News from the press

  • Final O’Neill report on AMR issued – specific recommendations about antifungal resistance included

    Lord Jim O’Neill’s global Review on AMR will set out its final recommendations (attached below), providing a comprehensive action plan for the world to prevent drug-resistant infections and defeat the rising threat of superbugs – something that could kill 10 million people a year by 2050, the equivalent of 1 person every 3 seconds, and more than cancer kills today. Building on eight interim papers, this is the final report from Lord O’Neill’s Review, established by the UK Prime Minister David Cameron in 2014 to avoid the world being “cast back into the dark ages of medicine”.

    There are 4 general recommendations and 5 ideas about how to pay for it:

     

    1. A global public awareness campaign to educate all of us about the problem of drug resistance.

    2. The supply of new antibiotics needs to be improved so they can replace existing ones as they become ineffective.

    3. We need to use antibiotics more selectively through the use of rapid diagnostics, to reduce unnecessary use, which speeds the incidence and spread of drug resistance.

    4. We must reduce the global unnecessary use of antibiotics in agriculture.


    With respect to fungal diseases and antifungals, similar priority areas were identified by O’Neill on page 64:

    • Agriculture: Most crops are treated with fungicides, many with triazoles, which are similar to human triazole antifungals. We do not believe you can take away these products en masse, without endangering global food security. However some of the areas where these products are used most extensively are in the production of luxury items such as flowers and wine, which are not critical to food security. In these products, limits or bans might make sense, though there could be economic repercussions. There needs to be greater research into where triazole antifungals are overused, how this use can be minimised and whether their use is really necessary in particular areas. Further to this, we think that new classes of antimicrobials should not be used in farming, unless essential to particular major crops.

    • Environment: Like antibiotics there is a problem with factories dumping active pharmaceutical ingredients or antifungals into the environment, and like antibiotics this needs to stop. Similar regulations should therefore be considered for antifungals as we have discussed for antibiotics.

    • Diagnostics: Often fungal infections are mis-diagnosed as TB or other illnesses, meaning that necessary antifungal treatment is not given and unnecessary antibiotic therapy is given. Fungal disease diagnostics have improved greatly over the last two decades, but some are not available and there remains an excess reliance on culture, which is insensitive and slow. Greater use of rapid diagnostics would play a major role in reducing inappropriate antibiotic and ensuring appropriate antifungal use. Surveillance of resistance also needs to be expanded both geographically and across populations. Furthermore, diagnostic reference capability needs to be enhanced and subsidised where appropriate in this area.

    • New drugs: The early clinical development pipeline has grown substantially in the last three years with eight compounds in early clinical development. If this healthier pipeline fails to translate into more new drugs, then governments should look at market entry rewards and early-stage funding for research.”


    Professor David Denning of the University of Manchester and President of the Global Action Fund for Fungal Diseases, welcomed the report and commented: “Imprecise diagnosis of infection leading to ‘blind’ therapy could be minimized with addition of rapid fungal disease diagnostics to every hospital’s normal test portfolio. Excess use of fungicides for crops and dumping of active pharmaceutical ingredients with antifungal activity in the environment needs to abolished. The call for enhanced ‘diagnostic reference capability’ chimes with GAFFI’s call for an expert in fungal disease and reference laboratories in every country in its 10 year Roadmap ’95-95 by 2025’.

  • Research power against fungal disease revealed at Manchester Centre launch

    09 Sep 2015

    Manchester leads the world in the fight against deadly fungal infections with the opening of new Centre - a powerful partnership between research, doctors and industry to help 300 million people across the globe.

    An international audience attended the launch

    An international audience attended the launch

     

    The latest scientific research against the potentially deadlyAspergillus fungus was displayed today (9 September) asthe Manchester Fungal Infection Group (MFIG) was officially opened by Professor Sir Robert Boyd.

    From new antifungal drug opportunities to the genetic basis for aspergillosis, the quality of science in this topic has ‘improved immeasurably over the last decade’, according to Professor Keith Gull FRS from Oxford University who spoke at the meeting.

    MFIG is a new international centre of excellence for fungal infection biology and translational antifungal research at The University of Manchester. It is integrating its research with that of clinicians and industry.

    Fungal disease is much more common than many people realise as Professor David Denning of The University of Manchester pointed out, with around 300 million individuals affected annually and over 1.5 million deaths.

    Aspergillus is responsible for many of these illnesses, a conservative estimate is 13 million. It is an airborne fungus that everyone breathes in daily. In those who are immunosuppressed such as those undergoing organ transplantation or treatment for leukaemia, it causes a disease called invasive aspergillosis.

    In those with damage in their lungs such as tuberculosis or COPD, it can cause chronic pulmonary aspergillosis – a slowly progressive and destructive disease of the lungs. In those with asthma or cystic fibrosis it can cause fungal asthma with wheezing?, mucous plugging of the airways, poor asthma control and life-threatening asthmatic attacks. 

    MFIG is focused on understanding the reasons for this range of disease and why Aspergillus is so commonly fatal.

    Professor Sir Robert Boyd, previously Dean of the Medical School in Manchester said: “The opportunity for major health improvements by high quality research crossing traditional boundaries has never been greater. MFIG exemplifies the range of skills and specialised resources necessary to bring out major breakthroughs in fungal disease. I am delighted to see such a strong multidisciplinary team hosted in Manchester.”

