Monday, 28 April 2014

Severe Asthma and Fungal Sensitisation: What We Currently Know

The role of fungi that we breathe in from our environment is suspected to be important for the stability of severe asthma. Those who have unstable asthma (e.g. requiring regular hospital admission) are also highly likely to be sensitive to fungi - a phenomenon known as Severe Asthma with Fungal Sensitivity (SAFS). Approximately 6.5 million people are thought to have SAFS and another 4.8 million have an allergic infection of the airways known as Allergic Bronchopulmonary Aspergillosis (ABPA) and both of these populations are thought to benefit from active management using antifungal medication.

Evidence to support this claim is not yet completely convincing but clear guidelines may well benefit many patients while further research is carried out. An extensive publication from the European Academy of Allergy and Clinical Immunology (EAACI) attempts to set out these and to define where new research is needed to further strengthen our confidence in these conclusions.

Fungal allergy in asthma–state of the art and research needs by DW Denning is now available for download


Sensitization to fungi and long term or uncontrolled fungal infection are associated with poor
control of asthma, the likelihood of more severe disease and complications such as
bronchiectasis and chronic pulmonary aspergillosis.
Modelling suggests that >6.5 million people have severe asthma with fungal sensitizations (SAFS), up to 50% of adult asthmatics attending secondary care have fungal sensitization, and an estimated 4.8 million adults have allergic bronchopulmonary aspergillosis (ABPA).
There is much uncertainty about which fungi and fungal allergens are relevant to asthma, the natural history of sensitisation to fungi, if there is an exposure response relationship for fungal allergy, and the pathogenesis and frequency of exacerbations and complications. Genetic associations have been described but only weakly linked to phenotypes.
The evidence base for most management strategies in ABPA, SAFS and related conditions is weak. Yet straightforward clinical practice guidelines for management are required. The role of environmental monitoring and optimal means of controlling disease to prevent disability and complications are not yet clear. In this paper we set out the key evidence supporting the role of fungal exposure, sensitisation and infection in asthmatics, what is understood about pathogenesis and natural history and identify the numerous areas for research studies. 

Thursday, 24 April 2014

The Magic of Mushrooms, BBC1

Professor Richard Fortey delves into the fascinating and normally-hidden kingdom of fungi. From their spectacular birth, through their secretive underground life to their final explosive death, Richard reveals a remarkable world that few of us understand or even realise exists - yet all life on Earth depends on it.

 In a specially-built mushroom lab, with the help of mycologist Dr Patrick Hickey and some state-of-the-art technology, Richard brings to life the secret world of mushrooms as never seen before and reveals the spectacular abilities of fungi to break down waste and sustain new plant life, keeping our planet alive.

Beyond the lab, Richard travels across Britain and beyond to show us the biggest, fastest and most deadly organisms on the planet - all of them fungi. He reveals their almost magical powers that have world-changing potential - opening up new frontiers in science, medicine and technology.

Worth watching, or get it on iPlayer later 

Wednesday, 16 April 2014

Global Warming and Fungal Biodiversity

It is perhaps not widely known that fungi - including Aspergillus - have a profound influence on our climate.
We have often mentioned and it is often stated elsewhere that fungi are the 'refuse recyclers' of the world. Without the work that fungi do to break down all dead plant and animal material we would quickly be submerged in non-composted rubbish!

Breaking down dead organic material results in the release of carbon dioxide into the atmosphere. We know that carbon dioxide is a 'greenhouse gas' that makes a major contribution to raising global temperatures. It follows that changes in the amount of recycling by fungi will have a large effect on global warming. We need to study the mechanism to find out just how important fungi might be!

A Stanford University research team have set out to find out more by taking hundreds of soil samples from multiple sites across Northern America. At each site they took samples from the surface where it was thought most decomposition takes place, and samples from deeper into the soil where it was thought different fungal species co-exist and co-operate with plant roots (Mycorhizzal fungi). Modern DNA sequencing techniques allow us to accurately identify virtually all the fungi in each sample and 10 000's were detected.

There were quite a few surprises!

  • It turns out that particular species/strains tend to live in local areas. West coast species tended not to be found on the east coast or mid west and vice versa.
  • Despite the fact that different fungi were present in different areas they all seemed to be doing the same job of decomposition in the same way
  • Fungi that live deeper in the soil seem to be doing a lot more of the decomposition work than was thought.
Because these fungi are important influencers of global warming we now need to do more work to understand what is going on - why particular species are not more widely dispersed, why they all work in the same way (e.g. why do we have thousands of species when they all apparently do the same thing) and the potential there is for changing the amount of carbon dioxide released if we for example remove the plant life from the soil that we now know supports fungi that release CO2.

This work was largely looking at soil samples taken in forests. Does this work tell us more about the consequences of deforestation?

Stanford University announcement

Tuesday, 15 April 2014

Ants use fungi as their 'pharmacy'

Scientists at the University of Madison have just received $16 million to help their search for new antimicrobial drugs. Many people will have heard that we need to constantly expand our range of antibiotics and antifungal drugs as the micro-organism infections that we fight with those drugs gradually become resistant.

