Macrophages, Metabolism, Mitochondria, Circadian Rhythmicity and the Pathogen: The Multidimensional Nature of Tuberculosis

Mycobacterium tuberculosis, the causative agent of tuberculosis (TB) was first identified in 1882 by Robert Koch, and it is estimated that this pathogen has been around for as long as 3 million years. The World Health Organization (WHO) reported that in 2022 alone an estimated 10.6 million people developed TB worldwide, making TB the world’s second leading cause of death from a single infectious agent, just after coronavirus disease (COVID-19), despite TB being a preventable and usually curable disease. Moreover, epidemiological studies suggest that approximately a quarter of the global population has been infected with TB bacteria, of which 5–10% will eventually develop symptoms and TB disease. Poverty, obesity, diabetes, and alcohol use contribute to the burden of TB. Alveolar macrophages play a pivotal role in the clearance of airborne pathogenic microorganisms and are the primary target of M. tuberculosis. Macrophage activity depend on metabolism and circadian rhythmicity, and mitochondria are a central hub that coordinates the communication between metabolism, circadian rhythmicity, and the immune system. Recent evidence has thrown light on how M. tuberculosis metabolism may regulate macrophage activity and the overall host responses to M. tuberculosis infection. This chapter explores how all these biological domains relate to each other, highlighting the multidimensional nature of TB, and positioning macrophages at center stage.