As of April 13, 2026 we found new information that warrants a TOE “Mechanisms” grade change. This includes a paper suggesting that fluconazole can upregulate the expression of IGF-1, a growth factor that has been implicated in human ALS progression https://pmc.ncbi.nlm.nih.gov/
As of March 10, 2025 we found no new data to support any changes in our TOE grades.
Key Information
It is unknown if fungi exist in the brain of PALS. If they do exist, it is unknown if they have any pathogenic effect, and unknown if antifungal drugs would modify ALS disease progression. There are no pre-clinical ALS model studies, verified ALS cases, or ALS clinical trials to suggest that antifungals would be of any significant benefit to PALS, and these medications can cause harm. At this time, we strongly discourage PALS from taking antifungal drugs for their ALS disease. We hope in the future that independent laboratories will look for fungi in the CNS of PALS using more appropriate experimental methods.
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