Showing posts sorted by date for query BIOPHAGES. Sort by relevance Show all posts
Showing posts sorted by date for query BIOPHAGES. Sort by relevance Show all posts

Wednesday, February 05, 2025

 

Phages love to kill bacteria. Could they be used as antibiotics?



University of California - San Francisco






Scientists are learning more about how an intriguing type of virus protects itself. Revealing its strategies could boost the fight against antibiotic resistance.

Phages are viruses that attack bacteria by injecting their DNA, then usurping bacterial machinery to reproduce. Eventually, they make so many copies of themselves that the bacteria burst.

By looking at this process in a unique type of virus called a jumbo phage, scientists hope to learn how to make new antibiotics that can address the growing crisis of resistance.

The jumbo phage has more than four times the DNA of an average phage. It uses this genetic material to create a restricted space inside bacteria where it can copy its DNA while surrounded by a protective shield made of protein.

Researchers at UC San Francisco have discovered that the shield works via a set of “secret handshakes.” They allow only a specific set of useful proteins to pass through.

The handshakes all involve a large, central protein. It has a shape that lets it use different parts of itself to screen and recognize different proteins and grant them passage.

“This isn’t what we expected to see at all,” said Joseph Bondy-Denomy, PhD, associate professor of microbiology and immunology at UC San Francisco and senior author of the study, which appears Feb. 5 in Nature.

“It’s a surprisingly complicated thing for a phage to be doing,” he said.

Secret handshakes

Jumbo phages belong to a group of viruses called bacteriophages, or phages for short, which were discovered more than a century ago. Initially, phages were seen as a way to treat bacterial infections, because they are harmless to humans and can kill specific bacteria while leaving others alone. 

Interest died away once antibiotic drugs were developed, but the urgency to find new ways of fighting antibiotic-resistant bacteria is sparking it once again.

Scientists first began working on jumbo phages in the early 1980s but it wasn’t until 2017 that researchers at UCSF and UC San Diego worked together to identify the flexible protein that makes up the shield. 

In 2020, Bondy-Denomy led a study showing that the protein shield protects the phage’s DNA from attacks by the bacteria’s defenses.

He and Claire Kokontis, BS, a graduate student, suspected this shield may give jumbo phages distinct advantages over regular phages when it comes to using these viruses against infections.

The researchers wanted to learn how the shield recognizes the useful proteins and gives them passage into the protected area. 

The secret, they discovered, was a group of proteins made by the phage that interact in an unexpected way. 

At the center was a phage protein Kokontis called Importer1, or Imp1. For proteins to be imported into the protected space, they had to interact with Imp1. 

The researchers also found an additional set of importer proteins that assist Imp1 in bringing outside proteins through the shield. 

The interaction between Imp1 and a protein outside the shield needs to be just right before the protein gets the go-ahead to enter the protected area. 

“It’s like a secret handshake between two friends,” said Bondy-Denomy. “The ones that have the right handshake get the OK, and the others are tossed out.”

To see exactly what those handshakes looked like, Kokontis mapped the surface of the Imp1 “hand” at the molecular level. 

The map revealed that each phage protein that is allowed into the protected area has its own unique way of interacting with the Imp1 hand – one protein touches a thumb, another a finger, another a different finger. 

This variety of combinations allows the group of importer proteins to recognize an array of handshakes. 

A new way of making antibiotics

The researchers did their work using Pseudomonas bacteria, which they chose because it is notorious for its resistance to most antibiotics. 

What they learned will help scientists improve on an old approach that was left behind once antibiotics had become standard. Called phage therapy, it involves fighting one infection with another. First a human gets infected by bacteria. Then the human uses a phage to kill the bacteria. 

But bacteria are quick to evolve new defenses. Once they have devised a way to get past the phage’s protective shield, they will kill the phages.  

Understanding exactly how the shield’s secret handshakes work will help scientists engineer phages that can withstand these evolutionary changes. 

Bondy-Denomy’s lab has already developed a CRISPR-based method to make the necessary genetic changes to this specific family of phage. 

Scientists can also employ that knowledge to engineer jumbo phages that produce drugs or fight cancers caused by bacterial infections.

“We’re just at the starting point of realizing all this potential,” Kokontis said. “By getting a handle on the basic science of how these phages work, we’re laying the groundwork to adapt them for fighting disease.”


