LETTER TO THE EDITOR

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Biofilms and Mycobacterium tuberculosis

Michael J. Brennan
Aeras, Rockville, Maryland, USA

KEYWORDS biofilms, Mycobacterium tuberculosis

T here is good evidence that Mycobacterium tuberculosis evolved with Homo sapiens

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and, like our ancestors, migrated throughout the rest of the world from Africa some Citation Brennan MJ. 2017. Biofilms and
70,000 years ago (1). Since M. tuberculosis, which is now a familiar human pathogen, Mycobacterium tuberculosis. Infect Immun
85:e00411-17. https://doi.org/10.1128/IAI
coexisted with other mycobacteria within different niches, it is possible that mycobac-
.00411-17.
teria once coexisted with man as a symbiont, much as bacteria such as gut bacteria Editor Sabine Ehrt, Weill Cornell Medical
assist and benefit mankind now. Related to this is the ability of mycobacteria, including College
M. tuberculosis, to form biofilms. A number of bacteria form biofilms, which likely helps Copyright © 2017 American Society for
them grow and communicate like Pseudomonas aeruginosa, which is associated with Microbiology. All Rights Reserved.
Address correspondence to
the disease cystic fibrosis. For human pathogens, biofilm growth helps bacteria become
mbrennan@aeras.org.
more tolerant of antibiotics and persist in chronic disease and to elicit different immune For the author reply, see https://doi.org/10
responses which can affect the efficacy of vaccines (2). This is good for the bacteria. In .1128/IAI.00436-17.
the case of certain mycobacteria, biofilms coat medical devices and are a nemesis of
patients in hospitals. Biofilms require a matrix, and, for M. tuberculosis, species-specific
mycolic acids (3) or complex sugars (4) or DNA (5) may be utilized. Anyone who has
cultured mycobacteria in a laboratory has noticed the peculiar aggregated growth.
They seldom grow as single organisms. Indeed, growth of tuberculosis (TB) organisms
as pellicles in stationary cultures, which is the method used by most manufacturers of
Mycobacterium bovis BCG vaccine, occurs in the form of biofilms and new recombinant
BCG vaccines cultured in fermenters may differ in safety and efficacy. In a recent issue
of Infection and Immunity, Wright et al. (6) showed that mycobacterial membrane
protein large (MmpL), a cell wall lipid transporter, is essential for the formation of
biofilms in M. tuberculosis. The investigators used a unique in vitro granuloma model
generated from peripheral blood mononuclear cells (PBMC) and containing macro-
phages, multinucleated giant cells, T cells, and B cells to suggest that biofilms are
important in vivo in granulomas. The results of those studies affirm the importance of
biofilms in tuberculosis and imply that biofilms are underappreciated in M. tuberculosis
pathogenesis. Additional investigations are needed to determine if TB vaccines man-
ufactured from biofilms are more efficacious, if biofilm growth in vivo affects the
pathogenesis of tuberculosis, and if vaccines produced from mycobacterial biofilms
may be more effective against different stages of the disease such as the chronic phase.

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