in the intensive ward at the Radboud University Medical Center, a sprawling hospital in the southeast of the Netherlands, Paul Verweij was concerned. The physician-scientist was used to dealing with very sick patients; As chair of medical microbiology, his job was to identify terrifying pathogens so he could prescribe the right treatments.
One group of patients had the kind of serious illnesses that are common in an ICU: blood cancers, immune disorders, end-stage lung disease. But on top of that, they were all suffering from a fast-growing and potentially deadly invasion of an environmental fungus called Aspergillus fumigatus. In the past, a class of drugs called azoles had reliably cured Aspergillus, but these fungal infections were strangely resistant to the drugs. Five out of six patients were dying.
Those deaths were tragic, but also strange. It is common for organisms to become resistant to drugs that a patient has taken for a long time. But these patients had not been prescribed azoles; the fungus was already resistant when it infected them. In his laboratory, Verweij was able to see an explanation: his Aspergillus it had new mutations, the likes of which I had never seen in decades as a microbiologist. With the help of the Dutch public health system, he looked beyond his own hospital and discovered an identical pattern in deathly ill patients across the country, an unrecognized outbreak scattered across a dozen ICUs.
Verweij realized that no single hospital could be the source. He had to have something outside the medical system, something present throughout the Netherlands and exerting as much mutational pressure as a prescription drug would. With the help of other researchers, he identified it: a class of agricultural chemicals, functionally identical to azole drugs, that are critical to growing food and flowers. Famous for tulips, the Netherlands is the world’s leading producer of flowers. While protecting their plants from disease, Dutch farmers had unknowingly endangered the health of their neighbors.
“We created a niche,” Verweij says, “where these super-tough insects can emerge.”
That discovery occurred over a decade ago, a well-known episode in a limited portion of medicine, but little reported outside of it Since then, that pattern of resistance has spread to more than 40 countries, including the United States and the United Kingdom; three out of five patients develop resistance to azoles Aspergillus die of it. Disease specialists and plant pathologists expected that the parallel development of azoles in medicine and agriculture would have been unique. They thought that if they kept an eye on each other’s investigation, surely this would not happen again.
Except it has. Experts now fear that medicine may be at risk of losing a critically needed new drug because agricultural chemistry has once again deployed a similar compound first.
The looming conflict arises from the appearance of two compounds, one pharmaceutical and the other agricultural, that share a novel mechanism to kill fungi: a drug, olorofim, which is in human clinical trials, and a fungicide, ipflufenoquine ( trade name Kinoprol), which was registered by the US Environmental Protection Agency last year. Ipflufenoquine, manufactured by Nisso America, is intended to combat diseases of important tree crops, such as almonds, apples, and pears. Olorofim, developed by British firm F2G, is a desperately needed new treatment for Aspergillus and valley feverIt affects up to 150,000 people in the US each year, and occurs most densely in the part of California where most almonds are grown.
—————————————————-
Source link