A review published recently describes the new antifungals
that are in the pipeline that offer hope for the future.
The new drugs described in the review have novel mechanisms
of action to overcome resistance, and some offer new formulations providing
distinct advantages over current therapies to improve safety profiles and
reduce interactions. For example, Rezafungin has shown activity against Aspergillus species and has reduced
liver toxicity, better penetration and less risk of resistance.
A summary of the mechanism of action, spectrum of activity and expected benefits is provided in the paper which you can find on the Aspergillus Website. The authors have also produced a great illustration of the new antifungals and their activity so that the remaining gaps can easily be seen. Aspergillus species have been highlighted by the blue box.
It is very encouraging to see that several of the compounds have potent activity against Aspergillus species and that Ibrexafungerp, a compound affecting the fungal cell wall, has activity against several Aspergillus species and is in phase 3 clinical trials.
The potential benefits of this drug include:
Oral and IV formulation
Active against resistant strains
Better penetration (IAC)
Minimal drug-drug interactions
In addition, olorofim, VL2397 and ABA all have potent activity against Aspergillus species and are in various stages of clinical trial. All in all, there is real hope on the horizon
Air pollution is increasingly reported as being something we need to improve if we are to prevent damaging the health of millions of people. Anyone who experienced the ‘pea-souper’ fogs of the 1960s and earlier needs little introduction to the subject, but the Clean Air Acts in the UK in 1956, 1963 and 1993 sorted that out didn’t they? After all, we don’t see those dreadful weather conditions any more do we and now that we no longer burn coal very much those chimneys belching black smoke are a thing of the past?
In truth, conditions are very much better now compared with the 50s but we are a long way from eliminating the air pollution problem, The rise of the motor car and diesel goods transport is a major factor and the harmful, irritant gasses released are much less obvious so tend to be hidden. In the UK these pollutants are now closely monitored by the Environmental Agencyand include nitrogen dioxide, sulfur dioxide, carbon monoxide, pm2.5 particulates.
Exposure to airway irritants is still very common outside the home – the popularity of wood-burning stoves in urban and suburban areas is a good example of a new trend that can make matters worse. Bonfires and fireworks are a problem at some times of the year and Global Warming may also lead to increased risk of uncontrolled burning such as happened on the moors surrounding Manchester in 2018 and happens in the US and are currently ongoing in large parts of Australia. Burning causes vast quantities of very fine dust particles and gasses to be released that someone with asthma can find very disabling and after the ongoing bushfires National Asthma Council Australia have published useful help about how to cope with asthma if you find yourself in a smoky area.
Indoors as long as we keep doors and windows closed we can keep out a lot of the pollution in the outside air, but of course, it is not always possible to do so as we also need to vent out excess moisture from our homes at regular intervals eg when we shower, bathe, cook or do the laundry. Air filters for use in the home have long been available varying from the token small device to large floor standing devices but are they any good? The answer is that they can reliably clean some things out of the air provided that they are big enough to suit your room size. Good Housekeeping has written a useful guide.