NIH Awards $9 Million for Research on Life-Threatening Fungus

The National Institutes of Health has awarded $9 million over the next seven years to support research on Aspergillus, a common fungus that poses a major health threat to cancer patients and transplant recipients. Doctors and scientists at the University of Florida Health Science Center, Duke University, Brigham and Women's Hospital in Boston, and the Dana-Farber Cancer Institute are collaborating to learn more about the fungus and develop more accurate tests to detect it in patients.

"Apergillus is everywhere, particularly in the air we breathe; all of us breathe it in all the time," said principal investigator John Wingard, M.D., director of UF's blood and marrow transplant program and deputy director of the UF Shands Cancer Center. "On a windy day, especially in a dusty environment or every time some dirt gets moved around, lots of these organisms get aerosolized." The number of people contracting Aspergillus infections jumped enormously in the 1990s, Wingard said, and those with weakened immune systems are particularly susceptible. Aspergillosis is the leading cause of death from infection in bone marrow transplant and leukemia patients, as well as among those who receive certain other solid organ transplants, he said. About 15 percent of all bone marrow transplant patients, for example, will develop an infection from Aspergillus; of those, about two-thirds die.

"We haven't had good treatments, we haven't had good prevention methods and, most importantly, we haven't had good diagnostic methods to identify which patients have these infections," Wingard said. "Since we often don't recognize that patients have aspergillosis until very late in the course of the infection, by the time we try to treat the infection it is often so advanced we have very poor prospects of bringing it under control." Complicating the picture, he added, is that aspergillosis is frequently mistaken for bacterial pneumonia, and tests for the infection often are initially negative. Two-thirds of the time tests are negative even though patients have the infection, he said.

Officials are hoping to collect samples from about 200 patients a year for the next seven years to better characterize the fungus and improve the diagnostic accuracy and speed of tests used to detect aspergillosis. Patients' respiratory, urine, and blood samples will be sent to a repository at UF; these will include samples from patients with confirmed infections that will be compared with samples from patients whose diagnosis is less clear and with samples from patients who are at high-risk but not infected. Researchers also will work with Emory University, Indianapolis-based MiraVista Diagnostics, and the University of Manchester in England to evaluate existing tests and develop new, more accurate and less invasive ones.

While more potent treatment regimens are improving prospects for patients, so-called emerging pathogens--viruses, bacteria, and fungi--are a growing medical problem, Wingard said. "With advancing medical technology and more powerful antibiotics, patients are living longer," he said. "We have a growing population of patients who are susceptible to very serious infections by viruses, bacteria, and fungi that in years past were not medical problems.

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