Ah, the glory of mucous! With New Patent, Mayo Clinic Owns a Cure for the Sniffles:
Dr. Ponikau says his quest to solve the sinusitis mystery goes back to an assignment he received in 1994 during a six-month stint at Mayo. Eugene Kern, a veteran ear, nose and throat expert at Mayo, asked him to do a report on a handful of seemingly anomalous cases in which fungi — a common class of organism that includes molds and yeasts — were detected in patients with chronically inflamed sinuses. The problem: Many patients had symptoms that suggested an immune response to fungi, but actual fungi were detected in only 3% to 4% of them. Dr. Ponikau headed home to his father’s small ear, nose and throat clinic in Hof convinced that fungi must exist in more patients.The answer lay in an unorthodox area of investigation: human mucus. Traditionally, pathologists have studied sinusitis by examining the excised tissue of patients who undergo sinus surgery. In such surgery, doctors usually suction out the mucus first and discard it. By removing the mucus, which traps dust and other particles in the airways, “you destroy the evidence,” says Dr. Ponikau, chuckling at the way scientists sometimes miss clues right under their noses. “You won’t believe what we all did to make sure we didn’t find anything.”
At the Hof clinic, Dr. Ponikau took liquefied mucus samples and ran them through a centrifuge that would force any fungi to drift to the bottom. When he put the solution on a bed of nutrients, fungi grew like crazy, proving they had been present in the original mucus.
He proceeded to offer a few patients at the clinic an antifungal solution. Soon noses that had been stuffed for years cleared up.
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Dr. Ponikau realized that the white blood cells were marching through the sinus tissue to get to the open space of the sinus , a gathering space for fungi that the patients inhaled. Once there, the white blood cells fired off toxins to subdue the fungi — but the toxins also were destroying the outer lining of the sinus tissue, clearing the way for a bacterial infection that caused inflammation. Dr. Ponikau then looked at the mucus of healthy people. The eosinophil cells were absent, meaning the destructive immune-system response never got started.
It’s not clear that Ponikau is right and that he’s got the cure, but the Mayo clinic seems convinced:
Mayo doctors have now prescribed their antifungal agents to more than 1,000 patients, making it a standard treatment for chronic sinusitis at the clinic, although the method isn’t approved by the FDA. A study published last year by the Mayo team showed that a common, generic antifungal drug, amphotericin B, reduced nasal obstruction in 38 of 51 patients, removing it completely in 25 cases. (Daily doses of the drug are needed to prevent recurrence.) A larger placebo-controlled double-blind trial is now under way at Mayo. Long-term effects of the treatment, including potential side effects, aren’t known yet. Side effects of amphotericin B — when used in other treatments — could include fever and vomiting.At this point, there’s nothing to stop a doctor from prescribing a standard antifungal drug such as amphotericin B for sinusitis. But few doctors are familiar with the treatment, and a pharmacist would have to prepare the drug — which comes in a variety of forms, from ointments to pills — so that it could be taken nasally.
But that’s not all…
Recently, Dr. Ponikau has been working on an even more explosive theory — that chronic asthma is essentially the same disease as chronic sinusitis, and can also be cured with an antifungal spray. The theory sprang from anecdotal reports by Mayo patients who said that the antifungal solution for their sinuses cleared up their lungs, too.