Authors: Other authors of this study are Timothy Klein and Sukrit Silas of UCSF

Funding: This work was funded by the NIH (grants R01 AI171041 and R01 AI167412).

 

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at ucsf.edu, or see our Fact Sheet.

###

 

Follow UCSF
ucsf.edu | Facebook.com/ucsf YouTube.com/ucsf

Monday, November 25, 2024

Phages, towards a targeted alternative to antibiotics



Institut Pasteur
Representation of a phage bound to a bacterium. 

image: 

Representation of a phage bound to a bacterium.            

view more 

Credit: © Adrien Bernheim



With the rapid development of antibiotics in the 1930s, phage therapy – using viruses known as bacteriophages or phages to tackle bacterial infections – fell into oblivion. But as the current rise in antibiotic resistance is making it increasingly difficult to treat bacterial infections, phage therapy is once again sparking interest among physicians and scientists – although it remains complex in practice because of the great diversity and specificity of phages. Against this backdrop, scientists from the Institut Pasteur, Inserm, the Paris Public Hospital Network (AP-HP) and Université Paris Cité have developed a simple and effective new tool that recommends the best possible phage cocktail for a given patient. They did so by developing and training an artificial intelligence model capable of making a tailored selection of phages based solely on the genome of the targeted bacteria. The results of this research, published on October 31, 2024 in the journal Nature Microbiology, pave the way for personalized phage therapies to treat antibiotic-resistant bacterial infections.

Some bacteria, like Escherichia coli, are becoming increasingly resistant to conventional antibiotics and developing into what are known as "superbugs." To bypass the problem of resistance, which represents a major public health challenge, research teams are exploring the possibilities of phage therapy. The idea is to use viruses known as phages or bacteriophages, which only infect bacteria and specifically eliminate those that are pathogenic for humans. "Phage therapy was invented by the Institut Pasteur scientist Félix d'Hérelle in the 1920s, before being progressively abandoned since the late 1930s following the rise in antibiotics, which were much easier and cheaper to produce and use. Nowadays only a few countries in Eastern Europe, such as Georgia, continue to use phage therapy, while in Western countries, "broad host range" phages are occasionally used under compassionate care to treat chronic multidrug-resistant infections(1) if no other authorized drugs are effective," explains Baptiste Gaborieau, co-first author of the paper, an intensive care specialist at Louis Mourier Hospital (AP-HP) and a scientist in the IAME laboratory (Université Paris Cité-Inserm). "Over the past 20 years, after being promoted by WHO(2) and with clinical trials being launched recently, including in Europe, phage therapy has once again been sparking interest."

One challenge is knowing which phage will be effective in treating a given infection, since each phage can only infect certain bacterial strains.(3) In soil or water, where phages are naturally present, they circulate until they find the right target. Scientists from the Institut Pasteur, Inserm, the Paris Public Hospital Network (AP-HP) and Université Paris-Cité therefore set out to investigate bacteria-phage interactions in more detail to see whether it is possible to predict how effective a phage will be on a given bacterial strain. The first stage was to establish a quality dataset of interactions between 403 diverse Escherichia coli strains and 96 phages. This work took more than two years. "We put phages in contact with bacteria in culture and observed which bacteria were killed. We studied 350,000 interactions and successfully identified the characteristics in the bacterial genome likely to predict phage efficacy," summarizes Aude Bernheim, last author of the study and Head of the Institut Pasteur’s Molecular Diversity of Microbes laboratory. "Contrary to what we initially thought, the ability of phages to infect bacteria, which indicates their efficacy, is determined by receptors at the bacterial surface rather than bacterial anti-viral defense mechanisms," continues Florian Tesson, co-first author of the paper and a PhD student in the Molecular Diversity of Microbes laboratory at the Institut Pasteur and the IAME laboratory at Université Paris Cité-Inserm.

