
Phages are making a comeback - jackweirdy
https://www.motherjones.com/environment/2018/05/the-best-viral-news-youll-ever-read-antibiotic-resistance-phage-therapy-bacteriophage-virus/
======
aresant
Summary:

\- 68 year old male catches bacterial infection - Acinetobacter baumannii - on
vacation in Egypt

\- Traditional antibiotics courses don't work

\- Wife suggested trying bacteriophages - aka "phages" \- which are baceteria-
targeting viruses

\- Phages are not FDA approved, but can receive "compassionate-use
authorization" — effectively an acknowledgment that nothing with an FDA
license can save the patient’s life

\- 23,000 people a year die from antibiotic resistant bacterial infections and
phages are not necessarily on the radar due to their own bio-diversity (single
phage for a single bacterium vs mostly catch-all antibiotics)

\- The male patient was treated with phages, which worked, and lived

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Bucephalus355
This treatment has always been popular / common in the (former) Soviet Union.
Here is an article from 2014 on it: [https://gizmodo.com/soviet-doctors-cured-
infections-with-vir...](https://gizmodo.com/soviet-doctors-cured-infections-
with-viruses-and-soon-1587311881)

Also interesting is that medicine was never a particularly well paying job in
the Soviet Union. At best it would be comparable to a civil engineer today;
very much respected, but certainly not earning what a software engineer (or US
doctor) would.

~~~
aesh2Xa1
Why do you bring up the pay of Soviet doctors? Do you think the technology's
introduction to common use was related?

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emilga
Kurzgesagt goes through bacterophages in this video:
[https://www.youtube.com/watch?v=YI3tsmFsrOg](https://www.youtube.com/watch?v=YI3tsmFsrOg)

I think this is the case mentioned by Kurzgesagt in the video, although he
doesn't use names, so I can't be sure. Super cool, anyways!

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jamesblonde
A lot of cystic fibrosis patients I know that have been colonized with
bacteria, such as pseudomonas, resort to phage therapy. Typically they do it
in Georgia (former Soviet Union state that was very active in Phage Therapy).
Many CFers swear by phage therapy. It needs to be individualized, with
adaptation to every individual.

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teachrdan
Interesting plot twist regarding the former Soviet Union:

"D’Herelle was a restless researcher who seems to have felt undervalued
despite being awarded jobs in Paris and Vietnam and at Yale. That insecurity
made him vulnerable to an offer he received in 1933 to relocate to Tbilisi in
Georgia, home territory of Soviet dictator Joseph Stalin. With a protégé,
Georgi Eliava, d’Herelle co-founded the Eliava Institute of Bacteriophages,
Microbiology and Virology. Stalin showered the institute with attention and
money because it offered something he badly wanted: a scientific achievement
that he could portray as a pure product of communism. Antibiotics became the
basis of infectious-disease medicine in the West, but behind the Iron Curtain,
phages took their place."

"Eliava was murdered in a political purge in 1937, and d’Herelle died in 1949.
Their institute dwindled, but it survived the collapse of the Soviet Union in
1991 and the Georgian civil war the following year. When the former USSR
opened up to the West, physicians in the United States and Europe learned the
Eliava Institute was one of the few places in the world where researchers were
still studying and administering phages. That was fortunate timing, because
antibiotics in the West were losing their power under the onslaught of
antibiotic resistance."

It's interesting to consider how ideology (capitalist vs communist)
contributes to different approaches to problem solving. Is there anything
about bacteriophages--including their manufacture and use--that actually makes
them more "communist"?

~~~
Nasrudith
Lack of value of doctor labor and efficent labor in general perhaps? Since
phages need a culture first to be sure the right one is selected. You can't
just give broad spectrum phages. Which isn't just "laziness" or cutting
corners on expensive labor but helpful for patient results so they don't get
worse while waiting for results.

If I recall some accounts correctly Soviet doctors often depended upon grey
market bribes to afford supplies if they weren't party favored. Phages were
self replicating and needed fewer doses per patient if selected properly.
However they are highly specific, and the phage banks need updated with every
mutation which may happen mid-treatment. They are second in line for a good
reason.

~~~
Gibbon1
I remember reading a semi-biography of an old school doctor that went to med
school in the 1930's.

Mentioned being a lowly resident late at night sitting next to a deathly ill
patient with pneumonia trying to match antiserum to whatever bug the poor sap
had. Nothing, nothing nothing, and then a match. Injecting the patent with the
correct antiserum felt like magic.

Or the they would die anyways. Rarely they would go into shock and die.

Can imagine early antibiotics was so much easier. (big hammer)

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aaavl2821
there are a number of startups that have formed in the last year or two
genetically engineering phages to treat disease. resistant bacterial disease
is a common target, but given the growth in literature linking the microbiome
to diseases from autoimmunity to cancer, there are companies trying to
engineer phages to knockout bacteria implicated in non-infectious disease

eligo, locus biosciences, biomx have received venture funding and there are
many earlier stage companies as well. engineered phage therapy for cancer will
be a field to watch this year

