Host oxidative stress primes mycobacteria for rapid antibiotic resistance evolution

Abstract

The rapid emergence of multidrug-resistant Mycobacterium tuberculosis (Mtb) threatens global tuberculosis (TB) control, yet the mechanisms enabling rapid evolution of resistance in Mtb remain poorly understood. Here, we show that pre-existing mutations in oxidative stress response genes create permissive genomic backgrounds that accelerate high-level isoniazid resistance (INHR), challenging the paradigm that resistance mutations must precede compensatory adaptation. Using Mycobacterium smegmatis mc2155 (Msm) as a model, we demonstrate that brief exposure to sublethal isoniazid (INH) enriches for “low-level resistance and tolerance” (LLRT) mutants in a single step. LLRT mutants, particularly ..