John N. Galgiani, MD of the Valley Fever Center for Excellence will be presented with the AZBio Pioneer Award for Lifetime Achievement at the 2023 AZBio Awards on September 27th.
A Commitment to Excellence
If you live in Arizona, you should know about Valley fever. Coccidioidomycosis, or ‘cocci,’ is the medical name for what is primarily a disease of the lungs caused by the inhalation of airborne particles of the fungus Coccidioides. The “Valley” of Valley fever is California’s Central Valley, where the disease was first identified in the U.S., but with the population explosion in south central Arizona, two-thirds of the nation’s 150,000 annual infections come from here. Valley fever’s economic impact is $1.5 billion annually, and within endemic regions such as Phoenix, the risk of developing serious consequences is similar to that of polio, measles and chicken pox before there were vaccines.
John Galgiani, MD, director of the Valley Fever Center for Excellence at the University of Arizona College of Medicine – Tucson, is widely recognized as one of the leading experts on Valley fever. He is the author of more than 250 scientific papers and book chapters, most of which focus on medical mycology in general and Valley fever in particular. He has focused on the disease since his infectious disease fellowship at Stanford University in 1976. He joined the University of Arizona College of Medicine in 1978, and in 1996, the Arizona Board of Regents accepted his proposal to establish the Valley Fever Center for Excellence. The center provides education about Valley fever, helps patients with the severest complications of this disease, and researches the fungus that causes it.
Knowing about Valley fever and the symptoms it usually causes is valuable to anybody living or visiting areas where the disease is endemic. Approximately 60% of people who contract Valley fever do not develop symptoms serious enough to warrant a clinic visit. The roughly 30% who do get sick most often are told that their symptoms – which can include cough, chest paint, muscle and joint aches, and fatigue – are caused by pneumonia. But having those symptoms in Arizona means there is approximately a 1-in-4 chance the infection is actually Valley fever. Unfortunately, even here, doctors’ awareness of the disease and when to test for it is surprisingly low.
Early diagnosis of Valley fever has many benefits. People who know about Valley fever before they get sick are diagnosed sooner because they ask their doctor for the blood test. Once the correct diagnosis is made, other diagnoses can be ruled out and ineffective treatments that may have been prescribed, such as antibiotics, can stop. Those with more serious forms of Valley fever benefit from earlier diagnosis because receiving appropriate treatment sooner can help prevent much of the damage that the disease can inflict if left unchecked.
Valley fever researchers are pursuing several lines of investigation. Because cocci can affect people differently based on subtle differences in multiple genes, Dr. Galgiani has established a collaboration with National Institutes of Health scientists that may lead to the development of genetic tests to predict how serious a person’s Valley fever infection might become. While the diagnosis of Valley fever involves a simple blood test, results take at least days, and sometimes weeks, to become available to the treating doctor. The Valley Fever Center for Excellence is collaborating with others to develop rapid point-of-care tests that would greatly improve early disease diagnosis and management. ABOR and the University of Arizona Health Sciences have funded the Valley Fever Collaborative, a collaboration between Northern Arizona University, Arizona State University, and Valley Fever Center for Excellence investigators to better understand the environmental biology of the fungus within its desert soil habitat and the impact of climate change on the fungi’s spread. Since Arizona is the epicenter of this disease, it is quite appropriate that Arizona leads in solving this problem, which is true to Dr. Galgiani’s vision for establishing the Center 26 years ago.
Developing Drugs & Vaccines
It’s been almost 30 years since a new treatment for Valley fever became available. Fluconazole, originally marketed as Diflucan, is an antifungal drug used for the treatment of both systemic and superficial fungal infections in a variety of tissues. It was initially approved by the FDA in 1990 and is one of the few options doctors have for treatment of Valley fever. For more than 25 years, Dr. Galgiani was the subproject director for Valley fever clinical trials conducted by the NIH-supported Mycoses Study Group. Among many studies by this group, he led the seminal multicenter trial of fluconazole treatment for Valley fever meningitis, which completely changed the management of this life-threatening complication. In 2007, Dr. Galgiani co-founded Valley Fever Solutions Inc., an Arizona corporation working to develop Nikkomycin Z (NikZ) as a potential cure for Valley fever. That company continues to work toward developing this new treatment.
Since Valley fever creates life-long immunity, the hope of a preventative vaccine has driven research to find one. Valley Fever Center investigators discovered that the deletion of a particular gene from the fungus renders it unable to cause disease. When the gene-edited fungus was used to vaccinate mice, it produced very strong resistance to subsequent infection with the virulent fungus. This discovery led to an NIH award for the Center and its commercial partner, Anivive Lifesciences, to develop a canine vaccine, which has proven effective in laboratory testing and may result in a veterinary product within the next year. Now, with additional expertise from Crozet Biopharma, the focus is to continue a public-private partnership to develop the vaccine for humans.
Dr. Galgiani’s unwavering commitment to Valley fever education, research and improved treatments for people and animals affected by this disease is why he deserves to be recognized with the AZBio Pioneer Award for Lifetime Achievement