Metabolism underpins the physiology and pathogenesis of Mycobacterium tuberculosis. However, although experimental mycobacteriology has provided key insights into the metabolic pathways that are essential for survival and pathogenesis, determining the metabolic status of bacilli during different stages of infection and in different cellular compartments remains challenging. Recent advances-in particular, the development of systems biology tools such as metabolomics-have enabled key insights into the biochemical state of M. tuberculosis in experimental models of infection. In addition, their use to elucidate mechanisms of action of new and existing antituberculosis drugs is critical for the development of improved interventions to counter tuberculosis. This review provides a broad summary of mycobacterial metabolism, highlighting the adaptation of M. tuberculosis as specialist human pathogen, and discusses recent insights into the strategies used by the host and infecting bacillus to influence the outcomes of the host -pathogen interaction through modulation of metabolic functions.Ultimately, the process of pathogenicity itself will be describable in terms of the chemistry of the mycobacterial cell. Cite this article as Cold Spring Harb Perspect Med 2015;5:a021121 www.perspectivesinmedicine.org BOX 1. RECOMMENDED RESOURCES Physiology of Mycobacterium tuberculosis † Cook GM, Berney M, Gebhard S, Heinemann M, Cox RA, Danilchanka O, Niederweis M. 2009. Physiology of mycobacteria. Adv Microb Physiol 55: 81-319. † Russell DG. 2013. The evolutionary pressures that have molded Mycobacterium tuberculosis into an infectious adjuvant. Curr Opin Microbiol 16: 78-84. Central Carbon Metabolism † Ehrt S, Rhee K. 2013. Mycobacterium tuberculosis metabolism and host interaction: Mysteries and paradoxes.