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<article article-type="review-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">seamed</journal-id><journal-title-group><journal-title xml:lang="ru">Морская медицина</journal-title><trans-title-group xml:lang="en"><trans-title>Marine Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2413-5747</issn><issn pub-type="epub">2587-7828</issn><publisher><publisher-name>Research Institute of Industrial and Maritime Medicine of the Federal Medical and Biological Agency</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.22328/2413-5747-2025-11-1-7-26</article-id><article-id custom-type="edn" pub-id-type="custom">PKFIDR</article-id><article-id custom-type="elpub" pub-id-type="custom">seamed-797</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Обзоры</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Таргетное секвенирование генов лекарственной устойчивости Mycobacterium tuberculosis</article-title><trans-title-group xml:lang="en"><trans-title>Targeted sequencing of drug resistance genes Mycobacterium tuberculosis</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0005-5096-112X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ковров</surname><given-names>Игорь Константинович</given-names></name><name name-style="western" xml:lang="en"><surname>Kovrov</surname><given-names>Igor K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>врач-бактериолог, лаборант-исследователь Центральной научно-исследовательской лаборатории</p><p>Архангельск</p></bio><bio xml:lang="en"><p>Bacteriologist, Laboratory Researcher at the Central Research Laboratory</p><p>Arkhangelsk</p></bio><email xlink:type="simple">ingmar-kov@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1684-6636</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Попова</surname><given-names>Юлия Алексеевна</given-names></name><name name-style="western" xml:lang="en"><surname>Popova</surname><given-names>Yuliya A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>аспирант кафедры фтизиопульмонологии</p><p>Архангельск</p></bio><bio xml:lang="en"><p>Postgraduate Student of the Department of Phthisiopulmonology</p><p>Arkhangelsk</p></bio><email xlink:type="simple">yuliapopova0422@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0003-7897-0680</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Попова</surname><given-names>Ирина Алексеевна</given-names></name><name name-style="western" xml:lang="en"><surname>Popova</surname><given-names>Irina A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>студент факультета медико-профилактического дела и медицинской биохимии</p><p>Архангельск</p></bio><bio xml:lang="en"><p>Student of the Faculty of Medical Biochemistry</p><p>Arkhangelsk</p></bio><email xlink:type="simple">popova.irina.2754@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1542-6958</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Никишова</surname><given-names>Елена Ильинична</given-names></name><name name-style="western" xml:lang="en"><surname>Nikishova</surname><given-names>Elena I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>доктор медицинских наук, профессор кафедры фтизиопульмонологии</p><p>Архангельск</p></bio><bio xml:lang="en"><p>Dr. of Sci. (Med.), Professor of the Department of Phthisiopulmonology</p><p>Arkhangelsk</p></bio><email xlink:type="simple">e.i.nikishova@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8485-5625</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Марьяндышев</surname><given-names>Андрей Олегович</given-names></name><name name-style="western" xml:lang="en"><surname>Mariandyshev</surname><given-names>Andrei O.</given-names></name></name-alternatives><bio xml:lang="ru"><p>доктор медицинских наук, профессор, член-корреспондент РАН, заведующий кафедрой фтизиопульмонологии</p><p>Архангельск</p></bio><bio xml:lang="en"><p>Dr. of Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Phthisiopulmonology</p><p>Arkhangelsk</p></bio><email xlink:type="simple">maryandyshev@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Северный государственный медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Northern State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Северный государственный медицинский университет; Северный арктический федеральный университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Northern State Medical University; Northern Arctic Federal University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>03</day><month>05</month><year>2025</year></pub-date><volume>11</volume><issue>1</issue><fpage>7</fpage><lpage>26</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Ковров И.К., Попова Ю.