47Human tuberculosis is caused by members of the Mycobacterium tuberculosis Complex 48 (MTBC). The MTBC comprises several human-adapted lineages known as M. 49 tuberculosis sensu stricto as well as two lineages (L5 and L6) traditionally referred to as 50 M. africanum. Strains of L5 and L6 are largely limited to West Africa for reasons 51 unknown, and little is known on their genomic diversity, phylogeography and evolution. 52 Here, we analyzed the genomes of 365 L5 and 326 L6 strains, plus five related genomes 53 that had not been classified into any of the known MTBC lineages, isolated from patients 54 from 21 African countries. 55 Our population genomic and phylogeographical analyses show that the unclassified 56 genomes belonged to a new group that we propose to name MTBC Lineage 9 (L9). While 57 the most likely ancestral distribution of L9 was predicted to be East Africa, the most likely 58 ancestral distribution for both L5 and L6 was the Eastern part of West Africa. Moreover, 59 we found important differences between L5 and L6 strains with respect to their 60 phylogeographical substructure, genetic diversity and association with drug resistance.
61In conclusion, our study sheds new light onto the genomic diversity and evolutionary 62 history of M. africanum, and highlights the need to consider the particularities of each 63 MTBC lineage for understanding the ecology and epidemiology of tuberculosis in Africa 64 and globally. 65 3 MAIN TEXT 66 67 Introduction 68 Tuberculosis (TB) causes more human deaths than any other infectious disease, and it is 69 among the top ten causes of death worldwide (1). Among the 30 high TB burden 70 countries, half are in Sub-Saharan Africa (1). Africa also comprises the highest number 71 of countries with the highest TB mortality (1). TB in humans and animals is caused by 72 the Mycobacterium tuberculosis Complex (MTBC) (2), which includes different lineages, 73 some referred to as Mycobacterium tuberculosis sensu stricto (Lineage 1 to Lineage 4 and 74 Lineage 7) and others as Mycobacterium africanum (Lineage 5 and Lineage 6), a recently 75 discovered Lineage 8 (3), as well as different animal-associated ecotypes such as M. 76 bovis, M. pinnipedii, or M. microti among others (4, 5). Among the human-associated 77 MTBC lineages, some are geographically widespread and others more restricted (6). The 78latter is particularly the case for Lineage (L) 7 that is limited to the Horn of Africa (7, 8), 79 and L5 and L6 that are mainly found in West Africa (9). L5 and L6 differ substantially 80 from the other lineages of the MTBC with respect to metabolism and in vitro growth (10, 81 11). Several mutations in different genes of the electron transport chain and central carbon 82 metabolic pathway can explain metabolic differences between L5 and L6 and the other 83 lineages (12). L5 and L6 are also less virulent than other lineages in animal models, and 84 appear to transmit less efficiently in clinical settings (13, 14). Even though L5 and L6 are 85 mostly restricted to Wes...