This precise, comprehensive analysis of the interaction mechanisms between bacteria and phages enabled the bioinformaticians in the team to design an optimized, effective artificial intelligence program. The program is based on an analysis of the bacterial genome, especially the regions involved in coding bacterial membrane receptors – the gateway for phages. "We are not dealing with a "black box," and that's what makes our AI model so effective. We know exactly how it works, and that helps us to improve its performance," says Hugo Vaysset, co-first author of the paper and a PhD student in the Institut Pasteur’s Molecular Diversity of Microbes laboratory. After more than two years of development and training, the AI model was able to correctly predict the efficacy of phages in treating the E. coli bacteria in the dataset in 85% of cases, simply by analyzing the bacterial DNA. "This result exceeded our expectations," says Aude Bernheim. To take their research further, the scientists tested the model on a new collection of E. coli bacterial strains responsible for pneumonia and selected a tailored "cocktail" of three phages for each of them. In 90% of cases, the phages specifically chosen by AI were successful and destroyed the bacteria. This method, which can easily be transferred to hospital laboratories, paves the way in the coming years for a strategy whereby a personalized selection of phage treatments can be made rapidly if bacterial infection with highly antibiotic-resistant Escherichia coli is diagnosed. "We still need to test the effect of phages in different environments, but proof of concept has been established. We hope to be able to extend it to other pathogenic bacteria, since our AI model has been designed to adapt easily to other scenarios with the aim of offering personalized phage therapy treatments in future," concludes Aude Bernheim.

  1. In France, phages can be used if a temporary authorization for use (ATU) is issued for a named patient
  2. https://www.who.int/europe/news/item/25-06-2024-building-evidence-for-the-use-of-bacteriophages-against-antimicrobial-resistance
  3. A group of bacteria with the same characteristics within a given species

 

 

Sunday, June 02, 2024

  

Personalized phage therapy heals resistant wounds-squeaks makes full recovery




THE HEBREW UNIVERSITY OF JERUSALEM
Squeaks 

IMAGE: 

RELAXING AFTER FULL RECOVERY

view more 

CREDIT: MILAT AND LARRY BERKLEY



A new study demonstrates an advance in treating antibiotic-resistant infections in animals through personalized phage therapy. The treatment combined a specific anti-P. aeruginosa phage applied topically with ceftazidime administered intramuscularly, resulting in the complete healing of a persistent surgical wound after fourteen weeks. This highlights the potential of phage therapy as a practical and effective solution for antibiotic-resistant infections in veterinary practice, with implications for human medicine as well.

 

Link to pictures: https://drive.google.com/drive/folders/12ntfvgd_ZdpEYtMsgkZRjS9vB89ps5XM?usp=sharing

A new study led by Prof. Ronen Hazan and his team, from the Faculty of Dental Medicine at the Hebrew University of Jerusalem, in collaboration with the team of Vet Holim, JVMV -Veterinary medical center in Kiryat -Anavim, Israel, has shown an advance in the treatment of antibiotic-resistant infections in animals. This research, focusing on a five-year-old Siamese cat Squeaks  with a multidrug-resistant Pseudomonas aeruginosa infection post-arthrodesis surgery, marks the first published documented application of personalized phage therapy in veterinary medicine.

Squeaks, initially treated at the JVMV for injuries sustained from a high-rise fall, developed a severe infection in the right hind leg following multiple surgeries. This infection persisted despite various antibiotic treatments over four months. Facing a potential implant-replacement surgery, the team turned to the new treatment which involved a meticulously designed combination of a specific anti-P. aeruginosa phage, a virus that kills bacteria, applied topically to the surgical wound and ceftazidime administered intramuscularly. Moreover, the owners of the cat, after short demonstration, provides most of the treatment doses of phages and antibiotics at their home.

The integration of phage therapy with antibiotics was aimed at targeting the pathogen effectively and directly at the site of infection, leveraging the phage’s ability to be applied topically, which simplifies administration and maximizes its concentration at the infection site. This approach allowed the surgical wound, which had remained open for five months, to fully heal after to fourteen weeks of treatment.

The successful outcome of this case underscores the critical need for novel therapeutics like phage therapy to address the growing concern of antibiotic-resistant infections, which affect up to 8.5% of surgical sites following orthopedic surgeries in companion animals. These infections not only pose significant health risks to the animals but also increase the morbidity, mortality, and costs associated with these procedures.

