1. Support Meeting for
Aspergillosis Patients & Carers
LED BY GRAHAM ATHERTON
SUPPORTED BY
NAC CENTRE MANAGER CHRIS HARRIS
CREATIVE WRITING AND ASPERGILLOSIS AWARENESS:
REPORTING BACK
CAROLINE HAWKRIDGE
NATIONAL ASPERGILLOSIS CENTRE
UHSM
MANCHESTER
Fungal Research Trust

2. Programme
 1.30 Caroline Hawkridge– Poet-in-residence


How our poetry is benefitting awareness and more…
GAFFI launch
 2.00 Graham Atherton – Your subject (How do antifungals
work?)
 2.30 Patients Discussion (Break)
 3.20 Q & A from the floor or online

3. Using Creative
Projects
- UPDATE Caroline Hawkridge
Artwork by Sarah Woodward,
Stockport College
Finalist in Project LIFE schools
competition 2012 run by
Jenny Bartholomew at NAC

4. Open the
Windows:
Poetry & Medicine
Day
report by
Caroline Hawkridge,
Writer-in-residence
(I am a professional health
writer/poet doing occasional
very part-time projects with
the National Aspergillosis
Centre)

5. How did we get here?
Giving voice!
1. Help you write and collect stories & poems from
patients, carers and staff
1. Help to raise public awareness through creative
projects with major local Festivals and online

6. Raising awareness by collaborating with major
organisations
Free publicity, event
management & evaluation
Free venue, technical support
& video recording

7. Two prize-winning poets,
Rebecca Goss and Denise Bundred,
who write as doctor and carer/patient
‘Open the Windows’ : Poetry & Medicine
Saturday, October 12
2.00 – 3.30 PM, Kanaris room, Floor 2
Manchester Museum, M13 9PL
Free but please book (from early August) on 0843 208 0500
or via www.manchesterliteraturefestival.co.uk
Rebecca Goss grew up in Suffolk
and has recently returned to live
in the county, after spending
twenty years in Liverpool. Her
second poetry collection, Her
Birth (Carcanet Press/Northern
House) has just been short-listed
for the prestigious 2013 Forward
Prize Best Collection. Her first
was The Anatomy of Structures
(Flambard Press, 2010).
Rebecca Goss
Join us for the first joint reading by Rebecca Goss and Denise
Bundred, who have explored through poetry their respective
experiences as mother/patient and doctor.
In 2007 Rebecca's newborn daughter Ella was diagnosed with
a rare and incurable heart condition at the hospital where Denise
worked as a cardiologist. However, they only met later as poets.
This event also features music celebrating “breath”
specially commissioned from Chris Davies by the National
Aspergillosis Centre (NAC), University Hospital of South
Manchester, which treats patients with fungal disease of the lungs.
Rebecca Goss's second poetry collection Her Birth
(Carcanet/Northern House) begins with Ella’s birth, her short life
and her death, and ends with the joys and complexities
that accompany the birth of another child. Denise Bundred's poetry
was Highly Commended in the Hippocrates Prize 2012 and 2013.
The National Aspergillosis Centre (NAC) and Manchester
Literature Festival are delighted to host this unique celebration to
help ‘open the windows’ between families and NHS staff, and
between medicine and the arts.
Denise Bundred trained as a
paediatrician in Cape Town,
South Africa, and as a
paediatric cardiologist in
Liverpool where she worked
until her retirement in 2008.
An MA in Writing at
Liverpool John Moores
University persuaded her to
write poetry.
You are also welcome at our Poetry & Medicine discussion,
10. 00 – 12 noon, October 12 led by Caroline Hawkridge,
Writer-in-residence, NAC, UHSM.
Free but limited places, please
book via 0161 275 2648 or
museum@manchester.ac.uk
Denise Bundred

8. Chris Davies & Beth Allen
Asking two professional musicians who work in
healthcare (and schools) to write a piece of music
celebrating ‘breath’

9. ‘National Aspergillosis Centre, which treats patients with fungal
disease of the lungs’ mentioned in 25,000 Festival leaflets

10. Links to other publicity,
e.g. UK Fungus Day, Oct 13, 2013

11. The Guardian, UK national newspaper
183 shares on Facebook

12. - all 90 seats went
- everyone got an NAC
information booklet
featuring poetry and
school artwork about
apsergillosis
- we also had a NAC
information display with
microscopes in the foyer
[video extracts of the
event will be available
online & attract a further
audience]

13. Rave reviews
•
•
•
•
I will remember it for a long time and it was inspirational on so many fronts.
The booklet brings together poetry, art and medical information in a very telling
way. It brings home the central theme of the havoc aspergillosis can bring to
its victims.
Congratulations to everyone for delivering an event that was so eye-opening.
What an amazingly moving experience it was on Saturday. I never knew poetry
could be like that....
Professional MLF reviewer said, “Entering the foyer of the Manchester Museum’s
Kanaris Lecture Theatre to be greeted by a table set with self-help pamphlets and
microscopes, with assistants encouraging us to use them to look at slides of fungi,
before walking through to a soothing wind instrumental by musician Chris Davies, I
knew Open the Windows would be a remarkable event.”

