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Deadly fungus Candida auris is spreading across US hospitals – a physician answers 5 questions about rising fungal infections

Candida auris is a relatively new addition to a family of fungi that can infect people. Most of these infections occur in sick, hospitalized patients and…

Candida auris is a fungal yeast that can infect humans. Kateryna Kon/Science Photo Library via Getty Images

In late March 2023, the U.S. Centers for Disease Control and Prevention highlighted the threat posed by a rapidly spreading fungus called Candida auris that is causing infections and deaths among hospital patients across the country. The unexpected rise of this recently discovered pathogen is part of a larger trend of increasing fungal infections in the U.S.

Arif R. Sarwari is a physician and professor of infectious diseases at West Virginia University. Amid rising concerns among doctors and public health officials, Sarwari helped explain what Candida auris is, how it is spreading and how worried people in the U.S. should be.

1. What is Candida auris?

Candida auris is a recently identified, single-cell fungus that can infect humans and is moderately resistant to existing antifungal drugs. You might be familiar with superficial fungal infections – like athlete’s foot or vaginal yeast infections – which are quite common and don’t pose significant risks to most people. In contrast, Candida auris and other related fungi can cause infections within a person’s body and are much more dangerous.

Candida auris is a type of yeast that was first identified in 2009 and is one of a number of species in the candida family that can infect people. In the past, most invasive candida infections were caused by Candida albicans. Recently, though, infections with species of candida that are much more resistant to drugs than Candida albicanslike Candida auris – have shot up, with a nearly fivefold increase since 2019.

A person holding an IV line with a patient's arm.
Candida fungi can get into a person’s bloodstream through a contaminated IV line and cause a blood infection. Richard Bailey/Corbis Documentary via Getty Images

2. How dangerous are candida infections?

For the most part, healthy people do not have to worry about invasive candida infections. There are two groups of people who are most at risk for dangerous candida infections: first are patients in intensive care units who also have central intravenous catheters and are receiving broad spectrum antibiotics. Patients with weak immune systems, such as cancer patients on chemotherapy or patients with human immunodeficiency virus, are also at high risk of candida infection.

Nearly all people have candida fungi growing in their guts and on their skin as part of their microbiome. When a person is healthy, candida numbers are low, but the fungi can proliferate rapidly and overcome a person’s immune system when a patient is sick and on antibiotics.

If candida cells on a person’s skin contaminate an intravenous line, the fungus can get into a patient’s bloodstream and cause often deadly bloodstream infections. Candida species are the fourth most-common cause of hospital associated bloodstream infections.

There are three classes of antifungal drugs that can be used to fight invasive candida infections. Candida albicans is susceptible to all three and easier to treat than Candida auris, which is moderately resistant to all three classes of antifungals.

3. How common are invasive fungal infections?

The CDC estimates that in the U.S., around 25,000 patients get candida bloodstream infections every year.

Candida bloodstream infections are best understood as a tale of two eras. In the past, they were almost always caused by drug-susceptible Candida albicans that arose endogenously from a patient’s own microbiome. There was no concern about infections spreading to other patients.

The recent emergence of drug-resistant and more transmissible Candida auris is raising alarms among health professionals. Because this species can contaminate surfaces and easily spread from patient to patient, the fungus is causing outbreaks both within and between hospitals.

4. Why are fungal infections increasing?

Fungal infections have been rising in the U.S. in recent years, especially infections caused by Candida auris. The pathogen only caused a few infections each year between 2013 and 2016, but starting in 2017, infections began to rise rapidly with 2,377 confirmed cases recorded in 2022 according to the CDC. Deaths caused by all candida infections are rising, too, from 1,010 in 2018 to nearly 1,800 in 2021.

The reasons for this increase are complicated, but I think there are two main drivers: more, sicker patients in hospitals and a stressed health system, both of which got worse during the COVID-19 pandemic.

Hospitals are seeing more very sick patients with weak immune systems, especially as the population ages. This means there are more susceptible patients at hospitals to begin with.

