快速方法检测结核分枝杆菌耐药基因突变

快速准确地鉴定结核分枝杆菌与结核分枝杆菌对利福平和异烟肼耐药基因突变的快速检测,对结核病人的诊断与治疗具有重要指导意义。本次根据结核分枝杆菌标准株H37RV序列,利用覆盖rpoB、katG、inhA基因突变区的系列寡核苷酸探针,并检测临床样品中结核分枝杆菌的基因突变情况,以此来判断耐药结果,并对其进行方法学评价。     

PCR-SSCP检测结核分枝杆菌利福平耐药相关基因rpoB突变

目的 建立聚合酶链反应-单链构象多态性(PCR-SSCP)技术快速检测结核分枝杆菌利福平(RFP)耐药相关基因rpoB突变.方法 设计结核分枝杆菌RFP耐药相关rpoB基因PCR引物,建立PCR-SSCP技术检测临床菌株rpoB基因的突变导致的运动变位,同时采用PCR直接测序(PCR-DS)技术检测rpoB基因突变,并对上述方法检测结果进行分析和比较.结果 84株临床菌株均含有rpoB基因;PCR-SSCP和PCR-DS检测结果显示,56株RFP敏感菌株中rpoB基因分别有3株和2株检测出突变,检测特异性分别为94.6％ (53/56)和96.4％(54/56);28株RFP耐药菌株中rpoB基因分别有27株和28株发生突变,检测灵敏度分别为96.4％和100％.结论 本研究建立的PCR-SSCP技术能快速、简便、特异、敏感地检测结核分枝杆菌利福平耐药基因rpoB突变,具有临床应用前景.     

应用PCR-SSCP快速鉴定结核分枝杆菌复合群

通过聚合酶链反应（ＰＣＲ）－单链构象多态性（ＳＳＣＰ）技术分析结核分枝杆菌和非结核分枝杆菌临床株的１６ＳｒＤＮＡ基因。６０例临床标本中,２０例为阳性,与传统方法比较无差异。其中分型：１８例为结核分枝杆菌,２例为结核分枝杆菌和非结核分枝杆菌双重感染。２０例阴性标本中,ＰＣＲ－ＳＳＣＰ又检查出５例阳性。２０例对照标本中,３种传统方法与ＰＣＲ－ＳＳＣＰ法均检测为阴性。全部试验３ｄ报告结果。结核分枝杆菌复合群和卡介苗的图形相同以外,其它分枝杆菌的ＰＣＲ－ＳＳＣＰ电泳图谱均有差异。所以,应用ＰＣＲ－ＳＳＣＰ技术快速     

结核分枝杆菌耐异烟肼的分子机制

结核分枝杆菌对抗结核化疗药物异烟肼的耐药机制较为复杂,其中katG和inhA基因是主要的耐药基因,katG的丢或突变导致其编码的过氧化氧－过氧化物酶活性丧失或下降,而inhA基因突变减弱了异烟肼对分枝菌酸生物合成的抑制作用。此外,kasA和ahpC基因也与异烟肼的耐药有关,本文对近年来异烟肼耐药基因katG、inhA,kasA和oxyR-ahpC的进展作一综述。     

结核分枝杆菌对异烟肼耐药的分子机制

抗结核一线药物异烟肼是应用最广泛的抗结核药物之一,自1952年应用于临床以来,异烟肼就成了治疗结核和潜在感染的基础药物.有报道,我国异烟肼耐药已排在首位.结核分枝杆菌对异烟肼耐药的分子机制十分复杂,涉及katG、inhA、kasA、ndh、axyR等多种基因,本研究仅就此方面的研究作一综述.     

用于结核分枝杆菌与非结核分枝杆菌鉴定的4种方法效能比较

比较硝基苯甲酸/噻吩−2−羧酸肼（PNB/TCH）生长试验、胶体金法、荧光PCR法和基因芯片法用于结核分枝杆菌（MTB）和非结核分枝杆菌（NTM）鉴定的效能,从而为临床选择鉴别MTB和NTM的实验室方法提供参考依据。

收集2021—2022年疑似肺结核患者痰液和肺泡灌洗液样本,选择经BACTEC MGIT 960全自动快速分枝杆菌培养鉴定药敏仪液体培养阳性的440份标本,分别采用PNB/TCH生长试验、胶体金法、荧光PCR法和基因芯片法鉴定MTB和NTM。以16S rRNA基因测序法为金标准,比较4种方法的效能。

