About

Dr. Jerrold J. Ellner is a Professor and the Director of Research Innovations for the Center for Emerging and Re-Emerging Pathogens in the Department of Medicine, Division of Infectious Diseases, at Rutgers New Jersey Medical School. He previously served as the Chief of the Division of Infectious Diseases for 10 years. His research focuses on the immunopathogenesis of tuberculosis (TB) and TB in HIV infection, with collaborations in Uganda and Brazil. Dr. Ellner has conducted clinical trials on the prevention and treatment of TB, including the first HIV/AIDS Vaccine Trial in Africa. His group was the first to demonstrate that TB accelerates the course of HIV infection by activating viral replication in latently infected cells. He is a principal architect of the Uganda-Case Western Reserve University Research Collaboration, a founding member of the Academic Alliance for AIDS Prevention and Care in Africa, and the founding director of the TB Research Unit at Case Western Reserve University. Additionally, he is PI of an International Collaboration for Infectious Diseases Research (ICIDR) program in Brazil and the TB Clinical Diagnostics Research Consortium. With over 300 publications on TB, Dr. Ellner has trained numerous current leaders in infectious diseases.

Research topics

• Environmental health
• Immunology
• Medicine
• Microbiology
• Biology
• Internal medicine
• Genetics
• Demography
• Pathology
• Pediatrics

Selected publications

• Acceptability and feasibility of oral swabs for tuberculosis diagnosis in young children: a qualitative study from Uganda and Peru

  Frontiers in Tuberculosis · 2026-02-12

  articleOpen access

  Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality in young children, particularly in settings with limited diagnostic capacity. Oral swabs represent a promising alternative specimen type due to their ease of collection, but evidence on their acceptability and feasibility remains limited. Methods: This qualitative sub-study was nested within the NOD-pedFEND diagnostic trial evaluating novel tests for pediatric TB. We conducted semi-structured interviews and focus group discussions with 81 participants across Uganda (n=57) and Peru (n=24), including caregivers (Uganda n=30; Peru n=7), healthcare workers (Uganda n=23; Peru n=12), and National TB Program stakeholders (Uganda n=4; Peru n=5). Participants were recruited purposively from among those involved in or linked to the parent NOD-pedFEND study. Data were analyzed using thematic analysis. Results: Oral swabs were widely perceived as acceptable due to their non-invasive nature, minimal discomfort, and ease of collection. Caregivers and healthcare workers valued the reduced burden on children compared to more invasive sampling methods. Across both countries, participants expressed concerns about perceived low diagnostic sensitivity in children, particularly when compared with reference standard specimens. Despite these reservations, oral swabs were welcomed as a complementary, rather than substitute, diagnostic modality. Stakeholders highlighted their potential role within future point-of-care diagnostic strategies in low-resource settings. Conclusions: Oral swabs are acceptable and feasible for pediatric TB diagnosis in diverse settings, though concerns about sensitivity persist. Their integration as an add-on test could expand diagnostic access, especially if incorporated into scalable, point-of-care approaches.

  PublisherOA PDFDOI

• Immunometabolic reprogramming of Mycobacterium tuberculosis-responsive memory CD4+ T cell subsets is linked to long-term protective immunity

  Frontiers in Tuberculosis · 2026-04-10

  articleOpen access

  Introduction Memory CD4 + T cells are central to long-term immunity in tuberculosis (TB), yet their functional roles that define their protective capacity remain unclear. Understanding the immune mechanisms that prevent clinical progression from latent TB infection (LTBI) to active TB disease is critical for the development of next-generation vaccines and biomarkers. Methods We characterized the transcriptomic, metabolic, and functional programs of Mycobacterium tuberculosis (Mtb) antigen-stimulated peripheral CD4 + T stem cell (T-SCM), central (T-CM), transitional (T-TM), and effector (T-EM) memory subsets from individuals with remote LTBI. We utilized a multi-platform validation strategy that integrated RNA-sequencing data with protein-level metabolic profiling using “Met-Flow” cytometry and functional growth restriction assays to link memory CD4 + T cell differentiation states to immunometabolism and antimycobacterial function. Finally, we evaluated the immunometabolic profiles of memory CD4 + T cell subsets in an independent, longitudinal cohort of Mtb-exposed progressors and non-progressors from Brazil (GSE112104). Results We identified a differentiation gradient associated with distinct immunometabolic states. T-SCM and T-CM subsets exhibited elevated mitochondrial activity and oxidative metabolism (fatty acid oxidation), supporting their proliferative capacity. In contrast, T-TM and T-EM subsets underwent glycolytic reprogramming and engaged the pentose phosphate pathway, which fueled enhanced cytokine production and Mtb growth restriction. Importantly, we observed that non-progressors exhibit fatty acid oxidation-driven, stem/central memory-like signatures, while progressors and active TB cases display elevated exhaustion markers, glycolytic reprogramming and pro-inflammatory profiles aligned with disease progression. Conclusion Collectively, findings from our proof-of-concept study suggest metabolic state as a key axis connecting Mtb antigen-induced memory T cell differentiation, restimulation-induced transcriptional programming, and durability of immune control. The findings provide the basis for future longitudinal studies to examine the dynamic metabolic and functional modulation in Mtb antigen-specific memory T cell subsets from contained infection to disease progression.

