Bacteria-Eating Viruses Could Be New Ally Against Superbugs In A 'Post-Antibiotic Era'

Bacteria-Eating Viruses Could Be New Ally Against Superbugs In A 'Post-Antibiotic Era'

* Phage therapy uses viruses to destroy bacteria

* May offer last-resort option against resistant bugs

* Multi-center European clinical trial about to start

* EU and U.S. authorities convene bacteriophage meetings

By Ben Hirschler

LONDON, July 2 (Reuters) - Alarmed by rising resistance to antibiotics, the main line of defense against bacterial infections, scientists and governments are taking a fresh look at bacteria-chomping viruses first isolated a century ago from the stools of patients recovering from dysentery.

So-called bacteriophages, which attack bacteria but leave human cells unscathed, are still used in Russia, Georgia and Poland, but fell by the wayside in the West with the mass production of penicillin, the first antibiotic, in the 1940s.

Now, faced with the rise of drug-resistant "superbugs" such as MRSA or multi-drug-resistant tuberculosis, and a World Health Organization warning that a "post-antibiotic era" is dawning, European and U.S. researchers and authorities are thinking again.

The first major multi-center clinical trial of phage therapy, funded by the European Commission, will start treating French, Belgian and Swiss burns patients with infections in the next few days.

And last month, the European Medicines Agency hosted its first workshop on bacteriophages to discuss how the technology should be regulated and used.

"We need alternatives to the current armamentarium of antibiotics and we want to see more development activity in this area," Marco Cavaleri, the agency's head of anti-infectives and vaccines, told Reuters.

"In light of the increase in antimicrobial resistance and the lack of new antibiotics, it is important to open up the discussion."

Across the Atlantic, the U.S. National Institute of Allergy and Infectious Diseases is also convening a conference on phage therapy this month, having identified it in 2014 as one of seven key areas in the fight against antibiotic resistance.


It's not that the West has completely ignored the potential of phages until now.

In the 1930s, drug makers including Eli Lilly and E.R. Squibb made therapeutic phage preparations, and a phage product from Dutch firm Micreos has been used in Europe and the United States since 2006 to prevent listeria in food.

But phage therapy has never been tested in the clinic to the rigorous standards of Western medicine, as doctors have opted for tried and tested antibiotics.

Soviet doctors, by contrast, were deprived of access to early Western antibiotics and turned to phage therapy for everything from gastrointestinal infections to battlefield wounds.

Today, Russia's Microgen remains a leading supplier of bacteriophages, while the Eliava Institute in Tbilisi, Georgia, has been a center of phage expertise since 1923 and EU member state Poland still offers phage therapy, albeit for "compassionate use" only, because it lacks EU approval.

Phages kill bacteria by getting into bacterial cells and replicating - but the lack of hard data means their effectiveness and safety as a treatment is unclear.

The new 220-patient clinical trial known as Phagoburn, which has 3.8 million euros ($4.2 million) of EU funding, aims to close that knowledge gap - although Cavaleri believes it will still be at least five years before any product meeting stringent Western drug standards is ready for approval.

Jerome Gabard, chief executive of French biotech firm Pherecydes Pharma, which makes the phage cocktail used in the Phagoburn trial, hopes he might get a conditional green light before that, but acknowledges Western doctors will be wary.

"This will probably be a last-resort treatment, after three or four lines of antibiotics have been tried," he said. "It will be for fighting multi-drug resistant strains that are not cured by antibiotics."


That points to a niche market and Gabard says his company's phage therapy will probably cost between 2,000 and 7,000 euros per treatment.

There are plenty of hurdles ahead, including a need to quell public concerns about using live viruses, even if they are harmless to mammalian cells.

Regulators will also have to work out how to oversee a therapy that consists of a combination of multiple wild phage strains that will change over time. It may be that phage therapy is treated in a similar way to seasonal flu vaccines, which are adapted each year as flu evolves.