Additionally, any time the health system is stressed – like during a pandemic – drug-resistant bacterial and fungal infections increase. This is because very sick patients are usually in crowded wards and exposed to many antibiotics. In addition, loss of hospital staff and increased workload results in lower quality sanitation - causing more spread of resistant pathogens.

I view the rise of drug-resistant fungi like Candida auris through the same lens as worsening antibiotic resistance. The more antibiotics people use, the greater the chances a resistant strain will become dominant.

5. What can the medical community do about it?

There are a few options for fighting the rise of drug-resistant Candida auris.

The most effective measures are good infection control practices. These behaviors and protocols include practicing good hand hygiene before and after each patient contact, wearing isolation gowns and gloves that are carefully discarded in a patient’s room, and taking measures to detect Candida auris infections early and isolate patients to prevent the spread. Though relatively simple, these actions are key to preventing the spread of all antibiotic-resistant pathogens, not just fungi.

The second option is to develop better drugs to treat new, antifungal-resistant strains of candida. Many new antifungal drugs are already under development. However, prevention through sound infection control will always remain foundational, as further drug development is akin to an arms race.

Arif R. Sarwari does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Glimpse Of Sanity: Dartmouth Returns Standardized Testing For Admission After Failed Experiment

Glimpse Of Sanity: Dartmouth Returns Standardized Testing For Admission After Failed Experiment

In response to the virus pandemic and nationwide…

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Glimpse Of Sanity: Dartmouth Returns Standardized Testing For Admission After Failed Experiment

In response to the virus pandemic and nationwide Black Lives Matter riots in the summer of 2020, some elite colleges and universities shredded testing requirements for admission. Several years later, the test-optional admission has yet to produce the promising results for racial and class-based equity that many woke academic institutions wished.

The failure of test-optional admission policies has forced Dartmouth College to reinstate standardized test scores for admission starting next year. This should never have been eliminated, as merit will always prevail. 

"Nearly four years later, having studied the role of testing in our admissions process as well as its value as a predictor of student success at Dartmouth, we are removing the extended pause and reactivating the standardized testing requirement for undergraduate admission, effective with the Class of 2029," Dartmouth wrote in a press release Monday morning. 

"For Dartmouth, the evidence supporting our reactivation of a required testing policy is clear. Our bottom line is simple: we believe a standardized testing requirement will improve—not detract from—our ability to bring the most promising and diverse students to our campus," the elite college said. 

Who would've thought eliminating standardized tests for admission because a fringe minority said they were instruments of racism and a biased system was ever a good idea? 

Also, it doesn't take a rocket scientist to figure this out. More from Dartmouth, who commissioned the research: 

They also found that test scores represent an especially valuable tool to identify high-achieving applicants from low and middle-income backgrounds; who are first-generation college-bound; as well as students from urban and rural backgrounds.

All the colleges and universities that quickly adopted test-optional admissions in 2020 experienced a surge in applications. Perhaps the push for test-optional was under the guise of woke equality but was nothing more than protecting the bottom line for these institutions. 

A glimpse of sanity returns to woke schools: Admit qualified kids. Next up is corporate America and all tiers of the US government. 

Tyler Durden Mon, 02/05/2024 - 17:20

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Four burning questions about the future of the $16.5B Novo-Catalent deal

To build or to buy? That’s a classic question for pharma boardrooms, and Novo Nordisk is going with both.
Beyond spending billions of dollars to expand…

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To build or to buy? That’s a classic question for pharma boardrooms, and Novo Nordisk is going with both.

Beyond spending billions of dollars to expand its own production capacity for its weight loss drugs, the Danish drugmaker said Monday it will pay $11 billion to acquire three manufacturing plants from Catalent. It’s part of a broader $16.5 billion deal with Novo Holdings, the investment arm of the pharma’s parent group, which agreed to acquire the contract manufacturer and take it private.

It’s a big deal for all parties, with potential ripple effects across the biotech ecosystem. Here’s a look at some of the most pressing questions to watch after Monday’s announcement.

Why did Novo do this?

