How people with aspergillosis can help look after their liver

What does our liver do?

Our livers are really important for us to live a healthy life. Tucked right underneath our ribcage it is a large soft organ that has a rich blood supply. It can recognise and break down or filter any toxic substances that it may find – consequently our blood is quickly cleaned of anything that is not meant to be in our bloodstream.

Toxic substances can get into our body when we eat them, drink them, inhale then or when our doctors inject substances directly into our bloodstream. They can even be part of the daily process that continually renews the tissues that make up our bodies, breaking down proteins and ridding us of any toxic by-products of this process. This is a hugely complex process that we are as yet unable to reproduce artificially – the only way we can replace a badly damaged liver is to replace it with a transplanted donated liver.

What happens if our liver stops working?

Not surprisingly if our livers become dysfunctional our bodies soon start to suffer and there is a long list of illnesses caused by a sick liver. One of the most well-known ways we can damage our livers is to take alcoholic drinks to excess regularly, but we should also be aware that obesity is also a risk to our livers.

Why is this important to aspergillosis patients?

In addition aspergillosis patients should be aware that the medications that they have to take can risk damaging their livers. Doctors closely monitor their patients especially when they first prescribe a mediation that may cause toxicity. They need to watch closely for signs of the liver starting to be distressed by monitoring the signs using blood tests referred to as liver function tests. The purpose of these tests is to detect the very early signs of liver distress so that the doctor can take action to prevent any long term damage.
We know that antifungal medication can cause liver damage in some people, sometimes because the dose of an antifungal is too high and a quick adjustment can prevent further problems, or sometimes the patient is switched to a different drug if dose reduction doesn’t have the desired impact on the liver.

What can I do?

What can you, the patient do to help yourselves when taking an antifungal medication? Firstly, of course, it is very important to have a good working relationship with your medication team and report any new symptoms quickly to your doctor can assess if any action is needed.

You can also help by keeping your liver in the best condition it can be so that it can detoxify your blood quickly and keep you in the best health possible. You may be surprised by some of the things you should and shouldn’t do!

  • Smoking is bad. There are hundreds of toxins in cigarette smoke that your liver has to work on to keep you well while it should be working on other toxins
  • Coffee is good! Take a few cups a day but ensure you are still taking plenty of water as well
  • Alcoholic drinks – stick to medical advice. If you are taking antifungal drugs I am afraid the advice is no alcohol consumption (your liver will love you for it)
  • Eat the rainbow – select fruit and veg of every colour to be part of your diet.
  • Take care when using acetaminophen – often found in colds & flu remedies. No more than 4000 milligrams per day.
  • Weight – keep your Body Mass Index between 18 and 25
  • Infection control – wash your hands well after using the toilet and before preparing food
  • Exercise as much as you can – see your specialist physio for advice
  • Get vaccinated against hepatitis
  • Practice safe sex – diseases transmitted by sex can hurt your liver
  • Avoid ‘liver detox’ products eg milk thistle, turmeric. Tell your doctor what you are taking.

NOTE: Herbs and supplements cause 25% of the liver damage treated by doctors – especially borage, comfrey, groomwell, coltsfoot but also Atractylis gummifera, celandine, chaparral, germander and pennyroyal oil.

Good foods for your liver (all in moderation)

  • Coffee
  • Oatmeal
  • Green tea
  • Water
  • Almonds
  • Spinach
  • Blueberries
  • Herbs & spices

Foods you should limit

  • Sugar
  • Fatty foods
  • Salt
  • snack foods (usually rich in the above)
  • Alcohol

A step-change in computer power for aspergillosis genomics

Quantum supremacy

Future research in aspergillosis genetics will be (and is being) done with huge computers as they analyse entire genomes and generate huge amounts of data from the information gleaned when sequencing robots read entire genomes of complex living organisms – Aspergillus or human. The human genome contains about 3 billion base pair letters that together form a complex collection of 20-25,000 genes.

Each of these genes may be switched on or off in an infinite array of gene expression that not only makes an organism what it is but also regulates the response of a human body to external events such as infection. It is likely that mistakes in how some of these genes are expressed or how they function contribute to the reason why some of us are vulnerable to fungal infections such as aspergillosis while most of us aren’t.

Working out which of this huge number of genes is responsible for allowing fungal infection is clearly a massive task, but it is more complicated than that. If we were to sequence the genome of one person we would only get very limited information about which of their genes are fungal infection susceptibility genes. Perhaps there is more than one gene involved? As a consequence, we need to sequence the genomes of many more people who have aspergillosis in order to get a more accurate impression of the number of genes involved, and which genes are involved in permitting a fungal infection.

