United States: More than 2.8 million antimicrobial-resistant infections occur every year in the United States alone. Used in clinical trials, tiny tripod-looking viruses called phages were designed by scientists last year and since then have been called one of nature’s oldest predators.
These microscopic creatures have been able to destroy those superbugs while saving the lives of dying patients suffering superbug infections.
In 2019, according to the US Centers for Disease Control and Prevention (CDC), such infections have killed 5 million people worldwide and have become an “urgent global public health threat.”
The infectious disease epidemiologist and co-director of the first dedicated phage therapy center in North America, the Center for Innovative Phage Applications and Therapeutics, or IPATH, at UC San Diego School of Medicine, Steffanie Strathdee, said, “It’s estimated that by 2050, 10 million people per year — that’s one person every three seconds — is going to be dying from a superbug infection,” reported by CNN Health.
Growing antibiotic-resistant infections
In May 2022, various cases of severe antibiotic-resistant eye infections started to appear. In the following January, the CDC said that not less than 50 patients in 11 states developed infections caused by superbugs after consuming preservative‐free artificial tears.
By May 2023, the outbreak had spread to 18 states: Four people died, four others became blind, another fourteen lost vision, and dozens of others developed infections in other body parts.
Dr. Maroya Walter, an epidemiologist who led the CDC’s artificial tears investigation, said, “Only a fraction of patients actually had eye infections, which made the outbreak incredibly difficult to solve,” reported CNN Health.
Walter added further, “We saw people who were colonized by the organism develop urinary tract or respiratory tract infections months down the road, even though they were no longer using these drops,” and One patient spread the infection to others in the health care facility.”
As per the CDC, the culprit superbug was a rare drug-resistant form of Pseudomonas aeruginosa that was never documented in the United States before the incidence.
About the Natural Saviour- Phagus
Due to evolution, in the world today, gazillions of bacteria have a natural enemy called bacteriophages, which are tiny viruses genetically programmed for search-and-destroy missions.
Each set of phagus is specifically created in order to locate, destroy, and consume a particular type of enemy microorganism.
Paul Turner, a professor of ecology and evolutionary biology at Yale University and microbiology faculty member at Yale School of Medicine in New Haven, Connecticut, said, “Each bacterial species, or even genotypes within it, can have a whole repertoire of phages that are attacking it, using a wide variety of methods to enter and debilitate the bacterial cell.”
Bacteria respond to the attack by deploying a number of evasive tactics such as shedding their outer skins in order to eradicate docking areas located on those surfaces that phages utilize for navigation, invasion delivery, and eventually explode the pathogen into bits of bacterial goo, reported by CNN health.
This is a relieving fact because the newly naked bacteria might get rid of their antimicrobial properties and be susceptible again to elimination.
However, the Phage is rendered inactive, and it can no longer fight.
Specialists try to find several phages that can be utilized for a particularly dangerous superbug to maximize the success, hence, at times preparing a cocktail of microscopic warriors who could continue an assault even if one is blocked out.
An associate dean of global health sciences at UC San Diego, Strathdee, said one of those cocktails contained a phage that “scared the bacteria so much that it dropped its outer capsule.” He is also the co-author of “The Perfect Predator: A Scientist’s Race to Save Her Husband From a Deadly Superbug,” reported CNN Health.
What is Phage 3.0?
Phage scientists are researching and working on developing the next or what Strathdee calls “phage 3.0” in the labs across the country.
Turner’s Yale laboratory scientists are mapping which phages and antibiotics are most symbiotic in the fight against a pathogen.
Roach’s San Diego State lab is studying the immunogenicity of phages and developing new techniques to purify them from samples for intravenous use in patients.
Clinical trials are still ongoing in order to determine the effectiveness of phages against chronic constipation, joint infections, intractable urinary tract infections, diabetic foot ulcers, tonsillitis, and the persistent reoccurring infections that occur in patients with cystic fibrosis.
Common in cystic fibrosis, such chronic infections are generally caused by various strains of drug-resistant Pseudomonas aeruginosa- the same pathogen responsible for ear infections and the outbreak of artificial tears.
Libraries of phages, filled with strains found in nature that are effective in curing a particular kind of pathogen, are being developed by a number of labs.
A new facility in Texas is working on taking a step further to speed up evolution by creating phages in the lab.
Anthony Maresso, associate professor at Baylor College of Medicine in Houston, said, “Rather than just sourcing new phages from the environment, we have a bioreactor that in real-time creates billions upon billions of phages,” reported CNN Health.
Maresso added further, “Most of those phages won’t be active against the drug-resistant bacteria, but at some point, there will be a rare variant that has been trained, so to speak, to attack the resistant bacteria, and we’ll add that to our arsenal,” and “It’s a next-generation approach on phage libraries.”
Twelve patients were treated with custom phages in Maresso’s lab only last year. It is considered as a qualified success. In five patients, antibiotic-resistant bacteria were eliminated, while several more patients showed improvements.
Elizabeth Villa, a professor of molecular biology at UC San Diego who studies a new form of phage called “jumbo” phages, mentioned that to date, genetic manipulation of phages has been difficult due to the streamlined nature of the creature and “Normal phages are optimized by evolution to be lean, mean, killing machines. There’s very little room in there for us to get in and change things,” reported CNN Health.
Dr. Robert “Chip” Schooley, a leading infectious disease specialist at UC San Diego who is co-director of IPATH, said, “Jumbo phages have very large genomes and come close to having a nucleus that encapsulates the genetic material, which protects them from some of the mechanisms bacteria use against phages to deactivate them.”
Schooley said, “That also gives them room to be engineered to become more potent, so they’re very promising phages to be used therapeutically.”
What CDC is saying?
Since all these developments have been noticed by the CDC, Walters CDC stated that in order to use a phage cocktail to treat a superbug outbreak in real time, phages could also resolve a larger problem, and that is to prevent re-colonization of the infected person by resurgence with the same superbug.
Walters added, “The issue is that when patients have infections with these drug-resistant bacteria, they can still carry that organism in or on their bodies even after treatment,” and said further, “They don’t show any signs or symptoms of illness, but they can get infections again, and they can also transmit the bacteria to other people,” reported by CNN Health.
Nevertheless, if phages could be used to “decolonize” a bacterial population within an infected person, “patients could really decrease the likelihood of developing an infection and spreading to others, which is a big part of the problem,” Walters said.
She added, “We were thinking about trying to develop a curated phage collection that would be active against a large number of certain resistant organisms,” and “Pseudomonas is a good place to start — there are more than 140 different species. But there are many other organisms that threaten us that we also need to tackle.”