ArticleBMC pulmonary medicine2026
Lipid accumulation and interstitial lung disease associated with amikacin liposomal inhalation suspension in patients with Mycobacterium avium complex lung disease: a single-center retrospective cohort study.
Article in BMC pulmonary medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAmikacin liposomal inhalation suspension (ALIS), an inhaled aminoglycoside, can effectively treat refractory or relapsed Mycobacterium avium complex lung disease (MAC-LD). However, ALIS is associated with interstitial lung disease (ILD), and underlying pathological mechanisms are unclear. This study aimed to determine the pathophysiological insights of ALIS-associated ILD (A-ILD).
methodsThis retrospective cohort study included 25 patients with MAC-LD who received ALIS treatment between September 2021 and October 2024. Clinical data, laboratory findings, high-resolution chest computed tomography results and pathological findings from transbronchial lung biopsy, surgical lung resection and bronchoalveolar lavage were evaluated.
resultsOf the 25 patients, 8 developed A-ILD after a mean duration of 98.5 ± 159.8 days following ALIS initiation. Histopathological evaluation showed infiltration of enlarged foamy macrophages containing lipid deposits in patients with and without A-ILD. In patients with A-ILD, bronchoalveolar lavage fluid exhibited inflammatory cell infiltration; however, these findings were not diagnostic for a specific entity. Serum Krebs von den Lungen-6 levels increased modestly from baseline to the time of A-ILD diagnosis (407 ± 231 vs. 434 ± 250 U/mL), whereas eosinophil count, C-reactive protein, and lactate dehydrogenase levels showed no significant changes. Seven of eight patients with A-ILD exhibited clinical improvement following discontinuation or dose reduction of ALIS; one patient required corticosteroid therapy. Of these eight patients, five continued inhalation therapy on an every-other-day dosing schedule. The sputum culture conversion rate was maintained even among patients with A-ILD (63% vs. 47%; P = 0.673).
conclusionLipid deposition in the lungs was observed regardless of the A-ILD status, and no pathognomonic findings specific to A-ILD were identified. A-ILD may occur more often in patients with renal function decline and/or poorer baseline pulmonary function; therefore, closer clinical monitoring for A-ILD may be warranted in this subgroup.
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