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Nat Med DOI:10.1038/nm.3412

Sterilization of granulomas is common in active and latent tuberculosis despite within-host variability in bacterial killing.

Publication TypeJournal Article
Year of Publication2014
AuthorsLin, PLing, Ford, CB, M Coleman, T, Myers, AJ, Gawande, R, Ioerger, T, Sacchettini, J, Fortune, SM, Flynn, JAL
JournalNat Med
Date Published2014 Jan
KeywordsAdaptive Immunity, Animals, Disease Progression, Granuloma, Isoniazid, Latent Tuberculosis, Lung, Macaca fascicularis, Models, Biological, Mycobacterium tuberculosis, Population Dynamics, Positron-Emission Tomography, Tuberculosis

Over 30% of the world's population is infected with Mycobacterium tuberculosis (Mtb), yet only ∼5-10% will develop clinical disease. Despite considerable effort, researchers understand little about what distinguishes individuals whose infection progresses to active tuberculosis (TB) from those whose infection remains latent for decades. The variable course of disease is recapitulated in cynomolgus macaques infected with Mtb. Active disease occurs in ∼45% of infected macaques and is defined by clinical, microbiologic and immunologic signs, whereas the remaining infected animals are clinically asymptomatic. Here, we use individually marked Mtb isolates and quantitative measures of culturable and cumulative bacterial burden to show that most lung lesions are probably founded by a single bacterium and reach similar maximum burdens. Despite this observation, the fate of individual lesions varies substantially within the same host. Notably, in active disease, the host sterilizes some lesions even while others progress. Our data suggest that lesional heterogeneity arises, in part, through differential killing of bacteria after the onset of adaptive immunity. Thus, individual lesions follow diverse and overlapping trajectories, suggesting that critical responses occur at a lesional level to ultimately determine the clinical outcome of infection. Defining the local factors that dictate outcome will be useful in developing effective interventions to prevent active TB.


Alternate JournalNat. Med.
PubMed ID24336248
PubMed Central IDPMC3947310
Grant ListU19 AI076217 / AI / NIAID NIH HHS / United States
R01 AI094745 / AI / NIAID NIH HHS / United States
T32 AI007638 / AI / NIAID NIH HHS / United States
AI094745 / AI / NIAID NIH HHS / United States
DP2 OD001378 / OD / NIH HHS / United States
HL106804 / HL / NHLBI NIH HHS / United States
/ / Howard Hughes Medical Institute / United States
R01 HL106804 / HL / NHLBI NIH HHS / United States
HL110811 / HL / NHLBI NIH HHS / United States
AI076217 / AI / NIAID NIH HHS / United States