New strategies for the treatment of tuberculosis: research progress and clinical translation in immune modulation and inflammation control
Year: 2026
Type: review
Abstract: Tuberculosis (TB) remains a major global public health challenge, with treatment complicated by drug resistance, adverse effects, and suboptimal host immune responses. Whilst conventional anti-TB drugs are effective bactericidally, their immunomodulatory effects may, in certain contexts, contribute to immune imbalance and affect treatment outcomes. Host-directed therapy (HDT), which aims to modulate the host immune response to enhance pathogen control and limit immunopathology, has emerged as a promising adjunctive strategy. This narrative review critically evaluates the current evidence for HDT in TB, focusing on immunosenescence, trained immunity, cytokine and lipid mediator networks, immunometabolic reprogramming, neuroendocrine regulation, and repurposed drugs including metformin and statins. Importantly, we distinguish between evidence derived directly from TB models ( in vitro , animal, and clinical studies) and evidence extrapolated from other diseases, highlighting knowledge gaps and areas requiring further investigation. We propose that future progress depends on evidence-based stratification of HDT candidates, rigorous clinical trial design, and a personalised approach that accounts for patient comorbidities and immune status. This review aims to provide a balanced framework for advancing HDT from bench to bedside in TB therapy.
Source: Frontiers in Immunology
Authors: Shihao Du, Lulu Zhen, Ji Zhou, Di Deng
Institution: University of Health and Rehabilitation Sciences
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7221772041