  PublisherDOI

• PET–CT benchmarked detection and 5-year progression of asymptomatic tuberculosis: a longitudinal, prospective cohort study

  The Lancet Respiratory Medicine · 2026-03-01 · 2 citations

  articleOpen access

  BACKGROUND: F]-fluorodeoxyglucose PET-CT) and compared with chest x-ray computer-aided detection (CAD). METHODS: We enrolled a prospective longitudinal cohort in Khayelitsha, Cape Town, South Africa, of asymptomatic, HIV-uninfected contacts aged 18-65 years of patients with rifampicin-resistant tuberculosis, a tuberculosis high-risk group not eligible for chemoprophylaxis. Participants underwent baseline PET-CT, chest x-ray, phlebotomy, and intensive sputum collection, and were classified into four PET-CT lung categories: consistent with tuberculosis, inactive tuberculosis, other lesions, and normal. Chest x-ray was processed by three types of CAD software (CAD4TB [version 7.0], qXR [version 3.0.0], and Lunit [version 3.1.4.111]). Follow-up included symptom-agnostic tuberculosis screening (23-38 months) and provincial register review (≤74 months), and a subgroup had repeat PET-CT (5-15 months). Tuberculosis was defined as bacteriologically confirmed or clinically diagnosed. The primary outcome measures were hazard ratio (HR) for tuberculosis diagnosis and treatment by baseline PET-CT lung abnormality category with normal as the reference group, and diagnostic performance of chest x-ray CAD software using area under the receiver operator characteristic curve (AUC). FINDINGS: 250 asymptomatic adults were enrolled between March 3, 2015, and Oct 11, 2017, irrespective of tuberculosis history or previous infection, and followed up for 1107 person-years (median 4·7 years [IQR 4·0-5·1]). 18 (7%) participants were treated for tuberculosis (16 [89%] of 18 bacteriologically confirmed). Six of 18 participants were diagnosed at baseline (four requiring induced sputum culture) and 12 of 18 after a median of 32 months (IQR 12-35). By baseline PET-CT category, tuberculosis was diagnosed and treated in 12 (41%) of 29 participants with scans consistent with tuberculosis, two (7%) of 30 with scans consistent with inactive tuberculosis, two (2%) of 83 with scans showing other lesions, and two (2%) of 108 with scans showing normal lungs. Participants with baseline PET-CT scans consistent with tuberculosis had the highest risk of 5-year tuberculosis diagnosis (HR 28·54 [95% CI 6·37-127·81] compared with those with scans showing normal lungs, p<0·0001), with no significant risk for scans consistent with inactive tuberculosis (3·55 [0·50-25·21], p=0·21) or other lung lesions (1·30 [0·18-9·23], p=0·79). 11 (69%) of the 16 participants with bacteriologically confirmed tuberculosis were asymptomatic at bacteriological confirmation, and ten (91%) of 11 had baseline PET-CT scans consistent with tuberculosis. Using baseline PET-CT classification as reference, the AUC for chest x-ray CAD software ranged from 0·86 (95% CI 0·72-0·99) to 0·89 (0·75-1·00) for bacteriologically confirmed tuberculosis. INTERPRETATION: Most adult asymptomatic contacts diagnosed with tuberculosis over 5 years had baseline radiographically evident disease, not radiographically negative incipient tuberculosis. Although PET-CT is not feasible for routine screening, it provides a highly sensitive reference benchmark for diagnostic development, with chest x-ray CAD performing comparatively well. FUNDING: South Africa Medical Research Council, US National Institutes of Health, Gates Foundation, Wellcome, UK Research and Innovation Medical Research Council, and Walter and Eliza Hall Institute of Medical Research.

