A narrative review of transcriptomic biomarkers for non-sputum tuberculosis diagnosis and triage: From bench to bedside.

Rapid and accurate detection of tuberculosis (TB) remains challenging, especially in resource-limited settings. Considering the limitations of sputum-dependent assays, the World Health Organization (WHO) has prioritized the development of non-sputum biomarker-based TB diagnostic tools. Transcriptomic biomarkers represent promising candidates for TB detection. This narrative review updated the latest advances in transcriptomic biomarkers for TB diagnosis and triage. mRNA signatures demonstrate significant potential for TB triage, meeting or approaching the WHO Target Product Profiles. Non-coding RNAs also hold diagnostic potential and require further validation in large cohorts. Accelerating the translation of high-performing biomarkers into practical clinical tools is essential. Xpert MTB Host Response, a cartridge based on a three-gene signature, has demonstrated strong triage capabilities in multinational evaluations. Additionally, integrating transcriptomic biomarkers with clinical parameters or established diagnostics may enhance accuracy. Speeding the clinical adoption of available near point-of-care tests is crucial to the successful implementation of the End TB strategy.