While at The European Congress of Clinical Microbiology and Infectious Diseases in Vienna, Austria, Dr. Ghannoum sat down for an interview with the Infectious Diseases Hub.
Here's what you'll discover...
- Why fungal infections present a research area of unmet need
- Is the mycobiome relevant to oral and intestinal health?
- The most promising strategies for overcoming the growing threat of anti fungal resistance
- … and more
Listen here, and check out the transcript below.
Introduction: Welcome to ID Hub Talks. In this podcast, we’re reporting from ECCMID 2017 in Vienna, Austria. We’re speaking to Mahmoud Ghannoum from Case Western Reserve University and the University Hospitals Cleveland Medical Center. He Presented his work at the conference on Candida auris.
IDHTalks: First, could you introduce yourself and tell us a bit about your career today?
Dr. Ghannoum: My name is Mahmoud Ghannoum. I am professor and director for the Center of Medical Mycology at Case Western Reserve University and University Hospitals Cleveland Medical Center. I’ve been there for the last twenty years and before that I was at UCLA in infectious diseases. And, really, I started in England, my entire career, where I did my PhD on the study of Candida in particular. So for the last forty years I’ve been focusing on fungal infections.
IDHTalks: Yeah, great! Why do you think fungal infections present a research area of unmet needs?
Dr. Ghannoum: For a very long time, people focused on the study of bacteria, which is, of course, important. Having said that, fungi, especially since we have started new medical procedures and new ways of prescribing drugs, has become more and more important. Because what happens, if you use immunity in transplantations for example, or if you use a drug, such as an antibiotic, is you affect not only the bad bacteria, but also the good bacteria. And since bacteria and fungi work together, and they live in our body, fungi then have the opportunity to come out and stop causing disease. Why it’s an unmet need is because fungal infections are the third or fourth most common bloodstream infections, infections in hospitals. And it is associated with the highest mortality, even when you compare it to other bacterial infections. So, for us, a lot of the time people, for example cancer patients, when they die, they don’t die from the cancer, they die from fungal infections. And therefore, it’s really an area which needs to be investigated, unlike the bacterial world, where we have a lot of antibacterials, although we have the resistance issues. Now, for fungi, we have a handful of drugs. And it’s been very important recently, there’s a new species of Candida called Candida auris, which is multi-drug resistant. This is the first time we have a fungus that will pose a problem regarding how to treat it because of the resistance. So that’s why it’s an unmet need and that’s why we need more funding to look at fungal infections and how to manage them, and how to really optimize our health when it comes to fungi.
IDHTalks: Yeah, yeah, great! Thank you! And can you outline the product you’re currently working on?
Dr. Ghannoum: You know, as I mentioned, I run the Center of Medical Mycology and this center is from test tube to patient. So, I have some basic research areas, in particular I work on biofilms, fungal and bacterial interactions with biofilms. But more recently in the last seven or eight years, I started focusing on understanding what is the fungal community instead of the bacterial community in our body. And that’s why we named the mycobiome, which is the fungal community in our body. I have been looking at it, not only in health, for example what fungi is present in our oral cavity or in the gut in healthy situations, but also looking at it in diseased state, for example we looked at Crohn's disease. And, you know, what’s so exciting about this is that we knew very little about the mycobiome, so even being a part of dermatology, we’re starting to look at the skin. So that’s our basic research. But, in addition, we do a lot of translational research where we try to help companies to develop the drug, as we have our own development with respect to new ways, through probiotics for instance, to combat the imbalance in our mycobiomes.
IDHTalks: Yeah, thank you! That’s really interesting. So, the microbiome has had a lot of interest in the last few years, and you’ve pioneered research into the fungal component, the mycobiome, as you’ve mentioned. Do you feel the mycobiome is likely to be relevant in oral and intestinal health?
