Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
German Center for Infection Research (DZIF) Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.
Front Immunol. 2020 Oct 8;11:566608. doi: 10.3389/fimmu.2020.566608. eCollection 2020.
Tuberculosis is a bacterial infectious disease that is mainly transmitted from human to human via infectious aerosols. Currently, tuberculosis is the leading cause of death by an infectious disease world-wide. In the past decade, the number of patients affected by tuberculosis has increased by ~20 percent and the emergence of drug-resistant strains of challenges the goal of elimination of tuberculosis in the near future. For the last 50 years, management of patients with tuberculosis has followed a standardized management approach. This standardization neglects the variation in human susceptibility to infection, immune response, the pharmacokinetics of drugs, and the individual duration of treatment needed to achieve relapse-free cure. Here we propose a package of precision medicine-guided therapies that has the prospect to drive clinical management decisions, based on both host immunity and strains genetics. Recently, important scientific discoveries and technological advances have been achieved that provide a perspective for individualized rather than standardized management of patients with tuberculosis. For the individual selection of best medicines and host-directed therapies, personalized drug dosing, and treatment durations, physicians treating patients with tuberculosis will be able to rely on these advances in systems biology and to apply them at the bedside.
结核病是一种细菌性传染病，主要通过传染性飞沫在人与人之间传播。目前，结核病是全球范围内导致死亡的主要传染病。在过去十年中，受结核病影响的患者人数增加了约 20%，而且耐药菌株的出现对近期消除结核病的目标提出了挑战。在过去的 50 年里，结核病患者的管理一直遵循标准化的管理方法。这种标准化忽略了人类对感染的易感性、免疫反应、药物药代动力学以及实现无复发治愈所需的个体治疗持续时间的差异。在这里，我们提出了一套基于宿主免疫和菌株遗传学的精准医学指导治疗方案，有望推动临床管理决策。最近，取得了重要的科学发现和技术进步，为结核病患者的个体化而不是标准化管理提供了视角。对于最佳药物和宿主导向治疗的个体化选择、个性化药物剂量和治疗持续时间，治疗结核病患者的医生将能够依赖系统生物学的这些进展，并将其应用于床边。