14. What next? Raising public awareness
projects with…

15. Your ‘Hope is’ poem
at GAFFI launch

16. GAFFI
http://www.gaffi.org/
Katie Melua has expressed support and
allowed us to use her music
Rupert Everett came to the opening and read our
poetry!

17. How do antifungals work?
Several images & slides used here were taken from a
slideshow published by MIT
wi.mit.edu/files/wi/cfile/programs/teacher/presentations/antif
ungal_drugs.pdf
And also the doctorfungus website ‘Antifungal
pharmacology’
www.doctorfungus.org/thedrugs/antif_pharm.php

18. Types of disease
Skin infections: e.g. foot fungus (usually smelly but
not life threatening, sometimes becomes serious),
ring worm
Mucosal infections: oral or vaginal (range from
annoying to painful to very difficult; uncomfortable
but rarely life threatening)
Systemic infections: fungus in the blood and tissues
(immunocompromised population, usually life
threatening)

19. Systemic infection
Not localised, need to treat entire body!
If the drug can get at the whole body then it has
many demands restricting its design





Low toxicity towards a wide range of tissues
Penetration (Blood/brain barrier)
Kill as many different fungi as possible
Not interact with other drugs
LOW COST

20. Toxicity – Why a major problem?
Fungi are closely related to us!

21. Targets for attack
Targets to attack in the fungus MUST be only
present in the fungus, otherwise the drug would
attack the patient as much as it attacks the fungus
Different classes of drugs target the plasma
membrane, sterol biosynthesis, DNA biosynthesis,
and β-glucan biosynthesis

22. Targets for attack
Fungal membranes and sterol biosynthetic enzymes
are different enough from ours that these agents can
kill fungi but not us
 Fungi make β-glucan, we don’t, so drugs that target
β-glucan biosynthesis have low side-effects
DNA – slightly more toxic (but safe when used
correctly)

23. Fungal cell membranes
http://www.youtube.com/watch?v=QcuPKy_Slng

24. Fungal Cell Structure

25. What drugs do we have now?
Target
Antifungal
Sterol (Direct binding - Cell membrane)
Polyene group: Amphotericin B
Interfere with ergosterol synthesis
(Cell membrane)
Azole group: Itraconazole,
Voriconazole, Posaconazole
Allylamine group: terbinafine
Cell Wall
Glucan synthesis inhibitors:
Echinocandins:Caspofunfin,
Micafungin, Anidulafungin
DNA
Inhibits DNA synthesis: Flucytosine

26. Polyene Binds sterol – (membrane)

27. Polyene Binds sterol – (membrane)

28. Polyene Binds sterol – (membrane)
http://www.youtube.com/watch?v=H11LP48mbTI

29. Azoles – interfere with ergosterol synthesis –
(membrane)

30. Azoles – interfere with ergosterol synthesis –
(membrane)
http://www.youtube.com/watch?v=T-dwE11AhqA

31. Echinocandins – interfere with glucan
synthesis (cell wall)

32. Echinocandins – interfere with glucan
synthesis (cell wall)
http://www.youtube.com/watch?v=FSH52CmN114

33. More than one way to kill fungi
Recognition of glucan stimulated our immune
response
We know fungi can ‘hide’ their glucan under a layer
of mannan
Rather like an M&M

34. M&M fungus

35. M&M fungal structure

36. Glucan uncovered

37. Drugs are not distributed evenly

38. Summary
We have already exploited 4 different targets to
attack fungi
Still a need to develop new drugs





Some against new targets
Some with better distribution
Lower toxicity
Fungicidal (more deadly)
Cheaper!!!

39. Suggest a subject
Can be on any relevant subject you would like to hear
our opinion or get our help with
Send suggestions to admin@aspergillus.org.uk
Pass notes to me at clinic or at the meeting
Phone them in (24 hrs) at 0161 291 5866

40. Thank You
“The best chance we have of beating this illness is to
work together”
Living with it, Working with it, Treating it
Fungal Research Trust