  PublisherDOI

• P-1407. Beyond the Patient: Educational Disruption and Household Poverty in the Wake of Tuberculosis

  Open Forum Infectious Diseases · 2026-01-01

  articleOpen access

  Abstract Background Tuberculosis (TB), a leading cause of global mortality, disproportionately affects low socioeconomic households and deepens poverty. In India, persons with TB (PWTB) and their families face disrupted education and reduced income, further limiting access to care. TB must be recognized not just as a clinical condition but as a social disease—intertwined with education, nutrition, and economic stability—if elimination goals are to be met. Household Income Over Course of Treatment by Education Discontinuation StatusFigure 1.Comparison of household income over course of TB treatment between households that have at least one individual who experienced educational disruption versus the control group.Multidimensional Poverty Index Score Comparison Based on Education StatusFigure 2.Comparison of Multidimensional Poverty Index score between households that have at least one individual who experienced interrupted schooling Methods We used data from the RePORT India cohort, which follows PWTB in Puducherry, Tamil Nadu, Maharashtra, and Telangana. Participants were assessed at baseline; months 1 and 2 (intensive phase); month 6 (treatment completion); and at 6 and 12 months post-treatment. Clinical data included symptoms, treatment history, BMI, and Karnofsky scores. Structured interviews assessed TB’s socioeconomic effects using the Multidimensional Poverty Index (MPI), which includes education, living standards, and household composition. Results Among 663 households surveyed, 14% reported disrupted education, 85% of which involved household contacts of PWTB. Disruption often affected multiple members; 26 unique households reported educational interruption. Households without disruption showed steady income gains between months 2 and 6 post-treatment, while those with disruption exhibited fluctuating income, suggesting prolonged vulnerability. MPI scores averaged 38.4 in disrupted households vs. 30.8 in others (poverty threshold: 33). Conclusion TB’s impact extends beyond the patient, disrupting education and eroding household resilience. Each missed year of schooling reduces lifetime earnings by ∼8%. Protecting education during TB illness is critical to achieving household stability and national TB elimination targets. Disclosures Robert C. Bollinger, Jr., MD, MPH, [SCENE] Health: Advisor/Consultant|[SCENE] Health: Board Member|[SCENE] Health: Stocks/Bonds (Private Company)|Merck: Advisor/Consultant|miDiagnostics: Co-inventor of IP owned by Johns Hopkins University|miDiagnostics: Eligible for equity and royalty payments received by Johns Hopkins University

  PublisherDOI

• A Narrative Review of the Regional Prospective Observational Research in Tuberculosis International Consortium: Sharing Diverse Data and Specimens in the Fight Against Tuberculosis

  Clinical Infectious Diseases · 2026-03-03

  articleOpen accessSenior author

  BACKGROUND: Clinical tuberculosis (TB) research has been hampered by a lack of reliable predictors of Mycobacterium tuberculosis infection progression and active TB treatment's cure, relapse, and failure. Given host and bacterial variability, large sample sizes from harmonized datasets are needed to study infrequent endpoints. Therefore, global observational research consortia, such as Regional Prospective Observational Research in Tuberculosis (RePORT) International (RI), can help make meaningful inroads into successful TB prevention, diagnosis, and treatment. METHODS: RePORT International was created in 2012 by the US National Institute of Allergy and Infectious Diseases (NIAID) with bilateral country funding. The Consortium's country networks (Brazil, India, Indonesia, Korea, Philippines, South Africa, and Uganda) use a common protocol to recruit for 2 participant cohorts (active TB and close contacts). A coordinating center, led by a multinational executive committee, provides early-stage investigator research and mentorship opportunities, guidance on quality-assured data and specimen collection, and scientific direction while allowing networks to pursue geographically relevant research and implementation. RESULTS: Consortium biorepositories house 632 000+ specimens with associated epidemiological data from ∼11 900 participants. There have been 67 country- and consortium-wide projects via multiple funding sources, resulting in about 200 publications covering epidemiology, drug resistance, biomarkers, comorbidities, transcriptomics, diagnostics, and immunology. Capacity building is conducted through research fellowships and collaborations with other consortia including with a public resource database and data/specimen dashboard. CONCLUSIONS: Public health research has had funding limitations on ideal patient enrollment and follow-up, as well as the maintenance of research infrastructure and personnel. However, RI is well prepared to meet these challenges while supporting better point-of-care diagnostics, screening for asymptomatic TB, post-TB care, and successful treatment outcomes.

