Abstract
BackgroundMycobacterium avium complex lung disease (MAC-LD) can deteriorate rapidly to become fatal. Reported poor prognostic factors include radiographic findings, undernutrition, anemia and high inflammation test values. However, the association of these prognostic factors with the pathophysiology of the disease remains unknown. We aimed to clarify the pathophysiology of MAC-LD and develop a new biomarker that reflects the immune response to the disease.MethodsWe performed the cytokine panel analyses of serum from patients with MAC-LD and compared each cytokine level with clinically negative prognostic factors (radiographic disease type, body mass index, albumin, C-reactive protein and hemoglobin) and high-resolution CT scores.ResultsWe analyzed 27 patients with MAC-LD, 6 with the fibrocavitary form and 21 with the nodular bronchiectatic form on high-resolution CT. Serum CXC motif ligand 10 (CXCL10) concentration was significantly elevated in patients with the fibrocavitary form (p = 0.008). CXCL10 levels correlated with body mass index (r = − 0.60, p = 0.0008), serum albumin concentration (r = − 0.45, p = 0.016) and high-resolution CT scores (r = 0.61, p = 0.0006). Among 14 patients initially untreated, antibiotic therapy was initiated for five during the study period. CXCL10 concentration was significantly higher in these patients (p = 0.046), and receiver operating characteristic analysis for CXCL10 concentration on treatment initiation produced an area under the curve of 0.844, with a sensitivity of 100%, specificity of 66.7%, and cut-off value of 366.5 pg/mL.ConclusionWe revealed cytokine profiles in patients with MAC-LD. Serum CXCL10 levels probably reflect the severity of MAC-LD. Our findings suggest that CXCL10 concentration may be a promising biomarker for managing treatment for patients with MAC disease of the lung.
Highlights
Mycobacterium avium complex lung disease (MAC-LD) can deteriorate rapidly to become fatal
The fibrocavitary type (FC) form was observed in six participants (22%), who had lower Body mass index (BMI) and serum albumin and higher C-reactive protein (CRP) and erythrocyte sedimentation rates (ESR) than those with the nodular bronchiectatic type (NB) form
We found that CXC motif ligand 10 (CXCL10) concentrations were significantly higher in those with the FC form and that CXCL10 concentration correlated with other poor prognostic factors, the High-resolution computed tomography (HRCT) scores and disease activity
Summary
Mycobacterium avium complex lung disease (MAC-LD) can deteriorate rapidly to become fatal. The association of these prognostic factors with the pathophysiology of the disease remains unknown. We aimed to clarify the pathophysiology of MAC-LD and develop a new biomarker that reflects the immune response to the disease. Prevalence and incidence of nontuberculous mycobacterial lung disease (NTM-LD) have been increasing worldwide [1,2,3]. The most common pathogen for NTM-LD is the Mycobacterium avium complex (MAC), which comprises of M. avium and M. intracellulare [1, 3, 5]. MAC lung disease (MAC-LD) is mainly classified into two forms: the nodular bronchiectatic type (NB) and the fibrocavitary type (FC) [5]. Because there is no consensus on the optimal timing to start antibiotic therapy and the treatment period, it would be beneficial to establish useful biomarkers to monitor therapeutic effectiveness and evaluate prognosis
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