440份分枝杆菌阳性标本,16S rRNA基因测序法鉴定出MTB和NTM分别为316株和124株。PNB/TCH生长试验、胶体金法、荧光PCR法和基因芯片法鉴定MTB的敏感度分别为96.5%、97.8%、100.0%和99.7%,差异具有统计学意义（χ² = 17.261,P = 0.012）;特异度分别为90.3%、100.0%、100.0%和98.4%,差异具有统计学意义（χ² = 29.110,P＜0.001）;符合率分别为94.8%、98.4%、100.0%和99.3%,κ值分别为0.87、0.96、1.00和0.98。

PNB/TCH生长试验、胶体金法、荧光PCR法和基因芯片法均可用于MTB和NTM鉴定。胶体金法和荧光PCR法鉴定MTB时效性较好,但胶体金法经济、便捷,更适合于基层临床实验室MTB快速鉴定;基因芯片法对软、硬件均有一定要求、检测成本较高,在一定程度上限制了临床的普及应用。

     

应用4种方法检测结核分枝杆菌临床分离株对链霉素的耐受性

通过DNA测序、SSCP、RFLP和反向斑点杂交技术分析167株结核分枝杆菌临床分离株的耐药基因型,评价结核分枝杆菌rpsL或rrs基因突变与链霉素（SM）耐受性之间的关系,比较4种分子方法检测SM耐受性的临床价值。98株耐SM分离株中,78株（79．6％）rpsL 43位或88位密码子错义突变导致赖氨酸置换为精氨酸,6株（6．1％）rrs 513位碱基A突变为C或T或516位C突变为T,14株（14．3％）未发现突变;69株SM敏感的分离株未发现这两个基因突变。应用SSCP、RFLP和RDBH方法分析上述突变和野生序列的结果与DNA测序完全一致,RDBH方法可从98株耐SM分离株中正确鉴定出84株（85．7％）分离株的5种突变基因型。结果表明,应用分子技术分析rpsL和rrs基因突变可快速检测大多数结核分枝杆菌对SM的耐受性,反向斑点杂交方法是一个快速、简便和可靠地检测药物耐受性的分子方法。     

结核分枝杆菌进化与致病性的研究

分子流行病学是研究结核分枝杆菌传播和种群进化的有力工具。特别是近年来建立起来的单核苷酸多态性分型方法,能将结核分枝杆菌临床菌株分为三大家族,并且确立其种系发生关系。研究表明,不同进化分支上的结核分枝杆菌在不同的国家和地区流行,不同基因型菌株的致病性和传播力不尽相同。如细胞和动物模型都证明在东亚流行的北京基因型菌株比其他基因型菌株具有更高的毒力,能抑制宿主的免疫反应。本文综述近年来在结核分枝杆菌进化、分型及菌株致病性方面的研究成果。     

二代测序技术在结核分枝杆菌研究中的应用进展

结核病是由结核分枝杆菌引起的全球第二大传染病。二代测序技术为从基因组水平研究结核分枝杆菌提供了重要的研究方法。本文从结核病流行病学、结核分枝杆菌耐药和进化及相关生物信息学等方面,介绍二代测序技术在结核分枝杆菌研究中的应用进展。     

结核分枝杆菌耐药性的分子机理研究进展

结核分枝杆菌内,抗结核药物的作用靶编码基因已在细菌染色体上定位,使人们能在分子水平上研究耐药结核分枝杆菌,并对其耐药机理有了深刻了解,本文就结核分枝杆菌对几种主要抗结核药物耐药性的分子机理相关的基因等方面的研究作一综述。     

In silico discovery of potential drug molecules to improve the treatment of isoniazid-resistant Mycobacterium tuberculosis

The emergence of multidrug-resistant Mycobacterium tuberculosis (M.tb) has become one of the major hurdles in the treatment of tuberculosis (TB). Drug-resistant M.tb has evolved with various strategies to avoid killing by the anti-tubercular drugs. Thus, there is a rising need to develop effective anti-TB drugs to improve the treatment of these strains. Traditional drug design approach has earned little success due to time and the cost involved in the process of development of anti-infective drugs. Numerous reports have demonstrated that several mutations in the drug target sites cause emergence of drug-resistant M.tb strains. In this study, we performed computational mutational analysis of M.tb inhA, fabD, and ahpC genes, which are the primary targets for first-line isoniazid (INH) drug. In silico virtual drug screening was performed to identify the potent drugs from a ChEMBL compound library to improve the treatment of INH-resistant M.tb. Further, these compounds were analyzed for their binding efficiency against active drug binding cavity of M.tb wild-type and mutant InhA, FabD and AhpC proteins. The drug efficacy of predicted lead compounds was verified by molecular docking using M.tb wild-type and mutant InhA, FabD and AhpC protein template models. Different in silico and pharmacophore analysis predicted three potent lead compounds with better drug-like properties against both M.tb wild-type and mutant InhA, FabD, and AhpC proteins as compared to INH drug, and thus may be considered as effective drugs for the treatment of INH-resistant M.tb strains. We hypothesize that this work may accelerate drug discovery process for the treatment of drug-resistant TB.

