Bespoke phages perform well in small study
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Key takeaways:
- Customized phages were mostly effective against antibiotic-resistant infections in a small study.
- Interest in phage therapy, a nontraditional alternative to antibiotics, has grown in recent years.
In a small study, custom-made bacteriophages produced by a center in Texas either cleared highly resistant bacterial infections or led to clinical improvement in the patient most of the time, researchers reported.
The phages were made at Tailored Antibacterials and Innovative Laboratories for Phage Therapy — or TAILOR — at Baylor College of Medicine.
“The study was prompted by the giant void in clinical care for suffering patients who have no therapeutic options for their antibiotic-resistant bacterial infections. These patients get a bad infection, antibiotics do not work, and their clinicians have nothing to turn to,” Anthony W. Maresso, PhD, Joseph Melnick Endowed Chair and professor of molecular virology and microbiology at Baylor College of Medicine, told Healio.
“This is a growing problem, with one of the miracles of modern medicine” — antibiotics —"failing and failing badly,” Maresso said. “The projections for antimicrobial resistance (AMR) are dire.”
The goal of the TAILOR lab “is to fight bacterial evolution to overcome modern antibiotics with evolution itself,” he said.
In the age of growing antimicrobial resistance, phages — viruses that target and consume bacteria — have gained attention as a promising alternative to antibiotics.
At the TAILOR lab, “we simply select for the best and brightest of phage to kill a patient’s drug-resistant bacterial strain,” Maresso said.
The process starts when a clinician sends an isolate to the lab, which adapts the phage to the isolate. Maresso and colleagues then purify the phage to make it safe and send it to the clinician to treat the patient.
“It is personalized infectious disease medicine, as the phage will only infect the bacterium that patient has,” he said.
For the study, Maresso and colleagues retrospectively assessed 12 cases of customized phage therapy from their center. They assessed outcomes as favorable or unfavorable using microbiologic and clinical standards and recorded other patient experiences, including time to treatment, antibiotic synergy and immune responses.
They received 50 requests for phage therapy over 30 months, and generated customized phages for 12 patients: three left ventricular assist device infections, three recurrent bacteremia and one retreatment of bacteremia, two prosthetic joint infections, one UTI, one bacteremia and UTI, and one sternal wound infection and bacteremia.
Patients were primarily treated with an average of 5.6 weeks of IV phage therapy, although four patients received an additional dose of phages through an additional method.
According to the study, five of the 12 (42%) cases experienced bacterial eradication, and seven (58%) showed clinical improvement after treatment. No major adverse reactions were observed among these patients, and only one patient reported a mild adverse reaction — diarrhea — which resolved during treatment.
“Modern infectious disease medicine must treat some bacterial infections as a chronic state, a constant war between the host and the infecting bacterium,” Maresso said, “If, however, you use phage, which have been naturally built to destroy bacteria in these environments over billions of years of evolution, and carefully formulate them to address the patient’s specific situation, you can give them a therapeutic option that they otherwise would not have had. The challenge now is to try to solve the scale of this process on a level that can reach more patients.”
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