For Immediate Release
April 30, 2009

BUFFALO, NY–A review summing up current understanding of aspergillosis—an infection that can attack cancer patients and others with weakened immune systems—by Brahm H. Segal, MD, Chief of Infectious Diseases at Roswell Park Cancer Institute (RPCI), has been published in the New England Journal of Medicine.

As Dr. Segal notes in the Journal’s April 30 issue, aspergillosis is the umbrella term for illnesses caused by spores of Aspergillus, a common fungus. “We inhale them at work, in our back yards, almost everywhere,” he said recently. “They’re in the soil and air all around us, but, for the majority of us, they’re harmless.”

“Those at risk fall into two groups. The first includes people with severely compromised immune systems, like patients receiving chemotherapy for leukemia, transplant recipients, and people with rare disorders of the white blood cells, such as chronic granulomatous disease.

“The acute, invasive form of aspergillosis usually manifests as an aggressive pneumonia that can be difficult to treat—and may be fatal. There are also slowly progressive forms of lung aspergillosis that generally occur in patients with pre-existing lung disease without severe immune impairment.”

In the second category, he said, are those suffering from allergies. “They don’t have an immune deficiency, but fungi trigger a response that may show up as severe asthma and lead to structural lung disease.”

“What I find interesting is that only a small number of people actually fall ill. It’s fascinating how well our immune systems are calibrated. We do it just right, almost always fighting off fungi without overreacting with allergy or excessive inflammation.”

Titled simply “Aspergillosis,” the paper reminds readers that for the past billion years almost every form of life has evolved anti-fungus defenses.

In humans, Dr. Segal writes, epithelial cells lining the respiratory tract are the first line of defense—a physical barrier to inhaled fungi. They gobble up spores or clear them away with a flow of mucus. White blood cells, such as macrophages, neutrophils and natural killer cells, also attack the fungus and usually stop the invasion cold.

When the immune system fails, however, aspergillosis can dig in for the long term. Leukemia patients who undergo multiple chemotherapy cycles, for instance, are at particularly high risk.

Fortunately, he reports, effective therapies do exist. Recent developments in diagnostic methods and antifungal therapy have led to improved outcomes, although managing drug side effects during treatments that may last 12 weeks or longer can present challenges. Reducing mold exposure is a key preventive step. Antifungal agents can be administered preemptively, but may introduce drug interaction problems or make aspergillosis harder to diagnose.

New therapies and even vaccines based on rapidly growing knowledge of immunity mechanisms and antifungal agents are areas of active research, he writes, suggesting that deeper understanding of both human and fungal genetics may also offer clues to more advanced therapies.

“I was deeply honored to be invited to write this review,” he said. “I hope both general-interest readers and frontline people who deal directly with aspergillosis will find it to be of interest.”

Roswell Park Cancer Institute, founded in 1898, is the nation’s first cancer research, treatment and education center. The Institute was one of the first cancer centers in the country to be named a National Cancer Institute-designated comprehensive cancer center and remains the only facility with this designation in upstate New York. RPCI is a member of the prestigious National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers; and maintains affiliate sites and is a partner in national and international collaborative programs. For more information, visit RPCI’s website at http://www.roswellpark.org, call 1-877-ASK-RPCI (1-877-275-7724) or e-mail askrpci@roswellpark.org.

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