  PublisherOA PDFDOI

• From Exposure to Disease: Predicting Tuberculosis Progression

  Clinical Infectious Diseases · 2026-02-26

  articleOpen access

  Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), infects nearly one-fourth of global population, with 5%-10% progressing to active TB, one of the deadliest infectious diseases worldwide. Despite advancements in identifying infected individuals, actual tools lack precision in identifying those at highest risk of active TB. Close contacts of TB cases are at particularly high risk of progression. Multinational networks, such RePORT (Regional Prospective Observational Research for TB) International-a consortium of eight country-based networks-have advanced the field through collaboration, data sharing, and large-scale studies across diverse populations. This review synthesizes current knowledge on TB transmission dynamics, biomarkers, and genetic factors influencing disease progression, predictive models for identifying high-risk individuals, and the implications for public health interventions and screening programs. By centering on findings from RePORT studies, we discuss the strengths and limitations of existing approaches, including the temporal dynamics and context dependence of host-response signatures, and consider key challenges for implementation in high-burden settings. Together, these insights highlight opportunities to refine targeted TB prevention strategies and advance progress toward TB elimination.

  PublisherOA PDFDOI

• Long-term Sequelae of Pulmonary Tuberculosis: A Narrative Review

  Clinical Infectious Diseases · 2026-02-26

  articleOpen access

  Despite effective chemotherapy, tuberculosis (TB) survivors experience excess morbidity and mortality associated with long-term sequelae. Ventilatory defects, such as airflow obstruction, restriction, and mixed patterns, have been reported in over half of treated pulmonary TB cases. Spirometry alone underestimates burden, with impaired diffusing capacity, gas trapping, heterogeneous airway, and parenchymal damage on lung imaging, functional impairment, and persistent respiratory symptoms commonly reported. Bronchiectasis and chronic pulmonary aspergillosis are also common and occur in approximately one-third of TB survivors. Beyond the lungs, observational data consistently link TB to elevated cardiovascular disease risk, including myocardial infarction, stroke, and peripheral arterial disease, during and after TB treatment. Tuberculosis is also associated with increased lung cancer risk independent of smoking exposure, with adenocarcinoma, squamous cell, and small cell carcinomas commonly reported. While ongoing research suggests a key role of a dysfunctional host inflammatory response in the pathogenesis of TB sequelae, several knowledge gaps persist. Key among them include identifying individuals at highest risk of TB sequelae, defining clinically relevant phenotypes, endotypes, and natural history trajectories, and identifying prognostic biomarkers and potentially modifiable targets for immunomodulatory therapies. In this narrative review, we discuss key long-term sequelae of pulmonary TB, highlight research priorities, and propose a way forward through new research initiatives such as the "Long TB Study."

  PublisherOA PDFDOI

• Nasal Gene Expression in ART-Naive Adults with HIV and Pulmonary Tuberculosis in Uganda

  medRxiv · 2026-01-08

  articleOpen access

  Abstract Background Diagnosis of pulmonary tuberculosis (TB) in people living with HIV remains difficult. Since the first pathogen-host interaction in TB occurs in the upper airway, we hypothesized that host transcriptomic analysis on nasal specimens may identify novel diagnostic biomarkers. We aimed to demonstrate differences in nasal gene expression between people with HIV and TB disease versus people with HIV without TB, evaluate the performance of nasal signatures in classifying TB and compare nasal gene profiles with blood gene profiles from the same cohort. Methods We enrolled adults in Uganda with newly diagnosed HIV and symptoms of pulmonary TB disease We collected nasal cells and blood for RNA sequencing to identify differentially expressed genes and enriched pathways between people with HIV and TB disease and people with HIV without TB. Supervised machine-learning of gene expression data was used to predict TB status. Results 40 adults living with HIV were enrolled (median age: 34 years, median CD4 count: 182), including 20 with TB disease and 20 without. We identified 44 nasal differentially expressed genes and 238 blood differentially expressed genes, with three overlapping genes between sample types. Models trained using all 44 nasal differentially expressed genes had a cross-validated area under the curve between 0.87-0.90 for predicting TB disease amongst adults living with HIV. A simplified four-gene signature ( SPIB, SHISA2, TESPA1 and CD1B ) met the World Health Organization criteria for a TB triage test. Among adults with TB, pathways related to the inflammatory response and innate immune system were downregulated in nasal samples and upregulated in blood. Conclusion This proof-of-concept study demonstrated that there were distinct nasal gene expression patterns associated with TB, not seen in blood. Differences in nasal gene expression in people with HIV who have TB disease, versus those without TB, highlight their potential as diagnostic biomarkers. Further validation studies of gene signatures using minimally invasive nasal samples are recommended in other difficult to diagnose groups.

