Tuberculosis (TB) treatment is plagued by liver damage, which often leads to treatment interruptions. Circular RNAs (circRNAs) are a special class of non‐coding RNAs abundant in body fluids with important biological functions. However, the role of circRNA in anti‐tuberculosis drug‐induced liver injury (ADLI) is unclear. We explored ADLI‐specific circRNAs in TB patients using circRNA microarrays and verified circMARS in a cohort of 300 individuals. In addition to the value assessment of circMARS in patients using a receiver operating characteristic (ROC) curve, cell experiments were also performed under the guidance of bioinformatics analyses. In particular, we found that circMARS acts as a miRNA sponge by binding to miRNAs. Compared with the blank group, the expressions of circMARS, KMT2C gene, and EGFR protein in the ADLI group were increased, while miR‐6808‐5p, miR‐6874‐3p, and miR‐3157‐5p were decreased. Furthermore, when si‐circMARS was used in the ADLI groups, circMARS demotion manifested the opposite results. Subsequently, a self‐controlled cohort of 35 participants was used to verify the circMARS–miR‐6808‐5p/‐6874‐3p/‐3157‐5p–KMT2C–EGFR function axis. Therefore, circMARS may participate in the compensatory repair mechanism of ADLI through the function axis, and may be a potential biomarker for ADLI diagnosis in TB patients.

This study aims to elucidate additional mutation loci associated with fluoroquinolone (FQ) resistance and evaluate the discriminatory capacity of mutation loci and allele mutation frequencies in identifying FQ-resistant Mycobacterium tuberculosis (MTB) isolates. A random selection of isolates was extracted from an ongoing collection. Drug resistance was determined using the resazurin microtiter assay (REMA) as the gold standard. Mutation loci and the burden of mutations in the quinolone resistance-determining region (QRDR) were elucidated through whole-genome sequencing (WGS). Novel amino acid mutations, namely, G520D and G520T, were identified in the gyrB and associated with FQ resistance. In the context of distinguishing FQ-resistant isolates, the AUC for the QRDR mutation frequency burden (0.969) surpassed that of the mutation locus (0.929), and this difference was statistically significant ( P = 0.03). Furthermore, using the resistance mutation locus as a reference, setting the QRDR mutation frequency burden threshold at 1.31% resulted in a 3.60% increase in the accuracy of classifying FQ-resistant isolates (NRI = 3.60%, P < 0.001). The QRDR mutation frequency burden appears to offer superior diagnostic efficacy in discriminating FQ-resistant isolates compared to qualitative detection of mutant loci. IMPORTANCE: Fluoroquinolone (FQ) drugs are recommended as second-line drugs for the treatment of multidrug-resistant tuberculosis. With the massive use of FQ drugs in the clinical treatment of tuberculosis (TB), there is an increasing rate of drug resistance to FQ drugs. In this study, we identified and demonstrated novel amino acid mutations associated with FQ resistance in Mycobacterium tuberculosis (MTB), and we quantified the mutation sites and identified the quinolone resistance-determining region (QRDR) mutation frequency burden as a novel diagnostic method for FQ resistance. We hope that the results of this study will provide data support and a theoretical basis for the rapid diagnosis of FQ-resistant MTB.

DNA Methylation of the CYP1A1 Promoter Region is Associated with Anti-tuberculous Drug-induced Hepatic Injury

Tuberculosis (TB) remains a leading global health threat, with the rise of drug-resistant (DR-TB) strains posing a significant impediment to disease control. An increasingly recognized and complex challenge is heteroresistance, the coexistence of drug-susceptible and drug-resistant Mycobacterium tuberculosis subpopulations within a single host. This phenomenon acts as a crucial intermediate in the evolution toward fixed resistance and has been strongly associated with poor clinical prognoses, including treatment failure and the amplification of resistance. This review synthesizes the current state of knowledge regarding the screening methodologies for and the adverse outcomes associated with TB heteroresistance. The diagnostic gap creates a substantial risk of misclassifying patients and prescribing functionally inadequate therapeutic regimens. Further, the presence of heteroresistance significantly correlates with diminished treatment efficacy and an increased likelihood of unfavorable outcomes. Importantly, the precise clinical significance of low-frequency resistant variants remains a critical area of investigation, with an urgent need to establish evidence-based thresholds to guide therapy. Future research must focus on defining clinically relevant heteroresistance thresholds, standardizing advanced diagnostic platforms, and further elucidating the biological mechanisms that govern the emergence and persistence of these heteroresistance bacterial populations to ultimately improve patient outcomes and curb the spread of drug-resistant tuberculosis.