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BEDREHELSE-Bedre helse og livskvalitet

Navigating the threat of azole resistance development in human, plant and animal pathogens in Norway

Alternative title: Utvikling av azolresistens hos patogener hos mennesker, planter og dyr i Norge – hvordan forholder vi oss til denne trusselen?

Awarded: NOK 10.2 mill.

Fungal infections threaten daily the health of humans, animals and plants alike, and the sole most efficient antifungal group to manage fungal pathogens is the azoles. The impact of azole resistance development should therefore be of major concern as it will compromise, not only human and animal health, but also large parts of the agricultural food production – world-wide. Only recently awareness of antifungal resistance has started to increase and the Centers for Disease Control and Prevention (CDC) have now included three fungi on the most recent urgent threats list; among them azole resistant Aspergillus fumigatus. Furthermore, cases of fungal infections associated with severe influenza and COVID-19 infection are increasingly being described leading to excess mortality. Navazole presents a concerted action to establish methods, networks and routines for diagnostics and surveillance. The consortium is international and interdisciplinary, including research environments, public authorities, businesses and organizations. The overall aims of the project are to explore how fungi develop resistance to fungicides and to identify and understand Norwegian conditions where the risk of resistance development is particularly high. Navazole will contribute to a global initiative for revision of regulations of the usage of azoles in therapeutics and agriculture, so to juggle the complex picture of azole resistance, human and animal health care and sustainable food production. As such Navazole answers to the UN development goals 2 (zero hunger), 3 (good health and well-being) and 12 (responsible production).

Fungal infections threaten daily the health of humans, animals and plants alike. Opportunistic fungi such as Aspergillus fumigatus kill more than 1.5 million people annually (equivalent to tuberculosis or malaria deaths). The sole most efficient antifungal group to manage fungal pathogens is the azoles. The widespread use of azoles (app. 300 million kg p.a.) is, however, causing a selection pressure, driving development of fungal resistance to azoles, thereby compromising the effectiveness of azoles used to treat and prevent fungal diseases in humans, animals, food production and horticulture. We have azole resistant fungal isolates of A. fumigatus and plant pathogens such as Zymoseptoria tritici and Parastagonospora nodorum in Norway, but we don’t know the prevalence and spread, the type of resistance or the origin/hotspots of the resistance mutations. The global community has a strong focus on antimicrobial resistance (AMR), but almost solely from the bacterial perspective. The Navazole project focuses on a neglected part of the One Health AMR resistance development, namely fungicide resistance, and addresses both mechanisms of AMR and strategies to prevent AMR. The project will collect and study azole resistant strains of A. fumigatus, Z. tritici and P. nodorum from a wide range of sources through an interdisciplinary examination of resistance and genetic variation. The Navazole project will establish methods, networks and routines for diagnostics and surveillance of azole resistance in Norway. By including in Navazole the Norwegian Food Safety Authority, regulating use of pesticides, and the Norwegian Cancer Society (Kreftforeningen), representing the patients most severely affected by a potential discontinuation of therapeutic azoles, the project aims for both national and international dissemination of the project results, with the intention of spurring a global initiative regulating azoles, while securing their future use.

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BEDREHELSE-Bedre helse og livskvalitet