Health Rounds: Experimental antibiotic kills drug-resistant fungi

Reuters

21-03-2025

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A experimental antibiotic can kill dangerous drug-resistant fungi that are spreading around the world, Chinese researchers reported in Nature, opens new tab.
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Antibiotics are usually ineffective against fungal infections. Unlike conventional antibiotics, the new drug, mandimycin, targets the lipid membrane that encases the fungus, disrupting its physiological processes and circumventing resistance mechanisms.
Mandimycin belongs to a class of drugs known as glycosylated polyene macrolides, which also includes the last-resort antifungal amphotericin B.
In test tubes, mandimycin killed multiple types of drug-resistant fungi including species of Candida, Cryptococcus neoformans and Aspergillus fumigatus, researchers from China Pharmaceutical University reported.
All of the tested fungi were resistant to at least two existing drugs, and all are on the World Health Organization's fungal priority pathogens list, which includes infectious fungi with significant unmet need and public health importance, the researchers noted.
In mice, mandimycin was effective against a strain of Candida auris that is resistant to all major types of antifungals, the researchers said.
A commentary, opens new tab published with the report called mandimycin 'a probable treasure trove of actionable intelligence in the battle against drug-resistant fungal infections.'
The new antifungal molecule is so radically different from existing drugs that it 'breaks the mold,' the commentary authors said.
EARLY BREAST CANCER MIGHT NOT WARRANT LYMPH NODE SURGERY
The practice of removing armpit lymph nodes in patients with early breast cancer may not be necessary or particularly beneficial, a new study in The New England Journal of Medicine, opens new tab suggests.
Early-stage breast cancer has traditionally been treated with removal of the primary tumor and nearby lymph nodes. Pathologists then examine the nodes that were closest to the tumor for evidence that cancer cells have started to spread to other parts of the body.
So-called axillary nodal status has long been regarded as one of the most important prognostic factors in breast cancer and is used to guide therapy.
But lymph node removal often comes with pain, swelling, numbness, and risks of infection and fluid buildup. As medical therapies for breast cancer have improved, the need for lymph node removal is being questioned.
To learn more, researchers recruited 5,502 patients with breast tumors no greater than 5 centimeters and normal-appearing lymph nodes and randomly assigned half of them to skip armpit lymph node removal.
At five years, 91.7% of the retained-lymph node group and 91.9% of the removed-lymph node group were still free of invasive disease, and 98.2% and 96.9%, respectively, were still alive.
Patients whose lymph nodes were removed were less likely to eventually have a recurrence found in a lymph node, but that did not afford them any benefit in terms of survival without invasive disease, or overall survival.
An editorial, opens new tab published with the study notes that the findings are in line with those of a similar trial reported in 2023.
While noting that more study is needed, Dr. Eric Rubin, Editor-in-Chief of the journal, said in a statement, "We are beginning to see a future where many women with early-stage breast cancer are going to be able to avoid axillary-node dissection and its attendant complications.'
OVARIAN CANCER SCREENING MISSES CASES IN MINORITY GROUPS
Current blood test thresholds for patients with possible ovarian cancers are likely contributing to underdiagnosis in U.S. minority groups, according to a new study.
International guidelines use blood levels of a protein produced by ovarian cancer cells, called cancer antigen 125, to recommend which patients with pelvic masses should undergo evaluation for ovarian cancer. The thresholds were developed from studies in white patients, according to a report in JAMA Network Open, opens new tab.
When researchers reviewed data on 212,477 U.S. patients with ovarian cancer diagnosed from 2004 through 2020, they found that Black patients and Native American patients had significantly lower odds of having an elevated CA-125 level when their ovarian cancer was diagnosed.
After accounting for individual risk factors, Native American and Black patients were 23% less likely to have an elevated CA-125 level at diagnosis.
Ovarian cancer patients with misleadingly low CA-125 levels started chemotherapy an average of nine days later than patients with elevated CA-125 levels, the researchers also found.
Earlier studies found that Black patients are more likely to be diagnosed with late-stage ovarian cancer than white patients, the authors noted.
'Current CA-125 thresholds may miss racially and ethnically diverse patients with ovarian cancer,' they said.
'With 19,000 new ovarian cancer diagnoses annually in the U.S. and 314,000 worldwide, if the CA-125 thresholds were updated to have similar sensitivity for Black patients as White patients, we estimate that at least 60 patients each year would be diagnosed at an earlier stage in the U.S. and 1,500 worldwide.'