{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:33:37Z","timestamp":1790102017282,"version":"4.0.1"},"reference-count":168,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian Research Council Future Fellowship","award":["FT220100487"],"award-info":[{"award-number":["FT220100487"]}]},{"name":"Frazer Institute, The University of Queensland"}],"content-domain":{"domain":["www.plospathogens.org"],"crossmark-restriction":false},"short-container-title":["PLoS Pathog"],"abstract":"<jats:p>\n                    <jats:bold>Nontuberculous mycobacterial pulmonary disease (NTM-PD)<\/jats:bold>\n                    is increasingly recognised as a significant global health concern. It is characterised by a highly heterogenous clinical course and remains poorly understood, from host susceptibility to disease pathophysiology, and is notoriously difficult to treat. Recent advances highlight the\n                    <jats:bold>microbiome<\/jats:bold>\n                    as a critical modulator of host physiology, with site-specific \u2018microbiota\u2019 influencing the delicate balance between health, infection and disease. While microbial populations vary across discrete anatomical sites, there is a growing recognition that they are interconnected. For example, gut microbes can influence immune cell functions in the lung via the\n                    <jats:bold>gut\u2013lung axis (GLA).<\/jats:bold>\n                    Drawing parallels with other related chronic respiratory diseases, it is hypothesised that microbiota\u2013host-interactions shape susceptibility and manifestation of NTM-PD. This review synthesises current knowledge of some key host susceptibility factors in NTM-PD, and their potential interactions with host microbiota. With only recently emerging studies, we explore the potential role of the GLA in NTM-PD, given its promising links to microbial communities and immunological and metabolic pathways. We assess the limited, but growing body of research on the lung microbiota in NTM-PD and evaluate the small number of studies on faecal microbiota in NTM-PD. By considering insights across anatomical sites, this review aims to contextualise the microbiome within multiple dimensions of NTM-PD, including host susceptibility, disease progression, treatment responsiveness, and the effects of antibiotic therapy. A better understanding of the microbiome in NTM-PD could hold promise in uncovering the complex and multifactorial mechanisms that contribute to the heterogenous clinical course and challenging management of NTM-PD.\n                  <\/jats:p>","DOI":"10.1371\/journal.ppat.1013603","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T17:37:03Z","timestamp":1760722623000},"page":"e1013603","update-policy":"https:\/\/doi.org\/10.1371\/journal.ppat.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["The microbiome and gut\u2013lung axis in nontuberculous mycobacterial pulmonary disease"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6456-1565","authenticated-orcid":true,"given":"Ria N.","family":"Thompson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Blumenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Morrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Thomson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"issue":"1","key":"ppat.1013603.ref001","article-title":"Nontuberculous mycobacteria-overview","volume":"5","author":"W-J Koh","year":"2017","journal-title":"Microbiol Spectr"},{"issue":"4","key":"ppat.1013603.ref002","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciaa1125","article-title":"Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS\/ERS\/ESCMID\/IDSA clinical practice guideline","volume":"71","author":"CL Daley","year":"2020","journal-title":"Clinical Infectious Diseases"},{"issue":"4","key":"ppat.1013603.ref003","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1164\/rccm.200604-571ST","article-title":"An official ATS\/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases","volume":"175","author":"DE Griffith","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"ppat.1013603.ref004","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.ccm.2023.08.012","article-title":"Global epidemiology of nontuberculous mycobacterial pulmonary disease: a review","volume":"44","author":"DR Prevots","year":"2023","journal-title":"Clin Chest Med"},{"key":"ppat.1013603.ref005","doi-asserted-by":"crossref","first-page":"139796","DOI":"10.1016\/j.scitotenv.2020.139796","article-title":"Influence of climate variables on the rising incidence of nontuberculous mycobacterial (NTM) infections in Queensland, Australia 2001-2016","volume":"740","author":"RM Thomson","year":"2020","journal-title":"Sci Total Environ"},{"issue":"1","key":"ppat.1013603.ref006","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/s12890-018-0728-z","article-title":"Epidemiology of pulmonary disease due to nontuberculous mycobacteria in Southern China, 2013-2016","volume":"18","author":"Y Tan","year":"2018","journal-title":"BMC Pulm Med"},{"issue":"1","key":"ppat.1013603.ref007","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12890-018-0637-1","article-title":"Profiling non-tuberculous mycobacteria in an Asian setting: characteristics and clinical outcomes of hospitalized patients in Singapore","volume":"18","author":"AYH Lim","year":"2018","journal-title":"BMC Pulm Med"},{"issue":"1","key":"ppat.1013603.ref008","doi-asserted-by":"crossref","first-page":"1900798","DOI":"10.1183\/13993003.00798-2019","article-title":"Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: a 15-year follow-up study","volume":"55","author":"BW Jhun","year":"2020","journal-title":"Eur Respir J"},{"key":"ppat.1013603.ref009","first-page":"3476","article-title":"The survival of mycobacterium abscessus over twenty years","volume":"60","author":"C Santamar\u00eda Valencia","year":"2022","journal-title":"Eur Respir J"},{"issue":"8","key":"ppat.1013603.ref010","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1053\/crad.2001.0851","article-title":"Imaging of non-tuberculous (atypical) mycobacterial pulmonary infection","volume":"57","author":"SM Ellis","year":"2002","journal-title":"Clin Radiol"},{"issue":"6","key":"ppat.1013603.ref011","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1378\/chest.101.6.1605","article-title":"Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern. 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