We also have to sequence the genomes of people who haven’t got aspergillosis so that we have something to compare the test subjects with. All in all, we will need to sequence dozens of individuals in order to arrive at reliable conclusions. This takes many months to achieve.

Computer power

Even with our most powerful computers at the University of Manchester this still takes a lot of time. Investment in Edinburgh genomic computing resources uses state of the art computer power that is 5 x faster than its predecessor, but this is just a linear progression rather than a dramatic step-change in performance likely to radically speed up the genomics work.

Additionally, however fast these computers already are, the rate of advance in computing speed will be forced to slow down as current technology will soon reach its fundamental limits – for example current computers work with ‘bits’ that represent two states – I and O so we have lots and lots of power but only the ability to work with ‘yes’ or ‘no’. This isn’t enough to process the forthcoming mass of incoming data – we need a complete step-change in how computers work to achieve fundamental accelerations in speed.

Google and quantum bits

Google, apart from being a huge company that provided services to you and I, is also a computer research company. It has been working on this fundamental limit to computer speed for some time and has just announced the successful construction of a computer that uses quantum particles rather than ‘bits’. Quantum bits can work with many more states compared with ‘bits’ so you can imagine how that might speed things up a little. Instead of ‘yes’ or ‘no’, each particle can also store ‘maybe’, ‘yes and no’ and many more – each of these new states would have taken many current bits to achieve the same end.

We can only really appreciate the huge improvement in speed this offers by setting this new computer a really difficult problem to solve – one we know will take a computer using current technology a long time to finish. Google claims that when they set a current computer a particular test problem it would take 10,000 years for it to solve it – I presume that they haven’t actually tested that using a realtime run!

Quantum supremacy


How long did the computer using quantum bits take to work out the same problem? It would be really amazing if it could do it in 100 years, incredible if it could do it in 10 years. In fact, Google claims it took just 200 seconds – truly a step-change in computer power for aspergillosis genomics.
If we are able to use that kind of computer power for genomics work in the future we would have results in fractions of a second, speeding up work on aspergillosis genomics 1000’s of times, making it theoretically possible we could be doing complete genome checks in a single visit to the clinic in the future.

https://www.bbc.co.uk/news/science-environment-50154993

Stoptober

Stoptober is an initiative which aims to help people quit smoking. The dangers of smoking are well understood, but for those with chronic lung conditions the risks can be even greater – for example smokers are 5 times more likely to catch the flu, a major complication for aspergillosis patients.

We have had 2 talks at the National Aspergillosis Centre patient and carer support meeting that mentioned smoking and aspergillosis. At one meeting, Dr Khaled Al-shair (National Aspergillosis Centre Researcher) spoke of several guidelines to help patients suffering from Chronic Pulmonary Aspergillosis (CPA) feel their best while being treated at the NAC. Exercise and good diet played their part but one of the major improvements many patients can make to their lifestyle was to stop smoking cigarettes.

We have also had a talk from our local ‘Stop Smoking’ nurse – this talk focused what can be done locally using UHSM (University Hospital of South Manchester) services; so if you are a NAC patient or live withing striking distance of UHSM (Manchester, UK) you can take advantage of this help directly. There was also extensive information for anyone about the advantages of giving up cigarettes and different strategies to employ when trying to find a way to stop smoking.

The NHS also provides a wealth of information and advice on quitting smoking which can be found here.

Vitamin D deficiency may increase amphotericin B-related kidney toxicity

Graph showing that mice with vitamin D deficiency had more kidney toxicity from amphotericin B

Do you take vitamin D supplements over winter?

Current NHS/PHE guidelines say that all adults should consider taking vitamin D supplements between October and March, or all year round if they are at risk of deficiency (e.g. people who have darker skin, or spend most of their time indoors or covered up).

But a new study suggests it might be even more important for people living with aspergillosis. Ferreira et al 2019 found that mice with a vitamin D deficiency experienced more kidney toxicity when given amphotericin B (lipid formulation). Click here to read more here.

If you haven’t had your levels tested recently, it might be worth getting your doctor to check them.

When taking vitamin D supplements:

  •  For best absorption, take it with a meal containing fat and calcium
  •  Check the label for the dosage – it should be 10-25 mcg per day, or 400-1000 IU (don’t rely on % RDA/NRV)
  •  There are two forms: D3 (cholecalciferol) is more effective than D2 (ergocalciferol)

For more information on Vitamin D guidelines:

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