Distribution and origins of Mycobacterium tuberculosis L4 in Southeast Asia

Abstract

Molecular and genomic studies have revealed that Mycobacterium tuberculosis Lineage 4 (L4, Euro-American lineage) emerged in Europe before becoming distributed around the globe by trade routes, colonial migration, and other historical connections. Although L4 accounts for tens or hundreds of thousands of TB cases in multiple Southeast Asian countries, phylogeographic studies have either focussed on a single country or just included Southeast Asia as part of a global analysis. Therefore, we interrogated public genomic data to investigate the historical patterns underlying the distribution of L4 in Southeast Asia and surrounding countries. We downloaded 6037 genomes associated with 23 published studies, focusing on global analyses of L4 and Asian studies of M. tuberculosis. We identified 2256 L4 genomes including 968 from Asia. We show that 81% of L4 in Thailand, 51% of L4 in Vietnam and 9% of L4 in Indonesia belong to sub-clades of L4 that are rarely seen outside East and Southeast Asia. These sub-clades have been transmitted between East and Southeast Asian countries, with no recent European ancestor. Although there is considerable uncertainty about the exact direction and order of intra-Asian transmissions, due to differing sampling frames between countries, our analysis suggests that China may be the intermediate between Europe and Southeast Asia for two of the three predominantly East and Southeast Asian L4 sub-lineages. This new perspective on L4 in Southeast Asia raises the possibility of investigating host population specific evolution and highlights the need for more structured sampling from Southeast Asian countries to provide more certainty of the historical and current routes of transmission.