So far, only a few biotech companies are investing in the field, with Pherecydes' rivals including U.S. firms AmpliPhi Biosciences and Intralytix, Britain's Novolytics, Portugal's Technophage and China's Phagelux.

Large drug makers have so far remained on the sidelines, partly because of uncertainty about the ability to patent a technology that uses naturally occurring viruses and is nearly a century old.

Mark Fishman, head of research at Novartis, for example, told Reuters the Swiss drug maker was not currently looking at phage therapy since it still saw considerable potential for developing new antibiotics.

French critical care doctor Patrick Jault, one of the coordinators of the Phagoburn study, believes all options should be explored - but whatever the results of the current clinical trial, further studies will be necessary. "This is just the start," he said. ($1 = 0.9005 euros) (Editing by Kevin Liffey)

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Before You Go

Ebola is highly infectious and even being in the same room as someone with the disease can put you at risk
Not as far as we know. Ebola isn't contagious until symptoms begin, and it spreads through direct contact with the bodily fluids of patients. It is not, from what we know of the science so far, an airborne virus. So contact with the patient's sweat, blood, vomit, feces or semen could cause infection, and the body remains infectious after death. Much of the spread in west Africa has been attributed to the initial distrust of medical staff, leaving many to be treated at home by loved ones, poorly equipped medics catching the disease from patients, and the traditional burial rites involving manually washing of the dead body. From what we know already, you can't catch it from the air, you can't catch it from food, you can't catch it from water.
Cancelling all flights from west Africa would stop the spread of Ebola
This actually has pretty serious implications. British Airways suspended its four-times-weekly flights to Liberia and Sierra Leone until the end of March, the only direct flight to the region from the UK. In practice, anyone can just change planes somewhere else and get to Britain from Europe, north Africa, or the Middle East. And aid agencies say that flight cancellations are hampering efforts to get the disease under control, they rely on commercial flights to get to the infected regions. Liberia's information minister, Lewis Brown, told the Telegraph this week that BA was putting more people in danger. "We need as many airlines coming in to this region as possible, because the cost of bringing in supplies and aid workers is becoming prohibitive," he told the Telegraph. "There just aren't enough seats on the planes. I can understand BA's initial reaction back in August, but they must remember this is a global fight now, not just a west African one, and we can't just be shut out." Christopher Stokes, director of MSF in Brussels, agreed: “Airlines have shut down many flights and the unintended consequence has been to slow and hamper the relief effort, paradoxically increasing the risk of this epidemic spreading across countries in west Africa first, then potentially elsewhere. We have to stop Ebola at source and this means we have to be able to go there.”
Temperature screening at airports is an effective way to stop those who have the disease from travelling
The screening process is pretty porous, especially when individuals want to subvert it. Wake up on the morning of your flight, feel a bit hot, and you definitely don't want to be sent to an isolation booth for days and have to miss your flight. Take an ibuprofen and you can lower your temperature enough to get past the scanners. And if you suspect you have Ebola, you might be desperate to leave, seeing how much better the treatment success has been in western nations. And experts have warned that you cannot expect people to be honest about who they have had contact with. Thomas Eric Duncan, the Ebola victim who died in Texas, told officials he had not been in contact with anyone with the disease, but had in fact visited someone in the late stages of the virus, though he said he believed it was malaria. The extra screening that the US implemented since his death probably wouldn't have singled out Duncan when he arrived from hard-hit Liberia last month, because he had no symptoms while travelling.
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Screening at British airports should be implemented to stop unwell people coming in from affected areas
As mentioned before, the UK, especially London, is a major transport hub. Unlike the US, most of those coming from west Africa will have crossed through Europe, so infected people could be coming from practically anywhere, not just flights directly from those countries. This would require the UK to screen every returning traveller, as people could return to the UK from an affected country through any port of entry. This would be huge numbers of low risk people, at vast, vast expense.

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