
FDA approves first US phage therapy trial (2019) - apsec112
https://www.healio.com/infectious-disease/antimicrobials/news/online/%7B9f6c465a-3e93-476e-8397-665458cbc21f%7D/ucsd-researchers-get-ok-from-fda-for-first-trial-of-iv-phage-therapy
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rhombocombus
I was laughed out of my uni's microbiology department for even mentioning this
15 years ago. While my feelings were somewhat hurt, it wound up working out
great for me. That experience led me to neuroscience and a wonderful graduate
program, but I couldn't help but chortle a little bit with satisfaction
reading this this morning.

~~~
chews
It's a shame that progressive thoughts get laughed at in the field of
academia.

~~~
wpasc
really don't understand your down votes. How many breakthroughs were treated
with contempt and laughter when they were first presented.

Relativity? Immunotherapy? many others I'm sure

~~~
ppseafield
In the 80s in order to prove that ulcers were caused by bacteria, a doctor
infected himself with said ulcer-causing bacteria and treated himself with
antibiotics.

[https://www.discovermagazine.com/health/the-doctor-who-
drank...](https://www.discovermagazine.com/health/the-doctor-who-drank-
infectious-broth-gave-himself-an-ulcer-and-solved-a-medical-mystery)

~~~
jacobwilliamroy
In the 19th century, in order to prove that "dirtyness" causes cholera, a man
named Pettenkofer drank a vial of clear water contaminated with cholera.
Fortunately he attempted to control the experiment by neutralizing his stomach
acids beforehand, which prevented the cholera from becoming pathogenic. The
colony passed through his digestive tract without incident.

~~~
skyyler
He neutralised his stomach acids to keep the V. cholerae alive, actually.

They didn't pass through him without incident, every account of this story I
can find notes that he did get sick. The modern perspective of the story seems
to be that he had an immunity from previously having dealt with cholera.

~~~
jacobwilliamroy
The story I heard was that Cholera automatically stops reproducing if its
population gets high enough, and that keeping the cholera alive prevented it
from spreading.

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pinky1417
In the back of my mind, I knew that if I got an antibiotic resistant infection
in the US - an infection that didn’t respond to a few rounds of different
drugs - I’d fly ASAP to Tbilisi, Georgia to go to the Phage Therapy Center.

I’m beyond excited about this. Not only are phages useful as another option in
fighting resistant infection, they’re _targeted_ : the phages can be
engineering to only kill specific bacteria, unlike traditional antibiotics.
Your gut bacteria would be spared!

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627467
I recall a documentary of over 10 years ago mentioning phage therapy in USSR
and how it was completely dismissed and ignored in the west (not invented here
syndrome, I suppose). If my memory doesn't fail me, they showed nursed
collecting sewage (?) water to isolate the needed phages.

It's great to see this whole field finally overcoming prejudice.

~~~
Fomite
It's not a matter of NIH syndrome.

There's _very_ real obstacles to phage therapy. The west was using phage
therapy...until it started killing people (bad phage preps are dangerous).
Penicillin came along, and you have something that's just outright better.

Antibiotics are by and large less dangerous, more stable, broader spectrum,
etc. It's also a difficult challenge from the regulatory perspective - as with
fecal transplant, "bespoke set of microbes" is...weird...from a legal
perspective. The reasons the USSR was leading phage research was they were
_behind_ on antibiotics.

We've come back around because we need a backstop against antibiotics failing.

~~~
m0zg
Penicillin came along in late 19th century though. Well before anyone even
knew what a "phage" was.

~~~
Fomite
Flemming's work was in 1928, over a decade after folks were using phage
therapy, and the _mass production_ of penicillin was in the mid-40's.

Note that we were using phage therapy before we knew what phages were, because
as it turns out, that's not really necessary. Except that if you don't know
what they are, you also don't know that your preparation is full of endotoxins
from ruptured bacteria, which are a threat to your patient. Which is one of
the reasons it wasn't terribly popular.

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JMTQp8lwXL
I fail to understand why the broader scientific community failed to entertain
the idea of phages for sometime. You apply the scientific method, and you seek
truth. Maybe earlier indicators to the effectiveness weren't great, but you
will only know for certain if you apply the scientific method.

~~~
Fomite
The West used phage therapy for a long time. It developed a reputation for
killing people, because poorly prepared phage preparations contain bacterial
endotoxins that will kill your patient.

But it wasn't the scientific community "failing to entertain the idea of
phages". It was very real logistical challenges to the use of phage therapy,
which may or may not be overcome, but were definitely in a "The juice is not
worth the squeeze" realm until recently.

But I've been working in infectious diseases for 20 years, and we've been
discussing and evaluating the potential of phage or phage-derived compounds
that entire time.

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anonsivalley652
0\. Is this significant because the FDA was
institutionally-(/culturally-)against phage therapies because the Soviets went
that way rather than antibiotics? Does anyone know how much of a hurdle that
is still?

1\. Isn't it the case that resistances to phages should be perhaps (an)
order(s)-of-magnitude less likely for prokaryotes and fungi to evolve
resistances compared to static compounds like antibotics/antimycotics because
phages are probably the most abundant "almost life" parasitizing other
microbes in the wild?

2\. Are we any closer to computational molecular-level engineering of custom
antigens against any particular pathogen?

3\. Although probably tiny, is there a risk of horizontal gene transfer
between phages and other pathogens?

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waymon
Armata BioSciences and C3J Therapeutics merged in April.

[https://investor.armatapharma.com/2019-05-09-C3J-Therapeutic...](https://investor.armatapharma.com/2019-05-09-C3J-Therapeutics-
and-AmpliPhi-Biosciences-Announce-Successful-Completion-of-Merger-and-
Formation-of-Bacteriophage-Company-Armata-Pharmaceuticals-Inc)

------
dang
Loosely related, from 2019:
[https://news.ycombinator.com/item?id=19863445](https://news.ycombinator.com/item?id=19863445)

2018:
[https://news.ycombinator.com/item?id=17085827](https://news.ycombinator.com/item?id=17085827)

2017:
[https://news.ycombinator.com/item?id=14226790](https://news.ycombinator.com/item?id=14226790)

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mrfusion
So will this be one specific phage that they can package up and send out? Or
will it be unique to each patient?

Last I read about phage therapy they’d actually culture the infection and
locate phage viruses already preying on those exact bacteria and then scale
them up as the therapy.

~~~
karmajunkie
It'll end up being specific to the species of bacteria causing the patient's
infection, which means they'll first have to isolate the source of infection.
Sometimes this will be an easy task, sometimes not. I suspect over the long
term treatments that go to market will combine several (or many) natural or
engineered phages into a single delivery protocol and those that don't find
their natural targets will die out harmlessly.

This is a super interesting area of research that I think will ultimately
complement treatments like biota transplants for chronic diseases and
antibiotics for acute disease. As a therapeutic approach (at least in the US)
its still young though, so I wouldn't expect to see dramatic changes for years
yet.

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adrr
Curious how you get the persons immune system not to attack the phages in
order to keep it effective.

~~~
coolspot
Probably direct application - like injection to wound plus overwhelming
amount, so even if immune kills most, some will reach regions infected with
target bacteria.

After target is eliminated, regular antibiotics are used to kill remainder of
phage bacteria.

~~~
pocketstar
What is phage bacteria?Bacteriophages are a virus. If phage therapy is
successful, there shouldnt be any target bacteria left to kill.

~~~
coolspot
Oh, you’re right.

I somehow thought bacteriophages are another bacterias hunting for problematic
ones.