Recent studies suggest that phage therapy, already showing high success rates in human medicine for treating orthopedic infections and chronically infected wounds, can offer a promising solution for similar issues in veterinary practice. Moreover, the successful treatment of this cat by its owners at home highlights the practicality and efficacy of personalized phage therapy, which could be extended to treat other pets facing similar antimicrobial resistance challenges.

Interestingly, opposite to common situations, this case was performed on an animal based on the team's insights from treating humans first.

The positive reception from veterinarians and pet owners regarding phage therapy points to a growing awareness and acceptance of this treatment option. As the new treatment continues to be explored in veterinary settings, it not only improves the health and well-being of pets but also offers valuable data that contribute to the broader application of phage therapy in both animals and humans. This bridging of data can enhance treatment protocols and outcomes across a variety of bacterial infections, potentially changing the landscape of infection treatment in both veterinary and human medicine.

Phage therapy: In-depth discussion on ethical considerations and regulatory landscape at upcoming European conference “Targeting Phage Therapy 2024”





MITOCHONDRIA-MICROBIOTA TASK FORCE

Ms. Barbara Brenner, speaker at Targeting Phage Therapy 2024 

IMAGE: 

BARBARA BRENNER, A LEGAL EXPERT IN MEDICAL LAW AND HUMAN RIGHTS, WILL DELIVER A TALK TITLED "REGULATORY RESTRICTIONS VS. HUMAN RIGHTS, THE HIPPOCRATIC OATH, AND THE FREEDOM OF THERAPY – THE LEGAL ASPECT OF PHAGE THERAPY" AT TARGETING PHAGE THERAPY ON JUNE 20-21, 2024

view more 

CREDIT: TARGETING PHAGE THERAPY




The 7th World Conference on Targeting Phage Therapy 2024 is set to take place on June 20-21 at the Corinthia Palace in Malta, welcoming over 150 attendees from 30 countries and featuring more than 32 communications. This annual event showcases the latest advancements in phage research and therapy, emphasizing how these developments could revolutionize healthcare practices globally.

The Ethical Considerations and Regulatory Landscape of Phage Therapy will be highlighted

Targeting Phage Therapy 2024 will include a dedicated session on the ethical and regulatory aspects of phage therapy, particularly in Europe. Barbara Brenner, a legal expert in medical law and human rights, will deliver a talk titled "Regulatory Restrictions vs. Human Rights, the Hippocratic Oath, and the Freedom of Therapy – The Legal Aspect of Phage Therapy". Her presentation will focus on balancing regulatory frameworks with the urgent need for accessible, life-saving treatments.

Phage therapy faces significant regulatory and ethical challenges, and Brenner will address several critical points:

- Regulatory Frameworks and Human Rights: Brenner will provide an overview of EU and German legal and regulatory frameworks, highlighting the tension between the right to safe drugs and the right to life-saving treatment in emergencies, especially concerning antimicrobial-resistant (AMR) infections and non-GMP phages.

- Ethical and Legal Questions: The session will explore whether it is ethical to deny life-saving treatments for safety reasons and whether regulatory bodies like the FDA and EMA can be held liable for prohibiting non-GMP phages if GMP phages are unavailable or unaffordable. Additionally, Brenner will discuss the validity of scientific evidence derived from anecdotal sources versus the necessity of randomized controlled trials (RCTs) and whether these trials need to be redesigned. The legal status of phage therapy as "experimental" and the potential liability of clinicians who refuse phage therapy when it could save a patient will also be examined.

- Combatting Antimicrobial Resistance (AMR): The presentation will include the One Health approach, integrating human, animal, and environmental health practices. Brenner will highlight Georgia's successful model, advocating for the promotion of phages as primary interventions, reserving chemical antibiotics for situations where phages are ineffective.

 

Speakers Lineup

  • Robert T. Schooley, University of California, San Diego, USA

Clinical Trials in Phage Therapeutics: Looking Under the Hood

  • Ekaterina Chernevskaya, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Russia

Adaptive Phage Therapy in the Intensive Care Unit: From Science to Patients

  • Jean-Paul Pirnay, Queen Astrid Military Hospital, Belgium

Magistral Phage Preparations: Is This the Model for Everyone?