Novo Holdings isn’t the most obvious buyer for Catalent, particularly after last year’s on-and-off M&A interest from the serial acquirer Danaher. But the deal could benefit both Novo Holdings and Novo Nordisk.

Novo Nordisk’s biggest challenge has been simply making enough of the weight loss drug Wegovy and diabetes therapy Ozempic. On last week’s earnings call, Novo Nordisk CEO Lars Fruergaard Jørgensen said the company isn’t constrained by capital in its efforts to boost manufacturing. Rather, the main challenge is the limited amount of capabilities out there, he said.

“Most pharmaceutical companies in the world would be shopping among the same manufacturers,” he said. “There’s not an unlimited amount of machinery and people to build it.”

While Novo was already one of Catalent’s major customers, the manufacturer has been hamstrung by its own balance sheet. With roughly $5 billion in debt on its books, it’s had to juggle paying down debt with sufficiently investing in its facilities. That’s been particularly challenging in keeping pace with soaring demand for GLP-1 drugs.

Novo, on the other hand, has the balance sheet to funnel as much money as needed into the plants in Italy, Belgium, and Indiana. It’s also struggled to make enough of its popular GLP-1 drugs to meet their soaring demand, with documented shortages of both Ozempic and Wegovy.

The impact won’t be immediate. The parties expect the deal to close near the end of 2024. Novo Nordisk said it expects the three new sites to “gradually increase Novo Nordisk’s filling capacity from 2026 and onwards.”

As for the rest of Catalent — nearly 50 other sites employing thousands of workers — Novo Holdings will take control. The group previously acquired Altasciences in 2021 and Ritedose in 2022, so the Catalent deal builds on a core investing interest in biopharma services, Novo Holdings CEO Kasim Kutay told Endpoints News.

Kasim Kutay

When asked about possible site closures or layoffs, Kutay said the team hasn’t thought about that.

“That’s not our track record. Our track record is to invest in quality businesses and help them grow,” he said. “There’s always stuff to do with any asset you own, but we haven’t bought this company to do some of the stuff you’re talking about.”

What does it mean for Catalent’s customers? 

Until the deal closes, Catalent will operate as a standalone business. After it closes, Novo Nordisk said it will honor its customer obligations at the three sites, a spokesperson said. But they didn’t answer a question about what happens when those contracts expire.

The wrinkle is the long-term future of the three plants that Novo Nordisk is paying for. Those sites don’t exclusively pump out Wegovy, but that could be the logical long-term aim for the Danish drugmaker.

The ideal scenario is that pricing and timelines remain the same for customers, said Nicole Paulk, CEO of the gene therapy startup Siren Biotechnology.

Nicole Paulk

“The name of the group that you’re going to send your check to is now going to be Novo Holdings instead of Catalent, but otherwise everything remains the same,” Paulk told Endpoints. “That’s the best-case scenario.”

In a worst case, Paulk said she feared the new owners could wind up closing sites or laying off Catalent groups. That could create some uncertainty for customers looking for a long-term manufacturing partner.

Are shareholders and regulators happy? 

The pandemic was a wild ride for Catalent’s stock, with shares surging from about $40 to $140 and then crashing back to earth. The $63.50 share price for the takeover is a happy ending depending on the investor.

On that point, the investing giant Elliott Investment Management is satisfied. Marc Steinberg, a partner at Elliott, called the agreement “an outstanding outcome” that “clearly maximizes value for Catalent stockholders” in a statement.

Elliott helped kick off a strategic review last August that culminated in the sale agreement. Compared to Catalent’s stock price before that review started, the deal pays a nearly 40% premium.

Alessandro Maselli

But this is hardly a victory lap for CEO Alessandro Maselli, who took over in July 2022 when Catalent’s stock price was north of $100. Novo’s takeover is a tacit acknowledgment that Maselli could never fully right the ship, as operational problems plagued the company throughout 2023 while it was limited by its debt.

Additional regulatory filings in the next few weeks could give insight into just how competitive the sale process was. William Blair analysts said they don’t expect a competing bidder “given the organic investments already being pursued at other leading CDMOs and the breadth and scale of Catalent’s operations.”

