Advancements in Combatting Nontuberculous Mycobacterial Infections: Mechanisms and Treatments

The increasing prevalence of nontuberculous mycobacteria (NTM) infections worldwide poses significant public health challenges, underscored by high fatality rates and a broadening spectrum of susceptible populations. Previously regarded as mere environmental opportunists primarily affecting the immunocompromised, NTM pathogens such as the fast-growing M. abscessus and the slow-growing M. avium complex have gained recognition for their ability to cause severe diseases in both immunocompetent children and adults, especially in those with structural lung diseases like bronchiectasis and chronic obstructive pulmonary disease (COPD). The natural resistance of these organisms to multiple antimicrobials makes NTM lung infection notably difficult to treat. Current antibiotic regimens, though effective in vitro, often fail to yield predictable or successful outcomes in patients, reflecting an urgent need for improved understanding and treatment approaches.

This Research Topic aims to deepen the understanding of the mechanisms underlying NTM's intrinsic resistance and the host factors that enable these bacteria to withstand bactericidal antibiotic concentrations, leading to chronic and drug-resistant infections. Specifically, it seeks to elucidate the origins of NTM resistance, environmental and host influences that promote mycobacterial tolerance to antibiotics and immune defenses, and the bacterial metabolic shifts within hosts that support their persistence. Such insights are crucial for pinpointing critical and synergistic bacterial targets, ultimately fostering the development of effective and rational treatment strategies to preempt the rise of resistance.

To gather further insights into the complex interplay of NTM resistance mechanisms and therapeutic strategies, we welcome contributions, but are not limited to, the following themes:

- Mechanisms of intrinsic resistance in NTM infections
- Host-pathogen interactions in NTM disease progression
- Innovative therapeutic approaches targeting NTM
- Impact of lung structural diseases on NTM infection outcomes
- Advancements in the diagnosis and treatment monitoring of NTM infections

This Research Topic encourages the submission of original research articles, brief research reports, perspective pieces, opinion articles, and reviews that explore the inherent mechanisms of NTM resistance and host factors, and that propose innovative treatment strategies targeting these mechanisms.