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Substantial knowledge gaps still remain about the interplay between neutrophilic signatures and microbes in nontuberculous mycobacterial lung disease (NTM-LD), a phenotypically diverse lung infection that is increasingly prevalent in the United States and other parts of the world.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the lower airway microbiota and neutrophilic traits in NTM-negative (NTM\u2212) and NTM-positive (NTM+) bronchiectasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>16S rRNA gene sequencing, cell counts, and neutrophil extracellular trap (NET) immunoassays were performed on bronchoscopic lower airway samples in 200 bronchiectasis subjects (108 NTM\u2212, 92 NTM+). A preclinical model of oral commensal microaspiration and NTM infection was used to profile the murine lower airways with flow cytometry and a NET assay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and main results<\/jats:title>\n                    <jats:p>Lower airways of NTM+ bronchiectasis patients were enriched with Mycobacterium and oral commensals (eg, Veillonella, Prevotella, and Streptococcus). NET levels were higher in NTM+ BAL fluid. Mycobacterium and oral commensals co-occurred with NET and neutrophils in network studies. Distinct oral commensal taxa were associated with severe disease phenotypes such as cavitary disease and exacerbators. In a murine microaspiration model, the combination of oral commensals and Mycobacterium led to a sustained proinflammatory immune response marked by an increase in Th17 cells, \u03b3\u03b4T cells, and PD-1+ T lymphocytes as well as higher NET levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our analyses showed that distinct microbiome features beyond the primary pathogen can contribute to neutrophilic inflammation and severe disease phenotypes in bronchiectasis\/NTM-LD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamag015","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T12:47:06Z","timestamp":1769777226000},"page":"936-951","source":"Crossref","is-referenced-by-count":4,"title":["Lower airway dysbiosis in nontuberculous mycobacteria\u2013positive bronchiectasis is associated with neutrophil extracellular trap\u2013predominant severe phenotypes"],"prefix":"10.1093","volume":"212","author":[{"given":"Shivani","family":"Singh","sequence":"first","affiliation":[{"name":"Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine , New York, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fares","family":"Darawshy","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine , New York, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirby","family":"Erlandson","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine , New York, NY,","place":["United 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