Dr. Ghannoum: At least based on our studies—and also, more recently, I’m pleased to say, other researchers have started to go and look into it—it’s becoming clear that the fungi play a role in our health and wellness, and disease. For example, there are studies to show that fungi is associated with obesity. Our work shows that it is associated with Crohn's disease and ulcerative colitis, for example. So, what’s important is—I’m not saying it’s only fungal, clearly—the issue is that it’s not only bacteria, not only fungi, it’s the two together. They work and they operate. And I wrote an article in mBio, it’s a commentary about how fungi and bacteria have evolved in such a way that they come together and help each other, living inside the biofilm. And that’s why I think fungi will be very important to study in addition to bacteria, otherwise you are only taking half of the story.
IDHTalks: Yeah, so we need to look at both
Dr. Ghannoum: And that’s what I’ve been advocating since 2010 when I wrote the first article, actually an opening piece in the ASM Microbes. I said we really need to look at both. And this continues to become clearer to me especially, in the findings and the studies that we show, it’s more and more real and more and more important.
IDHTalks: Absolutely. Research at the Center for Medical Mycology at Case Western Reserve University combines basic and translational projects like you said, do you think a bench to bedside approach is important to your field?
Dr. Ghannoum: Oh no doubt about it. I mean, as a PhD, I am a scientist but I am a great believer in that we really need to work with the physicians and clinicians and come together as a team to try to translate what we discover so that we can help our patients. Without this step, we are lost. Most of the time people just focus in their own little area, for example, “Oh, let’s clone these genes,” and that sort of thing. To me this is great it is very important as a basic science, but then we need to start thinking how can we translate our discoveries to make them help people because that after all is what we are all about.
IDHTalks: What do you think the most promising strategies are for overcoming the growing threat of antifungal resistance?
Dr. Ghannoum: You know, really, this is very important question particularly as I mentioned earlier with this new Candida auris, the discovery of this emerging multi-drug resistance. I think, first of all, this particular resistance like, in a way, antibacterial resistance is we need to be sure that we are using the right drug, we need to be sure that we don’t under-dose. One of the big mistakes people did early in the 90’s where they used fluconazole to treat oral candidiasis, they under dosed it and instead of using 150 or 200 milligrams they used 50 milligrams per day and that allowed resistance to develop. So, it is important to have the right dose, it is important to be aggressive at the beginning to treat the disease, as I mentioned, like organisms. Also we need to keep looking for new ways to really discover new drugs that are able to deal with the risk of the threat of resistance.
IDHTalks: Great thank you! In your opinion what are they key hurdles to be overcome in this field?
Dr. Ghannoum: I mean we touched up on some of them. Number one is with respect to we need make sure we have the drugs to deal with the resistant issues. Number two, we really need to understand the organism and how they work together like with bacteria. If we understand the fungal-bacterial interactions, we will be able to come up with new strategies to deal with how can we maintain our balance for example. And one of the hurdles is we should not only focus on drugs, we should look into probiotics. And that is an area we started to look at, and what we found is that you can have probiotics that can balance both bacteria and fungi and maintain that balance. At the same time, we need to start thinking of new strategies like, for example, for Crohn's disease, should we just use antibacterial agent? So new releases now we are showing that there’s fungi in our gut so should we also use some antifungal agents. Also once you get rid of the other growth of the bad bugs, whether it is bacteria or fungi, can we maintain the balance using a probiotic? I just wanted to tell you that we started to develop actually such a probiotic and I am currently also working with some other biotech pharma where I am helping them see whether can we use for example antifungal to control the growth of fungi and then follow it by a probiotic. I think that is so exciting about this, it is all new areas, it’s all new, and the most important thing is having funding. Because without funding it is very difficult to do this research. It is an exciting time.
IDHTalks: Yeah, yeah, it’s an exciting area really. I noticed a lot of the talks here are quite based on fungi and fungus things.
Dr. Ghannoum: It is amazing to me is now there is standing room only.
IDHTalks: So, finally, what has been your highlight of ECCMID 2017 so far?
Dr. Ghannoum: You know, first of all, it’s amazing, with respect to ECCMID, how much it grew. I remember when I first came many years ago, it was only less than a thousand people. Now it’s huge, it’s becoming a very critical meeting. Also it’s fun because I am looking at all the new technologies that are being introduced, a lot of sequencing, a lot of automation. It’s really exciting!
IDHTalks: Thank You