A world without tuberculosis: moving from imagination to reality

Tuberculosis (TB), caused by Mycobacterium tuberculosis infection, remains a leading cause of death from an infectious agent, resulting in more than a million deaths per year. Despite vaccines and chemotherapies, patients often harbor persister M. tuberculosis cells that resist immune assault and chemotherapeutic treatments, resulting in a latent TB infection (LTBI). In this issue of the JCI, Sharan et al. used an aerosol-based macaque model to show that weekly treatments with isoniazid and rifapentine for 3 months reduced active M. tuberculosis infection and LTBI. Lung tissue from treated animals showed fewer granulomas when compared with the untreated control animals. These findings suggest that it is possible to eliminate persister M. tuberculosis cells, thereby eliminating LTBI. If similar elimination routinely occurs in patients undergoing the isoniazid and rifapentine treatment, the hidden reservoir of M. tuberculosis associated with LTBI would be greatly reduced, allowing us to imagine, and eventually achieve, a world without TB.