А., Попова И.А., Никишова Е.И., Марьяндышев А.О., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Ковров И.К., Попова Ю.А., Попова И.А., Никишова Е.И., Марьяндышев А.О.</copyright-holder><copyright-holder xml:lang="en">Kovrov I.K., Popova Y.A., Popova I.A., Nikishova E.I., Mariandyshev A.O.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://seamed.elpub.ru/jour/article/view/797">https://seamed.elpub.ru/jour/article/view/797</self-uri><abstract><sec><title>ВВЕДЕНИЕ</title><p>ВВЕДЕНИЕ. Лекарственно-устойчивые формы туберкулеза и их распространение являются актуальной проблемой современной медицины. Генетические механизмы возникновения лекарственной устойчивости – ключ к пониманию возможностей методов диагностики резистентного к терапии туберкулеза. В настоящее время определяются как фенотипические признаки устойчивости возбудителя к противотуберкулезным препаратам, так и генетические маркеры резистентности. Широкий спектр тематических публикаций и исследований, посвященных мутациям генов, связан с резистентностью к противотуберкулезным препаратам.</p></sec><sec><title>ЦЕЛЬ</title><p>ЦЕЛЬ. Провести анализ наиболее эффективных молекулярно-биологических технологий и методов, позволяющих определить устойчивость возбудителя туберкулеза к препаратам, рекомендованным Всемирной организацией здравоохранения (ВОЗ) в режимах лечения. Представить наибольшие частоты отдельных мутаций, ассоциированных с генами антибиотикорезистентности, формирующих значимый уровень устойчивости к противотуберкулезным препаратам. Рассмотреть спектр мутаций генов лекарственной устойчивости, обеспечивающих наибольший вклад в ее формирование.</p></sec><sec><title>МАТЕРИАЛЫ И МЕТОДЫ</title><p>МАТЕРИАЛЫ И МЕТОДЫ. Использованы материалы отечественных и зарубежных авторов, рекомендации ВОЗ, связанные с тематикой распространенности и оценки значения мутаций отдельных генов антибиотикорезистентности в разных странах и регионах. Проанализированы периодические литературные источники из международных и российских свободных баз данных: PubMed, сайт ВОЗ (https://www.who.int), международная база данных туберкулеза – Tuberculosis Drug Resistance Mutation Database (TBDReaMDB). (http://www.tbdreamdb.com), MDPI, eLIBRARY, КиберЛенинка, а также выборка статей по ключевым словам за 20 лет (с 2004 по 2024 г.).</p></sec><sec><title>РЕЗУЛЬТАТЫ</title><p>РЕЗУЛЬТАТЫ. Представлены наиболее эффективные молекулярно-биологические технологии, дающие возможность определить мутации в генах лекарственной устойчивости. Таргетное секвенирование позволяет при целевом выборе праймеров к фрагментам генов, связанных с лекарственной устойчивостью, получить результаты, необходимые для оценки уровня резистентности микобактерий к основным препаратам, входящим в схему лечения. Систематизированы наиболее частые локализации мутаций в генах Mycobacterium tuberculosis, ассоциированные со значимыми уровнями лекарственной устойчивости.</p></sec><sec><title>ОБСУЖДЕНИЕ</title><p>ОБСУЖДЕНИЕ. Распространенность лекарственно-устойчивых штаммов варьирует в странах и регионах и может быть сопоставлена только с использованием надежного и верифицируемого генетического метода. Целевое секвенирование является методом эффективного надзора за лекарственно-устойчивым туберкулезом, а для валидации этой информации используют фенотипическое исследование в системе Bactec MGIT. Результаты распространенности однонуклеотидных полиморфизмов, полученные с помощью методов секвенирования, должны дополнять и уточнять данные, выявленные с помощью метода ПЦР. ЗАКЛЮЧЕНИЕ. Таргетное секвенирование генов лекарственной устойчивости по Сенгеру занимает достойное место в ряду других молекулярно-генетических методов исследования туберкулеза. Особую роль целевое секвенирование имеет при анализе генов, ассоциированных с лекарственной устойчивостью к давно используемым препаратам 1-го ряда при нетипичных локализациях мутаций; оно также является единственным методом для исследования генов, связанных с резистентностью к новым и разрабатываемым препаратам. Для результативности сенгеровского секвенирования ключевую роль играет адекватный выбор наборов ряда праймеров к участкам генов лекарственной устойчивости, кодирующим критические для правильного формирования глобулярной структуры положения полипептидной цепи в ферментных комплексах M. tuberculosis.