d-cycloserine did not receive bedaquiline in their initial regimen (all at one site). Three different mixed SNPs were identified in sugI gene from a follow up isolate from three participants (P7A, P7T, and Q6stop). Mutations in sugI have previously been reported in spontaneous in vitro d-cycloserine resistant mutants. Alterations in the sugI gene may indicate a sub optimal d-cycloserine containing regimen and potentially be of clinical significance with respect to adaptation to d-cycloserine. Monitoring the accumulation of low frequency escape mutants may help identify regimens insufficiently powerful to block the accumulation of antimicrobial resistance mutants and identify drug(s) at risk of resistance selection.

microbiology↗

Identification of differentially recognized T cell epitopes in the spectrum of Mtb infection

Tuberculosis caused by Mycobacterium tuberculosis is one of the leading causes of death from a single infectious agent. Identifying dominant epitopes and comparing their reactivity in different tuberculosis (TB) infection states can help design diagnostics and vaccines. We performed a proteome-wide screen of 20,610 Mtb derived peptides in 21 Active TB (ATB) patients 3-4 months post-diagnosis of pulmonary TB (mid-treatment) using an IFN{gamma} and IL-17 Fluorospot assay. Responses were mediated exclusively by IFN{gamma} and identified a total of 137 unique epitopes, with each patient recognizing, on average, 8 individual epitopes and 22 epitopes (16%) recognized by 2 or more participants. Responses were predominantly directed against antigens part of the cell wall and cell processes category. Testing 517 peptides spanning TB vaccine candidates and ESAT- 6 and CFP10 antigens also revealed differential recognition between ATB participants mid-treatment and healthy IGRA+ participants of several vaccine antigens. An ATB-specific peptide pool consisting of epitopes exclusively recognized by participants mid-treatment, allowed distinguishing participants with active pulmonary TB from healthy interferon-gamma release assay (IGRA)+/- participants from diverse geographical locations. Analysis of longitudinal samples indicated decreased reactivity during treatment for pulmonary TB. Together, these results show that a proteome-wide screen of T cell reactivity identifies epitopes and antigens that are differentially recognized depending on the Mtb infection stage. These have potential use in developing diagnostics and vaccine candidates and measuring correlates of protection.

immunology↗