Where MAC and NTM Research Is Headed Next

In "Where MAC and NTM Research Is Headed Next," our expert turns to the research priorities that could reshape MAC and NTM care.

Dr. Losier closes the series by reflecting on the exciting advances in NTM pulmonary disease and bronchiectasis presented at ATS 2026. She is particularly excited about new oral antimycobacterial agents and combination therapies, pointing to the bedaquiline data as evidence that repurposing drugs with novel mechanisms can build additional all-oral regimens. She argues the field still needs new drug classes to construct combinations that are both potent and less toxic, with careful attention to whether patients can safely and effectively tolerate them long term.

She also highlights inhaled drug delivery as a promising direction, pointing to both the ENCORE and inhaled clofazimine data as evidence the strategy could extend to other drugs, maximizing concentration at the site of infection while minimizing systemic toxicity. Beyond new drugs, Dr. Losier is drawn to host-directed therapies and biomarker development. She notes that NTM pulmonary disease occurs disproportionately in patients with bronchiectasis, yet clinicians still do not fully understand why some patients progress while others remain stable despite similar environmental exposures. A better understanding of host factors, including macrophage function and immune response, could help clinicians target both the organism and the host more effectively.

On biomarkers, she sees a need to predict progression before it happens, identifying host responses early enough to distinguish patients likely to benefit from prolonged multidrug therapy from those who can be safely observed. This work matters especially because traditional culture-based techniques, while still the gold standard, remain problematic when patients cannot produce expectorated sputum or when cultures fail to grow. Dr. Losier frames the greatest remaining research need as matching the right treatment to the right patient, moving away from treating MAC as a single microbiologic disease and toward a multimodal view that weighs microbiology, underlying conditions, and patient-reported symptoms alongside culture conversion.

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