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>INTRODUCTION</title><p>INTRODUCTION. Drug-resistant forms of tuberculosis and their prevalence are an urgent problem of modern medicine. Genetic mechanisms of drug resistance are the key to understanding the possibilities of diagnostic methods for therapy-resistant tuberculosis. Currently, both phenotypic signs of pathogen resistance to TB drugs and genetic markers of resistance are being identified. A wide range of thematic publications and studies on gene mutations is associated with resistance to TB drugs. OBJECTIVE. Analyze the most effective molecular biological technologies and methods allowing to determine resistance of the tuberculosis pathogen to drugs recommended by the World Health Organization (WHO) in treatment regimens. To present the highest incidence of individual mutations associated with antibiotic resistance genes, which form a significant level of resistance to antituberculosis drugs. Consider the spectrum of mutations of drug resistance genes that provide the greatest contribution to its formation.</p></sec><sec><title>MATERIALS AND METHODS</title><p>MATERIALS AND METHODS. Materials of Russian and foreign authors, WHO recommendations related to the prevalence and assessment of the significance of mutations of individual antibiotic resistance genes in different countries and regions were used. Periodical literature sources from international and Russian free databases were analyzed: PubMed, WHO website (https://www.who.int), international tuberculosis database - Tuberculosis Drug Resistance Mutation Database (TBDReaMDB). (http://www.tbdreamdb.com), MDPI, eLIBRARY, CyberLeninka, and a sample of articles by keywords for 20 years (from 2004 to 2024).</p></sec><sec><title>RESULTS</title><p>RESULTS. The most effective molecular biological technologies that enable the detection of mutations in drug resistance genes are presented. Targeted sequencing allows the targeted selection of primers to fragments of genes associated with drug resistance to obtain the results necessary to assess the level of resistance of mycobacteria to the main drugs included in the treatment regimen. The most frequent localizations of mutations in Mycobacterium tuberculosis genes associated with significant levels of drug resistance have been systematized. DISCUSSION. The prevalence of drug-resistant strains varies across countries and regions and can only be compared using a reliable and verifiable genetic method. Targeted sequencing is a method for effective surveillance of drug-resistant TB, and phenotypic testing in the Bactec MGIT system is used to validate this information. Results of the prevalence of single nucleotide polymorphisms obtained by sequencing methods should complement and clarify the data detected by PCR methods.</p></sec><sec><title>CONCLUSION</title><p>CONCLUSION. Targeted Sanger sequencing of drug resistance genes occupies a worthy place among other molecular genetic methods of tuberculosis research. Targeted sequencing has a special role in the analysis of genes associated with drug resistance to long-standing first-line drugs with atypical localization of mutations; it is also the only method for the study of genes associated with resistance to new and emerging drugs. Adequate selection of primer sets for the regions of drug resistance genes encoding polypeptide chain positions in M. tuberculosis enzyme complexes that are critical for the correct formation of the globular structure plays a key role in the efficiency of Sanger sequencing.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>морская медицина</kwd><kwd>лекарственная устойчивость микобактерий туберкулеза</kwd><kwd>гены</kwd><kwd>ассоциированные с лекарственной устойчивостью</kwd><kwd>таргетное секвенирование</kwd><kwd>сенгеровское секвенирование</kwd><kwd>точечная мутация</kwd></kwd-group><kwd-group xml:lang="en"><kwd>marine medicine</kwd><kwd>drug resistance in Mycobacterium tuberculosis</kwd><kwd>drug resistance associated genes</kwd><kwd>target sequencing</kwd><kwd>Sanger sequencing</kwd><kwd>point mutation</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">финансирование подготовки обзора литературы осуществлялась в рамках государственного задания «Использование результатов молекулярно-эпидемиологических исследований и новых лекарственных средств, режимов в ликвидации туберкулеза в Архангельской области и Ненецком автономном округе» Министерства Здравоохранения Российской Федерации, №056-03-2024-072 от 24.01.2024.</funding-statement><funding-statement xml:lang="en">funding for the preparation of the literature review was carried out within the framework of the state assignment “Use of the results of molecular epidemiological studies and new drugs, regimens in the elimination of tuberculosis in the Arkhangelsk region and the Nenets Autonomous Okrug”, №056-03-2024-072 от 24.01.2024</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Андреевская С. 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