With superbugs—drug-resistant bacteria—poised to bring an end to the antibiotics revolution, researchers at the South Carolina-based HBCU Claflin University review the history and potential of a controversial, virus-based therapy that is getting a second look.
Think of superbugs as enemy soldiers that have mutated and can no longer be exterminated by even the best weapon in your arsenal. For decades, antibiotics have been our best weapons against deadly bacteria. Now, with the rise of superbugs—a popular term for antimicrobial-resistant bacteria—we’re in many ways back to square one.
Outbreaks of superbugs are on the rise. And that’s a huge problem, given how much society depends on antibiotics to fight or prevent diseases in humans, other animals, and plants. This year, in California alone, two medical facilities —UCLA’s Ronald Reagan Medical Center and LA’s Cedars-Sinai Medical Center had to notify more than 200 patients combined that may have been exposed to the drug-resistant bacterium carbapenem-resistant Enterobacteriaceae.
The superbug crisis is also a global one. Last year, the World Health Organization published a comprehensive report that called antimicrobial resistance “…a problem so serious that it threatens the achievements of modern medicine.” It even states that an era in which people die from the most common infections is “far from being an apocalyptic fantasy [and is] instead a very real possibility for the 21st Century.” Harvard Magazine framed the issue with its article, Superbug: An Epidemic Begins, as did PBS’s Frontline with its documentary, “Hunting the Nightmare Bacteria.”
In a review article published last year, Zhabiz Golkar, Omar Bagasra, and Donald Gene Pace at HBCU Claflin University in Orangeburg, South Carolina discuss the history of a novel solution to superbug crisis: fighting bacteria with viruses. Bagasra is director of the South Carolina Center for Biotechnology, located at Claflin; Golkar is his postdoc; and Pace is a professor in the school of humanities and social science. Their paper, Bacteriophage therapy: a potential solution for the antibiotic resistance crisis, presents some startling statistics that support the need for antibiotic alternatives. For example, superbug-related illnesses and deaths add $20 billion annually in costs to the US health care system.
After the background on antibiotics, the authors discuss the discovery and clinical history of bacteriophages–defined as “a diverse group of viruses which are easily manipulated, and therefore have potential uses in biotechnology, research, and therapeutics.” The legend of bacteriophages predates the antibiotic revolution. From ancient times to the turn of the 20th century, reports have claimed that some river waters (likely containing phages) could cure such diseases as cholera and leprosy—in this context, the authors mention the biblical story of Naaman, who was cured of leprosy after dipping in the Jordan River. The clinical analysis and application of bacteriophages did not begin until 1917; the authors believe it fizzled prematurely in the 1970s because antibiotics made it easy for physicians to treat illnesses without determining the source.
Bacteriophages hold a number of advantages over antibiotics. For example, phages are specific to their hosts and localize at the site of the infection, whereas antibiotics are much less discriminating, killing even normal flora within our bodies. As such, so-called phage therapies result in little or no side effects. Also, phages can evolve to counter the targeted bacterium’s mutation. Think of phages as a smart weapon that mutates when the enemy does.
No wonder, as stated in this Nature article, phage therapy is seeing a resurgence. And yet, very few places offer human phage therapies today: Poland, the nation of Georgia, and Russia are among the exceptions. In the US, phages have mainly been used in vaccine production. Recently, the Food and Drug Administration approved the use of phage additives on “ready-to-eat meat that target the bacteria, Listeria monocytogenes. The authors also discuss ongoing academic phage research, including the discovery of a phage that can kill acne-causing bacteria.
But for much the same reasons that make it attractive, phage therapy comes with some risks and costs. Because they are so selective, they need to be administered as a cocktail of multiple phages—cocktails drugs are frowned upon by the FDA. And given the bacteria variability from person to person, different cocktails may be needed to treat the same infection. That alone would make it difficult for a large-scale manufacturer to turn a profit. Another turnoff to businesses: It is very difficult to patent a living organism.
And although phages are believed to be harmless to humans, the body still treats them as foreigners and tries to expel them. So yet another challenge for pharmaceutical companies will be to develop methods to safely deliver the viral payload to the target site.