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Background <p>Amikacin liposomal inhalation suspension (ALIS), an inhaled aminoglycoside, can effectively treat refractory or relapsed <i>Mycobacterium avium</i> 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).</p> Methods <p>This 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.</p> Results <p>Of 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%; <i>P</i> = 0.673).</p> Conclusion <p>Lipid 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.</p>

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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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月9日

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  • Hiroki Wakabayashi,
  • Kazutoshi Isobe,
  • Nobuyuki Hiruta,
  • Shusuke Kasuya,
  • Atsushi Sano,
  • Yasuo Matsuzawa

摘要

Background

Amikacin 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).

Methods

This 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.

Results

Of 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).

Conclusion

Lipid 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.