Future Directions for Clinical Respiratory Fungal Research

Abstract

There has been a growing appreciation of the importance of respiratory fungal diseases in recent years, with better understanding of their prevalence as well as their global distribution. In step with the greater awareness of these complex infections, we are currently poised to make major advances in the characterization and treatment of these fungal diseases, which in itself is largely a consequence of post-genomic technologies which have enabled rational drug development and a path towards personalized medicines. These advances are set against a backdrop of globalization and anthropogenic change, which have impacted the world-wide distribution of fungi and antifungal resistance, as well as our built environment. The current revolution in immunomodulatory therapies has led to a rapidly evolving population at-risk for respiratory fungal disease. Whilst challenges are considerable, perhaps the tools we now have to manage these infections are up to this challenge. There has been a welcome acceleration of the antifungal pipeline in recent years, with a number of new drug classes in clinical or pre-clinical development, as well as new focus on inhaled antifungal drug delivery. The “post-genomic” revolution has opened up metagenomic diagnostic approaches spanning host immunogenetics to the fungal mycobiome that have allowed better characterization of respiratory fungal disease endotypes. When these advances are considered together the key challenge is clear: to develop a personalized medicine framework to enable a rational therapeutic approach.

Insights into the Profile of the Human Expiratory Microbiota and Its Associations with Indoor Microbiotas

“… 17 , 76 , 77 Other less abundant fungal genera, including Mortierella , Chaetomium , Curvelaria , Cryptococcus , Candida , Guehomyces , Phaeoacremonium , Myrothecium , Aspergillus , and Penicillium , have been found in the respiratory samples and are opportunistic pathogens for respiratory fungal infections. 77 , 78 …”

“…The dominant genus Fusarium serves as both a respiratory commensal and an opportunistic pathogen and has been reported in the BAL fluid samples from healthy subjects and diseased subjects. ,, Other less abundant fungal genera, including Mortierella, Chaetomium, Curvelaria, Cryptococcus, Candida, Guehomyces, Phaeoacremonium, Myrothecium, Aspergillus, and Penicillium, have been found in the respiratory samples and are opportunistic pathogens for respiratory fungal infections. , …”

“…17,76,77 Other less abundant fungal genera, including Mortierella, Chaetomium, Curvelaria, Cryptococcus, Candida, Guehomyces, Phaeoacremonium, Myrothecium, Aspergillus, and Penicillium, have been found in the respiratory samples and are opportunistic pathogens for respiratory fungal infections. 77,78 Assembly and Heterogeneity of EBC Microbiotas. Stochastic processes, for example, dispersal, birth, death, extinction, and immigration, play a role in the assembly of expiratory bacterial and fungal communities.…”

Invasive pulmonary aspergillosis in the intensive care unit: current challenges and best practices

“…In recent years, there has been a growing awareness of respiratory fungal diseases with the potential for major advances in their characterization and treatment as a consequence of post‐genomic technologies which rationalize drug development and a path toward personalized medicines (76).…”