~~~
blacksmith_tb
There are some phages being marketed as prebiotics, I have been taking
PreforPro[1], which does seem to have generally positive effects on my guts.
Of course, that would entirely depend on whether or not any of the bacterial
strains it targets happen to be present. But they being actively researched[2]
so we should know more eventually.

1: [http://www.deerlandenzymes.com/preforpro/the-
science/](http://www.deerlandenzymes.com/preforpro/the-science/)

2:
[https://clinicaltrials.gov/ct2/show/NCT03269617](https://clinicaltrials.gov/ct2/show/NCT03269617)

~~~
bhouston
Taking any anti bacteria medication on a regular basis will encourage
resistance. I can not how that would be considered a good idea.

~~~
blacksmith_tb
I don't take it daily, but obviously there's been an ongoing battle between
bacteria and phages for millions of years, it is unlikely they'd be selected
for too strongly in my gut (assuming the targeted species are even present at
any given time).

~~~
stevenwoo
In the article it is speculated the main patient didn't get better during the
initial course of treatment because the bacteria infecting him resisted the
multiple phages they used to treat him - they were all variants of the same
vector of attack(that worked in the labs on the bacteria in question), and the
researchers had to find different phages to continue treatment, so they came
across resistant bacteria immediately.

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dv_dt
Perhaps this is a superficial comparison, but to me it's odd about the
approval difficulty of phages considering that vaccines like the annual flu
vaccine also rely on assembling new recombinations of flu strains every year
too.

In general why do vaccines seem to be allowed approval to target specific
strains only, but antibiotics need to be general purpose as implied by the
article?

~~~
danieltillett
They don't. We are using vaccine technology from the 1940s. The FDA basically
allows something that was developed before 1962 to continue, while anything it
considers new (phages) have to go though the impossible FDA regulatory
process.

The bottom line is if we didn't have a vaccine for the flu already it would be
impossible to create one now.

~~~
dv_dt
The vaccine is new every year, some of the technologies for reproducing it are
old, but the fundamental vaccine I thought are remixed annually. Otherwise it
would not be effective vs constantly mutating wild flu strains.

Edit: added [https://www.cdc.gov/flu/protect/vaccine/how-fluvaccine-
made....](https://www.cdc.gov/flu/protect/vaccine/how-fluvaccine-made.htm)

~~~
danieltillett
Yes the flu vaccine is updated every year (and occasionally they put the right
strain into it), the technology used was developed in the 1940s. It is very
crude, but thanks to the FDA no advance is practicable.

You might think this doesn’t matter, but we now know how to make a universal
flu vaccine that doesn’t need to be updated each year. Apart from not needing
to be jabbed every year, if we get another 1918 epidemic then we will find out
how much we will regret not having a new vaccine.

~~~
dv_dt
The third method in that CDC link says it was approved in 2013. But I gather
that's a new productions/replication method as opposed to a new method of
selecting strains? But again, what is the difference between selecting flu
strains to combat a given flu season, and selecting phages to combat a given
resistant bacteria.

I'm excited for a universal flu vaccine too, and hope that somehow that
vaccine gets funded and succeeds.

~~~
danieltillett
The difference is the flu virus keeps mutating while with phages you have a
large collection and choose the ones that work on the infection the patient
has.

The big problem with the flu vaccine is the lead times are so long (6 months)
that the vaccine producers need to guess what strains will be circulating 6
months ahead. Since they lack a crystal ball they often get it wrong. The only
real advance with the cellular vaccines is for people allergic to egg.

I am not that hopeful that a universal flu vaccine will get funded.

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champagnepapi
Kurzgesagt video on bacteriophages released a few days ago.

[https://www.youtube.com/watch?v=YI3tsmFsrOg](https://www.youtube.com/watch?v=YI3tsmFsrOg)

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dredmorbius
Clickbai title.

~~~
mikestew
The original title was clickbait, yes: "He Was Dying. Antibiotics Weren’t
Working. Doctors Tried a Forgotten Treatment". Yea, but for one weird trick,
the patient would have died. I'm not sure who hates him, but I'm sure someone
does.

Mods or OP thankfully changed it.

~~~
codeulike
The bacteria hate him, obviously

