Phage therapy was once used to treat bubonic plague. Now with bacteria evolving resistance to more and more antibiotics, phage therapy is drawing a second look from researchers - sometimes with a novel twist. Instead of simply using the phages to kill bacteria directly, the new strategy aims to catch the bacteria in an evolutionary dilemma, one in which they cannot evade phages and antibiotics simultaneously.
More than 70 percent of hospital-acquired bacterial infections in the United States are resistant to at least one type of antibiotic. And some pathogens, such as Acinetobacter, Pseudomonas, Escherichia coli, and Klebsiella - classified by the World Health Organization as some of the biggest threats to human health - are resistant to multiple antibiotics. In 2019, antimicrobial resistance was linked to 4.95 million deaths globally, heightening the call for more effective treatment options.As Trump has now sucked all the oxygen out of the endless news cycles, here's a topic completely politically neutral. Obviously I'm no virologist, but antibiotic resistance is something with the potential to touch any of us at any time if we're exposed to a bacterial infection. Based on the article - with its simplified explanation above - the research being done indeed looks promising in addressing the potential ticking timebomb of medicine losing the ability to kill certain bacteria now resistant to our current collection of antibiotics.
One of the ways that bacteria can evolve resistance to antibiotics is by using structures in their membranes that are designed to move unwanted molecules out of the cell. By modifying these "efflux pumps" to recognize the antibiotic, bacteria can eliminate the drug before it poisons them.
As it turns out, some phages appear to use these same efflux pumps to invade the bacterial cell. The phage presumably attaches its tail to the outer portion of the pump protein, like a key slipping into a lock, and then injects its genetic material into the cell.
Treating a patient with phages and antibiotics simultaneously could trap bacteria in a no-win situation: If they evolve to modify their efflux pumps so the phage can't bind, the pumps will no longer expel antibiotics, and the bacteria will lose their resistance. But if they retain their antibiotic resistance, the phages will kill them, as Turner and colleagues explained in the 2023 Annual Review of Virology.
Poking around for Phage Theory, I stumbled upon this...
Virus fished from pond cures man's deadly antibiotic-resistant infection (March 2018)
arstechnica.com
... The clinical success suggests promising strategy for fighting antibiotic resistance.
In 2012, a 76-year-old Connecticut doctor had surgery to repair a life-threatening bulge in his aortic arch"the hulking bend that hooks the massive artery around the heart, routing oxygenated blood both upward and downward. Surgeons successfully used a synthetic graft to shore up the vital conduit. But soon after, a tenacious film of drug-resistant Pseudomonas aeruginosa bacteria formed on the graft.
The doctor spent the next four years battling the infection, slipping in and out of the hospital. His surgeons and doctors at Yale deemed him too high risk for another operation and put him on mega-doses of antibiotics, prescribed indefinitely. The drugs couldn't clear the infection, they merely knocked it back enough to keep it from killing him. But the chronic inflammation that ensued took its own toll. His team of doctors started to worry his immune system was chipping away at his aorta. With a bleak outlook, the man agreed in 2016 to an experimental treatment: a virus that researchers had fished out of a nearby pond.
The viral gamble paid off. The infection cleared and he went off antibiotics, according to a case study published recently by the Yale researchers and doctors in the journal of Evolution, Medicine, and Public Health[1].
Phages for the ages
The case is a clinical win for using viruses when antibiotics fail to kill bacteria. It's an idea that has been around for decades. Viruses that exclusively infect and kill bacteria"called "bacteriophages" or just "phages""have been used in former Soviet republics and some parts of Eastern Europe for nearly a century. Phages kill in the same way as many viruses; a phage infects a host cell, usurps its cellular machinery to make copies of itself, then the clone army bursts out, destroying the host cell in the process. And there are plenty of phages to harness for potential therapies. In water samples, for instance, some researchers have estimated that there are 10 phages for every bacterial/archaeal cell. To put that in perspective, the open ocean is estimated to contain 1.2 1029 bacterial and archaeal cells.
But in Westernized countries, phage therapy has largely been passed over by researchers, given the success of antibiotics. As such, phages have failed to garner the needed research attention to establish their safety and efficacy. That's changing now, albeit slowly, with the rise of antibiotic-resistant bacteria. ...
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1 - Phage treatment of an aortic graft infected with Pseudomonas aeruginosa (2018) academic.oup.com
This is why the research being done here is so vitally important.
Antibiotic resistance could cause over 39 million deaths by 2050, study says
The authors of the study forecast a nearly 70 percent increase in deaths due to antimicrobial resistance from 2022 to 2050 with older people most at risk and driving the rise in fatalities. Such resistance, also known as AMR, occurs when microbes, such as bacteria and fungi, evolve in a way that makes them harder to kill with existing medications.
"It's a big problem, and it is here to stay," said Christopher J. L. Murray, senior author on the study and director of the Institute for Health Metrics and Evaluation at the University of Washington.
Researchers have flagged antimicrobial resistance as a public health concern for decades, but this study - conducted by a large team of researchers as part of the Global Research on Antimicrobial Resistance Project - is the first to analyze AMR trends around the world and over time. The World Health Organization says the threat of such antimicrobial resistance not only makes common infections harder to treat but makes medical interventions, such as chemotherapy and Caesarean sections, more risky.
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