    At the opening meeting, Professor Jack Edwards from the University of California, Los Angeles spoke on the trials and tribulations of developing a fungal vaccine, in this case for potentially fatal Candida infections.

    Professor Gerald Bills of The Brown Foundation Institute of Molecular Medicine and Texas Therapeutics Institute, Houston spoke on the latest new class of antifungals, echinocandins, now selling nearly $1 billion annually.

    Professor Keith Gull FRS summarised the state of fungal diseases, contrasted with other infections in the keynote lecture, ’Infectious Diseases in the 21st Century: The current state of our ignorance’.  

    Professor Nick Read, Director of MFIG, stated: “Our intent is to transform the understanding of Aspergillus biology and disease. We anticipate identifying options for new antifungal drugs, the genetic basis of aspergillosis and a pathway to vaccine development.”

  • Fungicides for crops: worrying link to fungal drug resistance warn scientists Jul 15th, 2014

    Crop spraying on British farms could be aiding a life-threatening fungus suffered by tens of thousand of people in the UK each year.
    New research by British and Dutch scientists has found that Aspergillus – a common fungus that attacks the lungs and is found in soil and other organic matter – has become resistant to life-saving drugs in parts of rural Yorkshire. It’s the first time a link has been made in the UK between drug resistance in Aspergillus and fungicide used on crops. Experts warn their findings, now published, are significant and raise serious implications for transplant patients, those with leukaemia and people who suffer from severe asthma.
    In the three-year study, researchers from The University of Manchester and Radboud University, in the Netherlands, compared resistance profiles in 230 fungal samples, collected from rural areas in West Yorkshire which were treated with fungicides, to 290 air and soil samples from inner city sites across Greater Manchester. They found no resistance from the sites in Greater Manchester compared to 1.7% resistance detected in West Yorkshire, implicating fungicide use in agriculture. Dr Michael Bromley, Lecturer at The University of Manchester and study leader commented: “Given the frequent finding of resistance across northern Europe, it is not a surprise to see resistance in the UK. However, the clear association with triazole fungicide usage is very worrisome, as some unlucky people at risk will breathe in untreatable Aspergillus, with potentially dire consequences.” Diseases caused by Aspergillus affect millions of people worldwide, causing high morbidity and mortality. The only oral antifungal agents (triazoles) for human use are similar in structure to certain fungicides. The use of certain compounds in agriculture, notably difenoconazole, propiconazole, epoxiconazole, bromuconazole and tebuconazol are particularly likely to lead to resistance, yet are freely used in agriculture. There is a very limited range of antifungal compounds to treat fungal diseases, and some fungi are multi-resistant. The emerging antifungal resistance in human pathogenic fungi is causing a huge threat to patients, especially to those with weaken immune systems and this study emphasises that there may be even a greater problem in treating such diseases. Previously such resistance has been observed in a few other countries (Netherlands, Denmark, Belgium, Germany, France, India, China, Iran, Tanzania and a few others) raising great concerns among clinicians. No new classes of antifungal agent are currently in clinical development. These findings come as the Government has announced of a review of the economics of antimicrobial research. However, experts believe current practice across both health and veterinary services is failing to prevent the inappropriate prescription of antibiotics. The Science and Technology Committee has warned that the Government needs to set clear responsibilities at all levels of the NHS and veterinary medicine to achieve better stewardship of the antimicrobial drugs vital in modern medicine. 
  • Jo Armstead & David Denning Interviewed on BBC Breakfast: Aspergillosis Prevalence in Cystic Fibrosis

    Independent June 26th  "A  21 year old medical student spending her holidays doing work experience at a hospital made a major breakthrough in the treatment of cystic fibrosis. Jo Armstead, 21, spent hundreds of hours examining medical data from 30 countries and discovered that there are over 75,000 people with the genetic disorder, of whom half are over 18 years - with 50 per cent infected by the fungus, Aspergillus. Experts said the finding could help prolong the lives of patients with the debilitating lung condition, as well as help diagnose it where it had not been detected at birth."
    The research has now been published in prestigious scientific journal  Plos One, view article ; view interview

    It is known that CF patients have an increased chance of getting aspergillosis -diagnosed mainly as ABPA and estimates that 10 - 15% of all CF patients have this allergic infection, and more will eventually get the more invasive  (Aspergillus bronchitis) is now recognised in CF patients, this worsens the prognosis for CF patients.
    Aspergillus spp. can lead to allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitisation and Aspergillus bronchitis in CF patients. The relative frequencies of these entities have recently been ascertained in a large UK adult CF cohort. We have used this data to estimate the burden of aspergillosis and ABPA cases in adult CF patients in 30 countries reporting CF.​
    National and international CF registry data was accessed and assessed for completeness and age distribution. Published proportions of ABPA (17.7%), Aspergillus sensitisation (14.6%) andAspergillus bronchitis (30%) in CF were applied to those >18 years and compared with notified ABPA cases. Of the 76,201 estimated CF patients worldwide (not including India), 37,714 were >18 years. The proportion of adults to children varied from 63% in Norway to 20% in Brazil. ABPA caseload in adults is anticipated to be 6,675 cases of which only 2,221 cases (33%) are currently recorded, indicating substantial underdiagnosis.

    Country registries for CF have been ongoing for years, but never before has the problem infection aspergillosis been estimated. The UK has the second highest number of adult CF sufferers (5290), second only to the USA (13,657).​

    Press: Daily Telegraph July 9th , 2014

     

     

     

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