Molecular characterization of isoniazid-resistant Mycobacterium tuberculosis isolates collected in Australia

Abstract

Elucidation of the molecular basis of isoniazid (INH) resistance in Mycobacterium tuberculosis has led to the development of different genotypic approaches for the rapid detection of INH resistance in clinical isolates. Mutations in katG, in particular the S315T substitution, are responsible for INH resistance in a large proportion of tuberculosis cases. However, the frequency of the katG S315T substitution varies with population samples. In this study, 52 epidemiologically unrelated clinical INH-resistant M. tuberculosis isolates collected in Australia were screened for mutations at katG codon 315 and the fabG1-inhA regulatory region. Importantly, 52 INH-sensitive isolates, selected to reflect the geographic and genotypic diversity of the isolates, were also included for comparison. The katG S315T substitution and fabG1-inhA -15 C-to-T mutation were identified in 34 and 13 of the 52 INH-resistant isolates, respectively, and none of the INH-sensitive isolates. Three novel katG mutations, D117A, M257I, and G491C, were identified in three INH-resistant strains with a wild-type katG codon 315, fabG1-inhA regulatory region, and inhA structural gene. When analyzed for possible associations between resistance mechanisms, resistance phenotype, and genotypic groups, it was found that neither the katG S315T nor fabG1-inhA -15 C-to-T mutation clustered with any one genotypic group, but that the -15 C-to-T substitution was associated with isolates with intermediate INH resistance and isolates coresistant to ethionamide. In total, 90.4% of unrelated INH-resistant isolates could be identified by analysis of just two loci: katG315 and the fabG1-inhA regulatory region.

FIG. 1.

Genetic relationship, genotypic group, drug resistance profile, and mutations identified in the 52 INH-resistant M. tuberculosis isolates. This UPGMA tree was generated using the START program based on the 50 distinct MIRU-ETR patterns (Table 2) that represented the 52 isolates. I, isolate identification number; II, drug resistance phenotype; INHI, INH intermediate resistance; III, inhAP, fabG1-inhA regulatory region mutation; katG117, katG D117A substitution; katG257, katG M257I substitution; katG315, katG S315T substitution; katG491, katG G491C substitution.