The Blair analysts also noted the companies likely “expect to spend some time educating relevant government agencies” about the deal, given the lengthy closing timeline. Given Novo Nordisk’s ascent — it’s now one of Europe’s most valuable companies — paired with the limited number of large contract manufacturers, antitrust regulators could be interested in taking a close look.

Are Catalent’s problems finally a thing of the past?

Catalent ran into a mix of financial and operational problems over the past year that played no small part in attracting the interest of an activist like Elliott.

Now with a deal in place, how quickly can Novo rectify those problems? Some of the challenges were driven by the demands of being a publicly traded company, like failing to meet investors’ revenue expectations or even filing earnings reports on time.

But Catalent also struggled with its business at times, with a range of manufacturing delays, inspection reports and occasionally writing down acquisitions that didn’t pan out. Novo’s deep pockets will go a long way to a turnaround, but only the future will tell if all these issues are fixed.

Kutay said his team is excited by the opportunity and was satisfied with the due diligence it did on the company.

“We believe we’re buying a strong company with a good management team and good prospects,” Kutay said. “If that wasn’t the case, I don’t think we’d be here.”

Amber Tong and Reynald Castañeda contributed reporting.

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Petrina Kamya, Ph.D., Head of AI Platforms at Insilico Medicine, presents at BIO CEO & Investor Conference

Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb….

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Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb. 26-27 at the New York Marriott Marquis in New York City. Dr. Kamya will speak as part of the panel “AI within Biopharma: Separating Value from Hype,” on Feb. 27, 1pm ET along with Michael Nally, CEO of Generate: Biomedicines and Liz Schwarzbach, PhD, CBO of BigHat Biosciences.

Credit: Insilico Medicine

Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb. 26-27 at the New York Marriott Marquis in New York City. Dr. Kamya will speak as part of the panel “AI within Biopharma: Separating Value from Hype,” on Feb. 27, 1pm ET along with Michael Nally, CEO of Generate: Biomedicines and Liz Schwarzbach, PhD, CBO of BigHat Biosciences.

The session will look at how the latest artificial intelligence (AI) tools – including generative AI and large language models – are currently being used to advance the discovery and design of new drugs, and which technologies are still in development. 

The BIO CEO & Investor Conference brings together over 1,000 attendees and more than 700 companies across industry and institutional investment to discuss the future investment landscape of biotechnology. Sessions focus on topics such as therapeutic advancements, market outlook, and policy priorities.

Insilico Medicine is a leading, clinical stage AI-driven drug discovery company that has raised over $400m in investments since it was founded in 2014. Dr. Kamya leads the development of the Company’s end-to-end generative AI platform, Pharma.AI from Insilico’s AI R&D Center in Montreal. Using modern machine learning techniques in the context of chemistry and biology, the platform has driven the discovery and design of 30+ new therapies, with five in clinical stages – for cancer, fibrosis, inflammatory bowel disease (IBD), and COVID-19. The Company’s lead drug, for the chronic, rare lung condition idiopathic pulmonary fibrosis, is the first AI-designed drug for an AI-discovered target to reach Phase II clinical trials with patients. Nine of the top 20 pharmaceutical companies have used Insilico’s AI platform to advance their programs, and the Company has a number of major strategic licensing deals around its AI-designed therapeutic assets, including with Sanofi, Exelixis and Menarini. 

 

About Insilico Medicine

Insilico Medicine, a global clinical stage biotechnology company powered by generative AI, is connecting biology, chemistry, and clinical trials analysis using next-generation AI systems. The company has developed AI platforms that utilize deep generative models, reinforcement learning, transformers, and other modern machine learning techniques for novel target discovery and the generation of novel molecular structures with desired properties. Insilico Medicine is developing breakthrough solutions to discover and develop innovative drugs for cancer, fibrosis, immunity, central nervous system diseases, infectious diseases, autoimmune diseases, and aging-related diseases. www.insilico.com 


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