Abstract
BackgroundContinuing evolution of the Mycobacterium tuberculosis (Mtb) complex genomes associated with resistance to anti-tuberculosis drugs is threatening tuberculosis disease control efforts. Both multi- and extensively drug resistant Mtb (MDR and XDR, respectively) are increasing in prevalence, but the full set of Mtb genes involved are not known. There is a need for increased sensitivity of genome-wide approaches in order to elucidate the genetic basis of anti-microbial drug resistance and gain a more detailed understanding of Mtb genome evolution in a context of widespread antimicrobial therapy. Population structure within the Mtb complex, due to clonal expansion, lack of lateral gene transfer and low levels of recombination between lineages, may be reducing statistical power to detect drug resistance associated variants.ResultsTo investigate the effect of lineage-specific effects on the identification of drug resistance associations, we applied genome-wide association study (GWAS) and convergence-based (PhyC) methods to multiple drug resistance phenotypes of a global dataset of Mtb lineages 2 and 4, using both lineage-wise and combined approaches. We identify both well-established drug resistance variants and novel associations; uniquely identifying associations for both lineage-specific and -combined GWAS analyses. We report 17 potential novel associations between antimicrobial resistance phenotypes and Mtb genomic variants.ConclusionsFor GWAS, both lineage-specific and -combined analyses are useful, whereas PhyC may perform better in contexts of greater diversity. Unique associations with XDR in lineage-specific analyses provide evidence of diverging evolutionary trajectories between lineages 2 and 4 in response to antimicrobial drug therapy.
Highlights
Continuing evolution of the Mycobacterium tuberculosis (Mtb) complex genomes associated with resistance to anti-tuberculosis drugs is threatening tuberculosis disease control efforts
These isolates are within a global drug resistance data set [13], which has been further complemented by additional phenotypic data
With the recognition of Extensively drug-resistant (XDR) transmission [36, 43], our study suggests that further critical information on lineage and transmission clustering would be important to determine the full impact of specific mutations, that might lead to further phenotypic descriptions related to transmission, virulence and degree of drug resistance
Summary
Continuing evolution of the Mycobacterium tuberculosis (Mtb) complex genomes associated with resistance to anti-tuberculosis drugs is threatening tuberculosis disease control efforts. Both multi- and extensively drug resistant Mtb (MDR and XDR, respectively) are increasing in prevalence, but the full set of Mtb genes involved are not known. As whole genome sequencing of Mtb becomes more routinely applied [11], association approaches using genomic variation have the potential to provide new insights into these resistance mechanisms Compensatory mutations such as those in rpoA and rpoC, associated with the rpoB rifampicin resistance mutations, have been associated with transmission of drug resistant strains [12]. As patients receive a cocktail of anti-Mtb drugs, multiple concomitant resistance can arise naturally, and this complicates the analysis of phenotype-genotype relationships [13]
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