Communicated by Ramaswamy H. Sarma     

Molecular fingerprinting of isoniazid-resistant Mycobacterium tuberculosis isolates from chest diseases hospital in Kuwait

Touchdown double-repetitive-element-PCR (DRE-PCR) was carried out for typing 38 consecutive isoniazid-resistant Mycobacterium tuberculosis strains isolated at Chest Diseases Hospital, Kuwait, during 1998-2000. The polymorphism at codon 463 in the katG gene was also determined and correlated with genotypic relationships among the isolates. The isolates exhibited 21 distinct patterns in DRE-PCR. Nearly half of the isolates (18 of 38) exhibited unique patterns. Majority of isolates (16 of 20) yielding multiple DNA fragments in DRE-PCR were unique strains while most of the isolates (16 of 18) yielding a single DNA fragment in DRE-PCR clustered together. The prevalence of L463 in the katG gene was much higher in isolates from Middle Eastern (mostly Kuwaiti) patients than is reported for this ethnic group. The data indicate the possibility of some strains of South Asian/Southeast Asian origin spreading among local populations.     

Plasmid-based controls to detect rpoB mutations in Mycobacterium tuberculosis by quantitative polymerase chain reaction-high-resolution melting

Quantitative polymerase chain reaction-high-resolution melting (qPCR-HRM) analysis was used to screen for mutations related to drug resistance in Mycobacterium tuberculosis. We detected the C526T and C531T mutations in the rifampicin resistance-determining region (RRDR) of the rpoB gene with qPCR-HRM using plasmid-based controls. A segment of the RRDR region from M. tuberculosis H37Rv and from strains carrying C531T or C526T mutations in the rpoB were cloned into pGEM-T vector and these vectors were used as controls in the qPCR-HRM analysis of 54 M. tuberculosis strains. The results were confirmed by DNA sequencing and showed that recombinant plasmids can replace genomic DNA as controls in the qPCR-HRM assay. Plasmids can be handled outside of biosafety level 3 facilities, reducing the risk of contamination and the cost of the assay. Plasmids have a high stability, are normally maintained in Escherichia coli and can be extracted in large amounts.     

两株超级广泛耐药结核分枝杆菌全基因组比较分析

【目的】结合现有数据,通过对两株临床超级广泛耐药的结核分枝杆菌全基因组的测序和分析,发现其型别相关的突变位点,解释发生广泛耐药的基因组突变机制。【方法】利用Solexa第二代测序技术对两株广泛耐药结核分枝杆菌(FJ05194和GuangZ0019)进行全基因组测序分析。以H37Rv为参考序列得到两株广泛耐药菌株的单核苷酸多态性(SNPs),构建系统发育树鉴定菌株型别,判断突变位点中型别相关和非型别相关的SNPs。定位SNPs所在的基因组区域,对型别相关的突变基因进行KEGG通路的富集分析,对非型别相关的突变基因和间隔区判断是否与耐药相关。【结果】两株广泛耐药菌株分别属于Lineage2和Lineage4型别,两菌株在碱基替换方面存在差异性,Lineage2型别相关的基因功能富集于ABC转运蛋白和核苷酸切除修复的通路。耐药方面,发现了已知的耐药相关基因的突变(rpoB、katG、rpsl、gyrA、gyrB、embB和ethA等),但卷曲霉素和卡那霉素相关的rrs、tlyA和eis启动子区域未发生突变,不足以解释其耐药性的产生。与最新报道的候选耐药基因比较,发现了卷曲霉素和卡那霉素相关的突变(Rv1393c、Rv0265c和narX等)和外排泵相关的pstB、Rv2333c和Rv2687c突变。【结论】结核分枝杆菌Lineage2型别相关的SNPs中含有影响结核分枝杆菌突变率和耐药性的突变。对于两株超级广泛耐药的结核菌,已知的激活药物或药靶相关的单耐药基因突变集合不能完全解释其广泛耐药性,还涉及新候选结核耐药基因、外排泵和补偿等其他潜在机制的相关基因突变。     