  • Barbara Brenner, Kanzlei BRENNER, Germany

Regulatory restrictions vs. Human Rights, the Hippocratic oath and the Freedom of therapy– The legal aspect of phage therapy

  • Nannan Wu, Shanghai Public Health Clinical Center, Fudan University, China

Phage Therapy: A Glimpse into Clinical Studies Involving Over 150 Cases

  • Graham F. Hatfull, University of Pittsburgh, USA

Mycobacteriophages and Their Therapeutic Potential

  • Antonia P. Sagona, University of Warwick, United Kingdom

Genetic Engineering of Phages to Target Intracellular Bloodstream E.coli Infections

  • Paul Turner, Yale University, USA

Leveraging Evolutionary Trade-Offs in Development of Phage Therapy

  • Pieter-Jan Ceyssens, Sciensano, Belgium

Quality control of phage Active Pharmaceutical Ingredients (APIs) in Belgium

  • Wolfgang Weninger, Medical University of Vienna, Austria

The Phageome in Normal and Inflamed Human Skin

  • Sabrina Green, KU Leuven, Belgium

Making Antibiotics Great Again: Phage resistance in vivo correlates to resensitivity to antibiotics in pan-resistant Pseudomonas aeruginosa

  • Rodrigo Ibarra Chávez, University of Copenhagen, Denmark

Phage Satellites, a Diversity of Extradimensional Symbionts and Pathways to Phage Therapy

  • Domenico Frezza, University of Roma Tor Vergata, Italy

Towards efficient phage therapies: investigation of phage / bacteria equilibrium with metagenome of dark matter in natural samples

  • Besarion Lasareishvili, Eliava Institute of Bacteriophage, Microbiology and Virology, Georgia

Modern Concepts of Phage Therapy: An Immunologist’s Vision

  • Kilian Vogele, Invitris, Germany

Cell-Free Production of Personalized Therapeutic Phages Targeting Multidrug-Resistant Bacteria

  • Frederic Bertels, Max Planck Institute for Evolutionary Biology, Germany

Improving Phages through Experimental Evolution

  • Eugene V Koonin, National Institutes of Health, USA

Evolution and megataxonomy of viruses: the place of phages in the virosphere

  • Federica Briani, University of Milan, Italy

Addressing Phage Resistance to Enhance the Robustness of Phage Therapy for Pseudomonas aeruginosa Infections in People with Cystic Fibrosis

  • Jumpei Fujiki, University of California San Diego, USA

Phage therapy: Targeting intestinal bacterial microbiota for the treatment of liver disease

 

Targeting Phage Therapy 2024 Supporters: Cellexus, Precision Phage, Jafral.

Contributing Partner: PHAGE Therapy, Applications, and Research Journal.

Media Partner: Bacteriophage.news.

For more information, registration details, list of attendees and the program, please visit: www.phagetherapy-site.com.


SEE

https://plawiuk.blogspot.com/search?q=PHAGES

Wednesday, March 06, 2024

 

Dr. Schooley's call to action: Elevating phage therapy trials through strategic translational research


Meeting Announcement

MITOCHONDRIA-MICROBIOTA TASK FORCE

Prof. Robert T. Schooley will present a keynote speech during Targeting Phage Therapy 2024 

IMAGE: 

IN HIS TALK AT TARGETING PHAGE THERAPY 2024, PROF. SCHOOLEY WILL DISCUSS CRITICAL STRATEGIES FOR INTEGRATING TRANSLATIONAL RESEARCH INTO CLINICAL TRIALS IN PHAGE THERAPY, ENSURING THEIR SUCCESS AND IMPACT.
 

view more 

CREDIT: TARGETING PHAGE THERAPY 2024



The 7th World Conference on Targeting Phage Therapy is being organized on June 20-21, 2024 at Corinthia Palace Malta.

Robert T. Schooley, M.D., Professor of Medicine at the University of California, San Diego, and Co-Director of the Center for Innovative Phage Applications and Therapeutics and member of the Executive Committee for the University of California Disaster Resilience Network, will introduce Phage Therapy 2024 with a key note talk titled "Phage Therapeutics 2024: Essential Translational Research Components for Clinical Trials.

Dr. Schooley will highlight the pivotal moment that phage therapy research finds itself in. With Phase 2 studies transitioning to Phase 3 trials, he stresses the critical need for a unified approach in integrating translational research components into clinical trials to ensure their success and meaningfulness.