Drug companies have of course known this for many years (the search for new antibiotics dates back to the 1940's)  and have been searching the natural environment for candidates for 70 years. Sadly this approach is becoming more difficult and new approaches are needed.

One new approach is to take advantage of the naturally evolved habit of some ant colonies to promote the growth of fungi in their nests.

It has been noted that only certain fungal strains are encouraged, some are good to eat but some are also known to secrete antibiotics. The ants take advantage of this ability and seem to use it to prevent bacterial growth in their nests - they tolerate the fungi well (and may well be adapted to do so) but too much bacterial growth would cause sickness.

This behaviour may be the result of millions of years of evolution, so it follows that the fungi have also evolved to fight bacterial infection and may be producing new compounds. The Madison group are looking for those novel compounds.

Friday, 4 April 2014

Posaconazole (Noxafil) Approved for Intravenous Use

Merck (NYSE: MRK), known as MSD outside the United States and Canada, today announced that the U.S. Food and Drug Administration has approved NOXAFIL® (posaconazole) injection (18 mg/ mL), a new formulation of NOXAFIL for intravenous (IV) use. Merck’s antifungal agent is also marketed as NOXAFIL (100 mg) delayed-release tablets and NOXAFIL (40 mg/mL) oral suspension. NOXAFIL injection, delayed-release tablets and oral suspension are indicated for prophylaxis of invasive Aspergillus and Candida infections in patients who are at high risk of developing these infections due to being severely immunocompromised, such as hematopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) or those with hematologic malignancies with prolonged neutropenia (low white blood cell counts) from chemotherapy.

NOXAFIL injection is indicated in patients 18 years of age and older. NOXAFIL delayed-release tablets and oral suspension are indicated in patients 13 years of age and older. With this approval, Merck now provides an IV formulation and two oral formulations of NOXAFIL for prophylaxis against invasive Aspergillus and Candida infections in high-risk patients. - See more at:

“Merck is pleased to add NOXAFIL injection to the NOXAFIL family of products. The availability of a NOXAFIL formulation for intravenous administration is particularly important for those patients who may benefit from or require intravenous therapy, or who, for a variety of reasons, might not be able to take an oral formulation. In addition, patients have the possibility to start on NOXAFIL injection and transition to oral NOXAFIL,” said Dr. Nicholas Kartsonis, executive director, Infectious Disease, Merck Research Laboratories.

In clinical trials, the adverse reactions reported for NOXAFIL IV injection were generally similar in type to that reported in trials of NOXAFIL oral suspension. The most frequently reported adverse reactions with an onset during the posaconazole intravenous phase of dosing 300 mg once-daily therapy were diarrhea (32%), hypokalemia (22%), fever (21%) and nausea (19%).

 NOXAFIL injection is expected to be available at wholesalers in mid-April.

Tuesday, 1 April 2014

Breaking News: UK Gnomes colonies under threat

Press Release Scientists succeed in mapping the Genome of the Garden Gnome but is it too late for the UK's Gnome colonies?

Editor’s note: Warning contains distressing pictures.

Video: Vimeo and Youtube:

Stills: and Dropbox:

Scientists have announced that, after years of research, they have managed to decode the Genome of the common Garden Gnome. The announcement coincides with a warning that a deadly fungus which lurks in compost heaps and flourishes in damp conditions could wipe out this entire endangered species by 2020 unless governments act to stem the tide of destruction.

The gnome genome contains nearly as many genes as its closest relative, the human, and its most remarkable feature is a growth hormone deficiency.

This major piece of research may come to nothing. The warning about fungal infection comes after latest research from GAFFI (The Global Action Fund for Fungal Infections ) shows garden gnomes around the country have suddenly, and mysteriously, become infected by fungal disease and are dropping like flies.

Normally shy and reticent, these generally resilient, stony-faced characters have been sighted in gardens all over the UK with pained expressions carved into their little features.

At a secret location, in a suburban garden in the UK, an entire colony has been wiped out by the fungus which causes a condition known as Aspergillosis. GAFFI has obtained exclusive footage of the latest outbreak. It’s available on the GAFFI website (

GAFFI President Dr. David Denning, who is Professor of Fungal Medicine at the University of Manchester, says that fungal disease is known to affect almost 300 million humans across the globe but this is the first time Aspergillosis has been diagnosed in gnomes. He wants people who discover diseased gnomes to report it on the GAFFI website. ( )

He explained: "Few people realise that these unlikely and endangered creatures are our oldest genetic cousins so we want to see if the unravelling of the human genome can provide a link to garden gnomes before it's too late for them and us. We are particularly concerned about the gnomes of Zurich, many of whom were badly affected by the financial crisis in 2008 and their immune systems are still at a very low ebb."

It is rumoured that the world-famous forensic detective, Sherlock Gnomes, has been asked to look into the case.

For more information and exclusive photos and video footage of the now extinct, gnome colony contact Susan Osborne, Director of Communications at The Goodwork Organisation on 07836 229208 or email Professor David Denning is available for down the line or studio interviews.


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