Phage therapy comes up every so often on HN. Some comments on why it's not more widespread and unfortunately not a cure-all for bacterial infections:
- narrow range: phages have very specific host requirements, i.e. they usually work only on very specific subtypes of bacteria. This means you will need to spend a significant effort on finding a matching phage to a given pathogenic bacterial strain. It's almost a type of personalized medicine. Antibiotics on the other hand are usually very broad and work on a wide range of strains.
- Resistance to phages: bacteria are much more adapted to deal with phages than with antibiotics. Bacteria can become immune to phages within a couple of generations, for antibiotics it takes significantly longer. So if the first problem can be overcome (a broadly acting phage cocktail), resistance will be an even bigger problem than with antibiotics.
Fun fact: the well known CRISPR system used for genetic engineering originally stems from such a bacterial system that deals with phage immunity.
- Manufacturing: antibiotics can rely on well established protocols for large scale production on the cheap mainly relying on chemical synthesis. Phages on the other hand will be needed to grow in a bacterial host culture (you can't build them synthetically) and will need extensive purification steps. You don't want to intravenously inject any bacterial remnants into a patient. Add to that the large diversity of phages with ever changing host requirements and it becomes a nightmare for production.
Perhaps I am simply not imaginative enough but I simply do not have any clue how the following could occur in three weeks. What am I missing? This seems like bullshit, similar to how I felt reading about Elizabeth Holmes in the early days, baffled how someone without any training could miraculously change medical testing.
> Then she convinced phage scientists around the country to hunt and peck through molecular haystacks of sewage, bogs, ponds, the bilge of boats and other prime breeding grounds for bacteria and their viral opponents. The impossible goal: quickly find the few, exquisitely unique phages capable of fighting a specific strain of antibiotic-resistant bacteria literally eating her husband alive.
> Next, the US Food and Drug Administration had to greenlight this unproven cocktail of hope, and scientists had to purify the mixture so that it wouldn’t be deadly.
> Yet just three weeks later, Strathdee watched doctors intravenously inject the mixture into her husband’s body – and save his life.
According to the published case study [1], the illness progressed over 4 months, so at the start of the "3 weeks" they had already diagnosed the infection and had isolates of the bacteria ready for testing.
The Texas institute had already been working on using phages to cure infections with the same bacteria in mice, and it sounds like they were in a position to start human trials. It's not like they invented the therapy on the spot.
So when the patients wife showed up, and took care of all the bureaucratic issues (like getting compassionate use authorization), they knew exactly what they had to do.
I think the story shows what a competent manager can achieve.
She was able to make contact with people who were already working on phages so they had the skills, laboratory machinery and protocols, and the contacts to make it happen.
In Georgia they do this all the time. For me the oddest thing about the article is how little Georgia was involved.
Likewise. It seems so very promising but I'm guessing that it would be challenging to scale to volumes that would interest big pharma.
Considering how antibiotics are being increasingly rendered ineffective we'd be well served by the government investing in more research on how to make it more viable so that we have better treatment options going forward.
Fascinating story that is also rather terrifying considering the steady decrease in the efficacy of antibiotics. Antibiotics are arguably the most important medical invention ever, and yet we use them so haphazardly and at such scale that we are throwing into doubt whether they will continue to be effective. This is a little-discussed facet of industrial animal farming in particular: we are jeopardizing our defence against superbugs so we can eat cheap chicken!
