Medications and Monitoring in Treatment of Nontuberculous Mycobacterial Pulmonary Disease

New antibiofilm strategies for the management of nontuberculous mycobacteria diseases

INTRODUCTION

Nontuberculous mycobacteria (NTM) represent a group of microorganisms comprising more than 190 species. NTM infections have increased recently, and their treatment is a major challenge because to their resistance to conventional treatments. This review focuses on innovative strategies aimed at eradicating NTM biofilms, a critical factor in their resistance. Important areas addressed include biofilm formation mechanisms, current therapeutic challenges, and novel treatment approaches. The main objective is to compile and analyze information on these emerging strategies, identifying pivotal research directions and recent advancements.

AREAS COVERED

A review of the scientific literature was conducted to identify emerging novel therapies for the treatment of NTM infections and to explore potential synergies with existing treatments.

EXPERT OPINION

Experts highlights a limited understanding of optimal treatment regimens, often supported by insufficient scientific evidence. Current therapies are typically prolonged, involve multiple antibiotics with adverse effects, and frequently do not achieve patient cure. Certain species are even considered virtually impossible to eradicate. A thorough understanding of these new approaches is imperative for improving patients outcomes. This review provides a robust foundation for developing of more effective antibacterial strategies, which are essential because of the increasing incidence of NTM infections and the limitations of existing therapies.

Drinking Water Microbiota, Entero-Mammary Pathways, and Breast Cancer: Focus on Nontuberculous Mycobacteria

The prospect of drinking water serving as a conduit for gut bacteria, artificially selected by disinfection strategies and a lack of monitoring at the point of use, is concerning. Certain opportunistic pathogens, notably some nontuberculous mycobacteria (NTM), often exceed coliform bacteria levels in drinking water, posing safety risks. NTM and other microbiota resist chlorination and thrive in plumbing systems. When inhaled, opportunistic NTM can infect the lungs of immunocompromised or chronically ill patients and the elderly, primarily postmenopausal women. When ingested with drinking water, NTM often survive stomach acidity, reach the intestines, and migrate to other organs using immune cells as vehicles, potentially colonizing tumor tissue, including in breast cancer. The link between the microbiome and cancer is not new, yet the recognition of intratumoral microbiomes is a recent development. Breast cancer risk rises with age, and NTM infections have emerged as a concern among breast cancer patients. In addition to studies hinting at a potential association between chronic NTM infections and lung cancer, NTM have also been detected in breast tumors at levels higher than normal adjacent tissue. Evaluating the risks of continued ingestion of contaminated drinking water is paramount, especially given the ability of various bacteria to migrate from the gut to breast tissue via entero-mammary pathways. This underscores a pressing need to revise water safety monitoring guidelines and delve into hormonal factors, including addressing the disproportionate impact of NTM infections and breast cancer on women and examining the potential health risks posed by the cryptic and unchecked microbiota from drinking water.

Therapeutic developments for tuberculosis and nontuberculous mycobacterial lung disease

Tuberculosis (TB) drug discovery and development has undergone nothing short of a revolution over the past 20 years. Successful public-private partnerships and sustained funding have delivered a much-improved understanding of mycobacterial disease biology and pharmacology and a healthy pipeline that can tolerate inevitable attrition. Preclinical and clinical development has evolved from decade-old concepts to adaptive designs that permit rapid evaluation of regimens that might greatly shorten treatment duration over the next decade. But the past 20 years also saw the rise of a fatal and difficult-to-cure lung disease caused by nontuberculous mycobacteria (NTM), for which the drug development pipeline is nearly empty. Here, we discuss the similarities and differences between TB and NTM lung diseases, compare the preclinical and clinical advances, and identify major knowledge gaps and areas of cross-fertilization. We argue that applying paradigms and networks that have proved successful for TB, from basic research to clinical trials, will help to populate the pipeline and accelerate curative regimen development for NTM disease.