Friday, 21 May 2010

Trying to break the mould - the current state of the art

In the germ world, fungi usually lack the flair of viruses or bacteria. To people with normal, healthy immune systems, a fungus will rarely show itself — even though you carry around a microscopic film of fungus on your hair and skin, and take in invisible clouds of fungal spores with each breath. While many other microbes prefer to make a living through disease and death, a fungus is often content to wait for its host to die of something else.

In fact, throughout the history of civilization fungi have mostly been humans’ friends, providing the bounty of bread and beer, recycling trash and enabling plants to extract nutrients from the soil. Scientists estimate that roughly 1.5 million species of fungus inhabit the Earth, but only a handful are capable of causing human disease.

Problem is, when they do, fungi can be remarkably lethal
This article by Laura Beil nicely explains where moulds come from and why we don't get infected by them as a general rule.

It goes on to suggest why some people do get infected and what genetic differences they may have compared with people who don't get infected, and finally discusses why they are so difficult to treat!

It is well worth a read.

Thursday, 20 May 2010

Cancer is not a fungus

Where is the fungus?
We recently became aware of the controversial claim that cancer is a fungus by an Italian ex-medical practitioner (Tullio Simoncini). Unlike many controversies that may have a grain of truth somewhere within, this one is complete nonsense.

Simoncini has been struck off by the medical authorities in his country and successfully convicted of manslaughter and defrauding of his patients, apparently sentenced to 4 years in 2006.

Is there anything to back up his claims? Well let's be charitable and suggest that what he actually means is the cancer is caused by fungi and that if we open up a tumour we will find a fungus within - though what he actually states is that the cancer IS the fungus. The fact that he presents no data, no pictures of fungi within a tumour must mean that it is technically a challenge to do so? Or that the thousands of histologists who do this every day are missing something?

In fact it is very easy to remove a tumour, thinly slice it, stain it and look at the cells within and here is a website of a pathologist doing exactly that. No sign of fungi there and plenty of evidence of human cells undergoing changes related to them turning cancerous.

The tumour must be fixed & stained to carry out these examinations - perhaps then that process removes all sign of the fungus from the tumour tissue and THAT will explain why histologists & pathologists don't see it? Well no that isn't the case either - this webpage clearly demonstrates that fungi (in this case yeast) are easy to fix, stain and see under the microscope. There are many more pictures here of Aspergillus (another type of fungus) fixed and stain in sections of lung tissue.

There is no obvious medical or scientific reason why Simoncini could not carry out similar work to back up his assertions. It would do his case a huge amount of good (and earn him a huge income) if he would adopt this approach, but as far as we can reasonable find, he doesn't. Likewise it would be straightforward for him to publish the results of his efforts at treating patients based on his hypothesis, but again there is no sign of that happening. Perhaps he would care to leave a comment below enlightening us?

Make your own conclusions.

Wednesday, 12 May 2010

Vitamin C acidic beverage is a good alternative to cola when taking itraconazole

People taking antacids (or who have other absorption problems) and the antifungal itraconazole have long been advised to take a cola drink with their antifungal in order to aid its uptake into the bloodstream. Other acidic drinks have also been used, most notably acidic fruit juice which has proven to have problems of its own, sometimes improving uptake but decreasing breakdown of the drug in the liver (overall effect can be to over-increase the levels of itraconazol in the blood) and sometimes to actually block uptake. Obviously care needs to be taken when taking fruit juices!

Cola can be unpalatable to some patients and as it contains a fair amount of caffeine and sugar it can have other unwanted effects, particularly for diabetics.

This paper has examined the use of a vitamin C drink which contains no caffeine for improving uptake of  itraconazole. This drink is shown to be very effective at enhancing uptake of itraconazole and the presence of its metabolite 7-hydroxyitraconazole (which also functions as an antifungal in addition to itraconazole, increasing its potency). It is shown to be very similar to cola, so this is a genuine alternative to cola and fruit juice for itraconazole users.

Is there is something about vitamin C that enhances uptake of itraconazole? This paper shows no such thing and states that this vitamin C drink had a similar pH (acidity) to cola. The acidity of the drink has always been stated to be what is important when choosing a drink to use to improve absorption of itraconazole - this drink is acidic so that is likely to be the reason why it helps rather than any specific activity of vitamin C.

The vitamin C drink also contains added fructose & fruit juices so will contain a fair quantity of sugar.

By all means consider drinks like this to help absorption of your itraconazole if you find it a pleasant alternative to cola, but think again if you need to avoid sugar!

Tuesday, 4 May 2010

Inhalable Amphotericin Powder get the Green Light from FDA

Amphotericin B Inhalation Powder (ABIP) have been granted fast track designation by the American Food and Drug Administration (FDA). The FDA are responsible for the safety of all drugs on the US market and their actions are often a precurser for drug availability across the rest of the world.

Amphotericin is an antifungal with a long history of use against aspergillosis - originally develped in the 1950's (we have written about it several times). It can be very effective against aspergillus but has long suffered from a major weakness - it is poorly soluble in water. This means that it couldn't be taken orally and that it had to be dissolved in a quite toxic substance that tends to give a lot of side effects. A pair of drugs emerged that were based on Amphotericin but which were prepared in a different way for intravenous use. These were very sophisticated drugs that were very expensive to use (i.e. Amphocil and Abelcet) and so had limited application.

There have been a series of new drugs based on Amphotericin coming out over the last year or two, several of which have been reported in this blog e.g. oral Amphotericin and aerosolised Amphotericin. A recent report demonstrated some success in the use of inhalable Amphotericin to provide prophylactic protection for a group of patients who are at high risk from Aspergillus infection, and who would be very difficult to treat if that infection took hold.

Success in the prevention of fungal infection for transplant patients clearly has had some impact and this new form of Amphotericin - a powder designed to be inhaled - has been made available for exactly that purpose and for other immunocompromised patients.

"Fast Track designation allows the FDA to expedite the review of new drugs that are intended for serious or life-threatening conditions and that demonstrate the potential to address unmet medical needs."
 Dr. David Johnston, Nektar senior vice president of research and development made the following hopeful comment:
“Our product could represent a major paradigm shift in antifungal therapies as we aim to prevent infections by targeting the lungs directly and therefore avoid the serious systemic and dose-limiting side effects of intravenous and oral therapies." 
As ever, time will tell whether or not this comment is valid.

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