  PublisherOA PDFDOI

• Development of a four-gene host signature for paucibacillary TB among symptomatic individuals with sputum Xpert MTB/RIF Ultra very low and trace results

  International Journal of Infectious Diseases · 2026-05-01

  articleOpen access

  OBJECTIVES: The Xpert MTB/RIF Ultra (Ultra) assay is widely used to diagnose pulmonary tuberculosis (TB), but 'very low' or 'trace' results may reflect either paucibacillary TB or TB-negative disease, complicating clinical decision-making. We evaluated host transcriptomic signatures to identify culture-confirmed paucibacillary TB among individuals with Ultra very low or trace results. METHODS: We performed whole blood targeted transcriptional profiling of 90 symptomatic adults from Uganda, Kenya, and South Africa with Ultra very low/trace sputum results. An 81-gene customized NanoString panel representing 13 published TB signatures was analyzed using machine learning to derive a novel four-gene host signature ("TRACE4") predicting MGIT and LJ culture positivity. Validation included individuals with other respiratory diseases (n=18) and North American-TB-negative controls (n=20). Data were randomly split 75/25 into training (n=67) and test (n=23) sets. Diagnostic performance was evaluated against WHO targets. RESULTS: TRACE4 outperformed all published signatures in both training (AUC 0.89) and test sets (AUC 0.88), achieving 82% specificity at 75% sensitivity. It also exceed reclassification based on prior TB history (specificity 0.58 (95% CI: 0.45-0.69); sensitivity 0.35 (95% CI: 0.15-0.61)). TRACE4 showed 100% specificity in non-TB controls. CONCLUSION: TRACE4 shows promise for identifying paucibacillary culture-positive pulmonary TB in this diagnostically challenging group.

  PublisherDOI

• Asymptomatic Tuberculosis Across the Disease Spectrum: A Scoping Review of Epidemiology, Diagnosis, and Public Health Implications

  Clinical Infectious Diseases · 2026-03-19

  articleOpen access

  BACKGROUND: Tuberculosis (TB) remains a leading infectious cause of death globally. While control strategies have traditionally prioritized symptomatic cases, growing evidence highlights the substantial burden of asymptomatic or subclinical TB, microbiologically confirmed disease without classical symptoms, posing challenges for detection, treatment, and elimination efforts. METHODS: We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We selected epidemiological studies, prevalence surveys, modeling analyses, and recent World Health Organization (WHO) guidance to summarize the current understanding of asymptomatic TB. We examined definitions, diagnostic approaches, transmission potential, natural history, and public health implications, with special focus on vulnerable populations. RESULTS: Prevalence surveys reveal that up to 30%-50% of bacteriologically confirmed TB cases may be asymptomatic at diagnosis, many of whom remain undetected under symptom-based screening. A substantial fraction of these individuals is smear positive, underscoring their potential role in community transmission. Despite clinical silence, radiographic and molecular studies demonstrate ongoing lung pathology and immune activation, with 20%-30% progressing to symptomatic disease within 2 years. Diagnostic challenges include low bacillary burden and inability to expectorate sputum, though innovations, such as computer-aided radiography, sputum pooling, and host transcriptomic biomarkers, are advancing detection. CONCLUSIONS: Asymptomatic TB represents a hidden but consequential component of the TB disease spectrum. Recognition and integration of this stage into TB control frameworks are essential for accurate burden estimation, timely treatment, and achievement of elimination targets. Future efforts must focus on scalable diagnostics, biomarker validation, and equitable screening strategies tailored to vulnerable populations.

  PublisherOA PDFDOI

Recent grants

• NIH Grant U01AI030189

  NIH · $4.3M · 1995

• NIH Grant R01AI025799

  NIH · $3.1M · 2004

• FEND for TB

  NIH · $20.0M · 2020–2026

• NIH Grant R22AI018471

  NIH · $141k · 1985

• NIH Grant R01AG008330

  NIH · $639k · 1992

Frequent coauthors

• John L. Johnson

  Johnson & Johnson (United States)

  288 shared

• Roy D. Mugerwa

  240 shared

• Alphonse Okwera

  Mulago Hospital

  174 shared

• Padmini Salgame

  173 shared

• Moses Joloba

  Makerere University

  152 shared

• Reynaldo Dietze

  Universidade Federal do Espírito Santo

  144 shared

• Kathleen D. Eisenach

  136 shared

• Edward C. Jones‐López

  136 shared

Education

• B.A.

  Cornell University

  1966

• M.D.

  Johns Hopkins University School of Medicine

  1970

• Other

  Johns Hopkins Hospital

  1970

• Other

  National Institute of Allergy and Infectious Diseases (NIAID), NIH

  1972

• Other

  Johns Hopkins Hospital

  1975