This viral therapy could help us survive the era of Superbug



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In November 2015, Steffanie Strathdee, an infectious disease epidemiologist, and her husband Tom Patterson, an evolutionary psychologist, spent Thanksgiving week exploring the pyramids and tombs of pharaohs in Egypt. But his state of health was rapidly deteriorating and he had to undergo a medical emergency, in Germany and then at the San Diego University Medical Center, where the two scientists were part of the staff, blood tests and blood tests. Imaging revealed why Patterson's body was failing. A cyst the size of a soccer ball located in the abdomen was infected, teeming with one of the world's most dangerous bacteria, resistant to antibiotics.

So begins The perfect predator, the true captivating story of a scientist's crusade aimed at saving her husband's life by resuscitating a secular Soviet remedy largely ignored by Western medicine. Part of the medical mystery, part of the personal memoirs, the couple's first book tells of Strathdee's unbridled attempts to recruit researchers willing to experiment with phage therapy – a cocktail of viruses that feed on bacteria – on Patterson, then in the coma.

Strathdee and Patterson attended an interview to discuss the experimental treatment that brought him back from the brink of death and how he had inspired US scientists and doctors to take a closer look at phage therapy as a potential solution for the coming era. superbugs.

CABLE: Steffanie, before Tom got sick, did you ever hear about phage therapy?

SS: No, I fell on it late one night on PubMed [a free, public search engine for biomedical journal articles] with a number of other alternative therapies for superbugs infections. Microbiology classes at my university had learned that phages were viruses that fed on bacteria but I did not know that they had never been developed for therapeutic purposes. And I thought wow, they have been used for decades in the former Soviet Union and it was like "why are not they used here?

CABLE: Well, why are not they?

SS: There were a few things that were happening. Félix d'Herelle, the main discoverer of bacteriophages, was a difficult man. He tended to tick people. And because he was a "vagabond scholar" without formal training, some of the people he was arguing with, including Western Nobel laureates, really wanted him. The other part was that phage treatment had been vigorously undertaken by the former Soviet Union, the Republic of Georgia and Poland. It was discovered before the arrival of modern antibiotics and persisted after because access to penicillin was very random at that time. Stalin and others have therefore adopted phage therapy as a pillar of the Soviet approach to health. And because of that, the West has really despised it. If you were a fan of phage therapy in the United States, you have been called pinko commie. It's actually a fascinating story about how geopolitical prejudices creep into science; the fact that this was perceived as a Soviet science has really changed Western conceptions of phage therapy for decades.

CABLE: So how did you convince Tom's doctors that this approach was worth trying, given its tumultuous history?

SS: You know, our approach to medicine is risk averse, particularly in the United States, because of litigation. We are concerned that if we try this experimental treatment and the patient dies, he will sue us. But in this case, we were fortunate enough to be at UC San Diego, a teaching and research hospital, where everyone knew Tom would die if we did not do anything serious. Some people said that he would have died in a few hours if we had not initiated phage treatment at that time.

CABLE: You eventually worked with researchers at Texas A & M University and US Naval Medical Defense Command to acquire three different phages able to attack acinetobacter infection. Tom, when did you first learn that you were the subject of this great experience?

TP: It was when I came out of a coma that I lived for more than two months. I turned to Steff and said, "What has I missed?" She added, "Well, Donald Trump is the presumptive candidate for the presidency of the United States. And we treated you with sewer viruses in Texas. I thought I must have hallucinations again!

SS: We had to repeat it again and again because he was not able to keep much information at this stage. It all seemed so fantastic.

CABLE: What do you think of this now that you have had time to think about your guinea pig experience?

TP: Steffanie and I met with our AIDS researchers in our work. In this world, viruses are always considered bad guys. So it was a real transition to think that viruses could be beneficial. But now, I can truly appreciate them from the point of view of evolution. I consider all this battle that has unfolded in my body in the image of the plain of Serengeti. The bacteria are herds of wildebeest and they have grown too much, engulfing all the grass because there were not enough predators in the vicinity. The predators in this case are the phages, so I like to think of them as lions. Our collaborators had to go out and find the lions. You can not just take a snow leopard and drop it in this environment and expect it to feed on wildebeest because it has evolved to become prey to something different.

SS: That's really cool. Our best guess is that there are 10 to the power of 31 phages on the planet – 10 trillion trillion. And they all evolved to attack different bacteria. One day, we may know enough about phages to use to clean the microbiome, to eliminate not only antibiotic-resistant bacteria, but also other types of bedbugs. Most experts say that we still do not know enough about the phageome to succeed, but that is the future.

CABLE: In the meantime, however, you have tried to more rigorously test phage treatment for serious infections in the United States. What is the last with that?

SS: It's very fast. After the publication of Tom's case in April 2017, we received funding to start the first center in North America dedicated to a better understanding of the role of phage therapy in the treatment of superbugs. It's at the University of San Diego, called IPATH, for Innovative Phage Applications and Therapeutics, and we now have two clinical trials in preparation. One of them is for people with ventricular assist devices that tend to be infected with bacteria forming biofilms, which are difficult to penetrate for antibiotics. And the other is for patients with cystic fibrosis who develop resistance to the drugs that keep them alive by fighting chronic lung infections.

These are small trials, but they will help answer many of the questions we still have at the end of Tom's trial. Like, what happened to all the phages we injected him? Where did they go? Did his immune system have pre-existing antibodies? What is the right dose? These kinds of things will help illuminate larger trials and help phage therapy become mainstream and not a whispered topic among scientists in university corridors.

TP: We are very aware that we have received resources and relationships that many people do not have. This position of privilege allowed us to escape relatively unscathed from this nightmare. We want to help ensure that in the future, about 1.5 million people who die each year from superbug infections have more resources available to them through our history.


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