Recent updates on drug resistance in Mycobacterium tuberculosis

Tuberculosis (TB) along with acquired immune deficiency syndrome and malaria rank among the top three fatal infectious diseases which pose threat to global public health, especially in middle and low income countries. TB caused by Mycobacterium tuberculosis (Mtb) is an airborne infectious disease and one-third of the world's population gets infected with TB leading to nearly 1·6 million deaths annually. TB drugs are administered in different combinations of four first-line drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) which form the core of treatment regimens in the initial treatment phase of 6–9 months. Several reasons account for the failure of TB therapy such as (i) late diagnosis, (ii) lack of timely and proper administration of effective drugs, (iii) lower availability of less toxic, inexpensive and effective drugs, (iv) long treatment duration, (v) nonadherence to drug regimen and (vi) evolution of drug-resistant TB strains. Drug-resistant TB poses a significant challenge to TB therapy and control programs. In the background of worldwide emergence of 558 000 new TB cases with resistance to rifampicin in the year 2017 and of them, 82% becoming multidrug-resistant TB (MDR-TB), it is essential to continuously update the knowledge on the mechanisms and molecular basis for evolution of Mtb drug resistance. This narrative and traditional review summarizes the progress on the anti-tubercular agents, their mode of action and drug resistance mechanisms in Mtb. The aim of this review is to provide recent updates on drug resistance mechanisms, newly developed/repurposed anti-TB agents in pipeline and international recommendations to manage MDR-TB. It is based on recent literature and WHO guidelines and aims to facilitate better understanding of drug resistance for effective TB therapy and clinical management.     

结核分枝杆菌三种耐药基因的检测方法

建立3种结核分枝杆菌耐药基因的检测方法,探讨耐药基因突变与耐药性的关系。将58株临床分离株均做聚合酶链反应-单链构象多态性分析(PCR—SSCP)和传统药物敏感试验。结果表明,结核分枝杆菌耐药基因突变与耐药水平有密切联系,绝大多数结核分枝杆菌耐药基因突变发生在高耐药株,少部分在低耐药株发生基因突变。     

Specific mutations in the Mycobacterium tuberculosis rpoB gene are associated with increased dnaE2 expression

In Mycobacterium tuberculosis (MTB), rifampicin resistance is almost invariably due to mutations in the rpoB gene, whose function is critical for cell viability. Most of these mutations, at least initially, impair the fitness of the bacteria but confer a selective advantage when antibiotic pressure is exerted. Subsequent adaptation may be critical to restore fitness. The possibility was considered that MTB with mutations in the rpoB gene elicits a constitutive stress response, increasing the probability of subsequent adaptation. In order to test this hypothesis, the expression of recA and dnaE2, an inducible putative error-prone DNA polymerase, was determined in six different isogenic laboratory-generated rpoB-mutants of MTB. Expression levels were determined with real-time PCR and the data obtained were compared with those of the wild-type parent. In four of the six rpoB mutants, a two- to fivefold induction of dnaE2 was detected (P<0.05). Thus, the presence of specific mutations in rpoB is not only associated with impaired fitness but also results in a detectable, moderate yet persistent increase in the expression of dnaE2 but not recA.     

结核分枝杆菌耐吡嗪酰胺分子机制研究

吡嗪酰胺(PZA)是结核病短程化疗中的一线抗结核药物,由吡嗪酰胺酶转换成为活性形式吡嗪酸而生效。吡嗪酰胺酶由pncA基因编码,pncA基因突变会导致该酶活性丧失,与PZA耐药性产生有关。为了进一步明确PZA耐药性产生的基因学基础和PZA耐药株的pncA基因突变率,对中国100株结核分枝杆菌临床分离株进行了DNA序列测定,其中85株为PZA耐药株,15株为PZA敏感株。PZA耐药株有27%(23/85)发生了pncA基因突变,从而导致吡嗪酰胺酶基本氨基酸序列的改变,突变分布在pncA基因开读框架17-546位的核苷酸。其中有一株突变位于pncA基因的调节区域-11位处。同时发现20%(3/15)pncA敏感株也发生了pncA基因突变。敏感株发生突变可能是由于PZA敏感性实验不准确或存在其它耐药机制。实验表明,pncA基因突变是PZA耐药的主要机制之一,中国PZA耐药临床分离株尚存在其它耐药分子机制。     

Polymorphisms of 20 regulatory proteins between Mycobacterium tuberculosis and Mycobacterium bovis

Mycobacterium tuberculosis and Mycobacterium bovis are responsible for tuberculosis in humans and animals, respectively. Both species are closely related and belong to the Mycobacterium tuberculosis complex (MTC). M. tuberculosis is the most ancient species from which M. bovis and other members of the MTC evolved. The genome of M. bovis is over >99.95% identical to that of M. tuberculosis but with seven deletions ranging in size from 1 to 12.7 kb. In addition, 1200 single nucleotide mutations in coding regions distinguish M. bovis from M. tuberculosis. In the present study, we assessed 75 M. tuberculosis genomes and 23 M. bovis genomes to identify non‐synonymous mutations in 202 coding sequences of regulatory genes between both species. We identified species‐specific variants in 20 regulatory proteins and confirmed differential expression of hypoxia‐related genes between M. bovis and M. tuberculosis.