Overview

• A large-scale metabolomic study analyzed 469 cerebrospinal fluid metabolites from 1,067 tuberculous meningitis patients in Vietnam and Indonesia.
• The study identified ten metabolites, including three hydroxylated fatty acids, as strong predictors of mortality, independent of HIV status and disease severity.
• Dysregulated β-oxidation, a critical fatty acid metabolic pathway, was highlighted as a potentially modifiable driver of mortality in the disease.
• Follow-up genetic studies, including quantitative trait locus mapping and rare variant analysis, are underway to explore host genetic influences on metabolic dysfunction.
• Plans are advancing for clinical trials to test interventions targeting cerebral metabolism and oxygenation to improve survival rates in tuberculous meningitis.