Antibiotics Out, Viruses in

Not all viruses harm humans; bacteriophages are being used to help us.

As bacteria become more resistant to antibiotics, viruses could become the best chance to stop bacterial infections. Bacteriophages are viruses that infect bacterial cells rather than human, plant, or animal cells. Phages are more populous than every other living organism on Earth combined, allowing them to kill up to 40% of the ocean’s bacteria each day.

Recently, researchers have begun exploiting the fact that humans are immune to bacteriophages to utilize them to fight infections. As multidrug-resistant bacteria proliferate, bacteriophages will become an ever more important tool in fighting infections. Sam Nugen, Professor of Food Science at Cornell University and bacteriophage researcher, says “Once our antibiotics run out we are kind of screwed and, eventually, we have to find something else. Phages were around before antibiotics were discovered and it seems we are going to have to go back to that.”

Although clinical use trials of phages are still in their infancy, phages have presented ample evidence that points to their efficacy in fighting infections. According to Dr. Nugen, phages are currently only approved for treatment as a last resort in life or death situations involving bacterial infections.

One notable example of phage treatment was the case of Dr. Tom Patterson, a psychiatry professor at the University of California, San Diego, who was treated intravenously with phages after contracting an antibiotic-resistant infection. Following treatment, he quickly recovered. As a result of Patterson’s experience, his wife, Dr. Steffanie Strathdee, Associate Dean of Global Health Sciences at UCSD School of Medicine, began treating more people with phages; her work spurred the creation of the Interdisciplinary Center for Innovative Phage Applications and Therapeutics (IPATH) at UCSD.

In an email exchange with The Jaguardian, Strathdee points out that IPATH has made strides in increasing usage and research of phages in the United States. “Phages have long been used in former soviet countries as an over-the-counter treatment. The medical community in the West believed that phage therapy was passé because of the geopolitical bias against what was perceived to be Soviet science. One physician even called it voodoo! It’s taken a lot of advocacy and research to ‘un-do’ that myopic kind of thinking. But we are getting there. Now that the NIH has invested about $20 million in phage therapy, we are changing minds.”

One such advancement for phage treatments might likely wind up in the form of topical applications such as a Neosporin alternative that uses phages instead of antibiotics. The concentration of phages within those topical pastes doesn’t need to be high because phages can naturally reproduce quickly enough to fight the infection. “If you have an infection site, then you can put a little bit of phage in there, and it can clear that out,” Nugen said.

Strathdee cites ESKAPE pathogens, which are a class of incredibly infectious yet antibiotic-resistant bacteria that are dangerous and hard to eliminate, as a future example of phages’ virus-fighting abilities. Strathdee hopes that GMP facilities—labs where pharmaceuticals can be produced—can make access to phages easier, an essential step in getting FDA approval. “We need a centralized phage library against the ESKAPE pathogens, and GMP facilities to grow clinical-grade phage. If we can develop those, the phage can be matched to bacterial isolates within 24 hours,” Strathdee explained.

Phages are also used in agriculture as an alternative to conventional treatments such as antibiotics, chlorine soaks, and radiation to kill food-borne pathogens. An alternative is actively needed given that overuse of antibiotics has made food-borne illnesses much more common. In 1982 the first E. coli outbreak happened in the United states, at that time fish and shellfish accounted for more than 75% of all food borne infections; now, lettuce and other leafy greens accounts for 47%.

The borderline obsession with antibiotics has important consequences for the ways that humans are affected by disease. Because animal waste, which contains multidrug-resistant bacteria, is often dissipated into waterways, when that water gets exposed to, for example, fields of lettuce, the lettuce can become infected. As a result of foodborne illnesses exacerbated by antibiotic-resistant bacteria, 3000 Americans die and another 125,000 are hospitalized each year. “We just use too many antibiotics, and that’s causing a huge problem,”Nugen said. “Antibiotics are really carpet-bombing that is killing bad bacteria and killing good bacteria. The only thing it’s not killing is multidrug-resistant bacteria. We could use, in some cases, phages instead if we are targeting a specific disease.”

More research into bacteriophages is vital to advance their clinical applications against disease. Nugen hopes his research can give him more knowledge about the world because “Bacteriophages give us insight into all higher organisms. We can study how they evolve… and it tells us about other viruses as well, how phages are put together. It gives us a lot more information about higher forms of life, and I think that they are cool because bacteria are so involved in our everyday life, whether it’s our microbiome, using bacteria to make food, or trying to kill bacteria because they are trying to kill us. Phages being this antagonist is something we should be using as a tool.”