LOS ANGELES — Antibiotics and antifungals are currently our best defense against any serious bacterial or fungal infection. These treatments don’t work against all diseases, so scientists must develop new modalities in cases where the medicines don’t work. Physicians and scientists from UCLA recently used a new strategy called “immune modulation” to successfully treat a young boy battling a rare, potentially fatal illness caused by a fungal infection.
Doctors were presented with a 4-year-old boy suffering from disseminated coccidioidomycosis. The coccidioides fungi, typically found in the southwest, infect more than 100,000 people each year. Most people infected are asymptomatic, but about 20,000 people develop a respiratory illness called Valley fever. If patients with Valley fever do not respond well to antivirals, it’s very common for the illness to progress and develop into disseminated coccidioidomycosis. The condition leads to bone and tissue damage, and often death.
The boy had been treated with multiple antifungals, but none of them worked. He could barely walk or talk and needed to eat through a feeding tube. After multiple rounds of different antifungals couldn’t treat the child, the team used the special technique, immune modulation, to heal him.
The power of immune modulation
When the team tested the boy’s immune system, they found it was failing to recognize the fungus. The specialized white blood cells, called T cells, were acting like the fungus was a parasite. The cells, as a result, were not trying to kill the infection like they normally do.
The team used an immune stimulator called interferon-gamma to try and get the T cells back on track. Dr. Maria Garcia-Lloret, a pediatric allergist and immunologist, suggested adding another medication, dupilumab. The drug was developed as an allergy medication and has never been used to treat infections.
Somehow this combination of immune modulators reprogrammed the T cells to start killing the infection and the boy’s illness went away in about a month.
Potential to treat COVID-19, other infections?
The team’s success with this technique leads them to believe this treatment approach can adapt to treat many severe infections. It’s possible that severe fungal infections, bacterial infections such as tuberculosis, and severe viral infections such as influenza and COVID-19 can all be treated with immune modulation.
“Immune modulation isn’t currently part of the strategy with any of these severe infections,” says senior author Dr. Manish Butte, in a press release. Butte holds the E. Richard Stiehm Endowed Chair in Pediatric Allergy, Immunology and Rheumatology at UCLA’s School of Medicine.
“Our case suggests that rather than hoping to get the upper hand with more and more antibiotics or antifungals,” he concludes, “we can have some success by combining these established approaches with the new idea of programming the patient’s immune response to better fight the infection.”
The case study is published in the New England Journal of Medicine.