Dr. Schooley critiques the current trend in trial design, which often aims narrowly at achieving clinical endpoints for regulatory approval, yet lacks the depth to provide insights or guidance should the trial not meet its objectives.

He references the instructive case of one study, which, despite its failure, offered valuable lessons due to its comprehensive assessment approach. This study revealed significant insights post hoc, such as issues with microbiology, phage-phage antagonism, and dilution effects, which were not addressed upfront. These revelations underscore the necessity of including detailed evaluations in clinical trials to verify that phages reach the infection site in effective quantities and intervals, to monitor the development of resistance during the study, and to assess the impact of phage-specific antibodies on treatment efficacy.

Dr. Schooley's message is a call to action for the phage therapy research community to adopt a more thorough and insightful approach in clinical trials. This includes the implementation of substudies to document key aspects of phage therapy application and the development of consensus protocols for evaluating phage-specific immunity, pharmacokinetics/pharmacodynamics (PK/PD) relationships, and phage resistance mechanisms. Such measures are vital for understanding why certain therapeutic interventions succeed or fail, enabling researchers to refine and improve treatment strategies.

In advocating for this approach, Dr. Schooley highlights a fundamental challenge: the repetition of past mistakes due to a lack of comprehensive analysis and learning from failed trials. Without addressing this issue, the field risks stagnation, unable to leverage cumulative experience to accelerate progress. His passionate plea underscores the importance of not just aiming for short-term successes in phage therapy research but also building a robust and insightful framework that enhances the field's overall efficacy and resilience.

To learn more about Targeting Phage Therapy 2024 program and speakers, please visit: www.phagetherapy-site.com 


SEE

https://plawiuk.blogspot.com/search?q=PHAGES


Thursday, February 29, 2024

SOVIET SCIENCE

Case study highlights the potential—and challenges—of phage therapy

 
February 28, 2024


For over two decades, Lynn Cole was in a protracted battle with bacteria and her own immune system.

Diagnosed as having the autoimmune disease Sjogren's syndrome in 1999, Cole suffered from pulmonary fibrosis, was oxygen dependent and highly susceptible to pneumonia, and frequently needed antibiotics for recurrent lung and urinary tract infections. Her daughter, Mya, was there for all of it.

"Most of my childhood was doctor's appointments, inpatient hospital stays, treatments…all that kind of stuff," Mya Cole told CIDRAP News.

But around 2010, Lynn Cole began to have recurrent bloodstream infections caused by the bacterium Enterococcus faecium. From 2013 to 2020, she underwent several hospitalizations at University of Pittsburgh Medical Center (UPMC) for E faecium bloodstream infections and received multiple courses of intravenous antibiotics. At some point in her complex medical history, the bacterium had colonized her gut and become the source of the recurrent infections.

Over that period, Cole, whose case was described in a recent report published in the journal mBio, would typically be sent home with a PICC (peripherally inserted central catheter) line to continue the antibiotic treatment. But within a few days of finishing the antibiotics and removing the PICC line, Cole's blood cultures would be positive for E faecium again.

"We just continued that cycle over and over again, which was frustrating," Mya Cole said.

The cycle continued, with increased frequency, into late 2020, when Cole experienced 26 days of persistent E faecium bacteremia despite treatment with multiple antibiotics that showed in vitro activity against the bacteria.

At that point Cole's treatment team suggested bacteriophages—bacteria-killing viruses—as a potential solution. Cole, after conferring with Mya and her partner, Tina Melotti, said yes.

"We did a little research, and then we talked as a family and agreed that if it could give us a chance, we would try it," Mya said.

A phage cocktail suppresses the infection

To find a phage that might work for Lynn Cole's infection, her doctors turned to researchers at UPMC's Van Tyne lab, which studies how bacteria evolve to resist antibiotics and develops new approaches to treat resistant infections. After receiving the request from Cole's doctors in June 2020, when it had become clear that antibiotics were not going to solve the problem, the lab set out to find a phage that matched the strain of E faecium that was causing the recurrent infections.

Phages aren't hard to find, because they're one of the most abundant organisms on the planet. They can be found in soil, plants, sewage water, and even in the human body. But unlike antibiotics, which work against a narrow or broad spectrum of bacteria, phages have to match the exact strain of bacterium they are targeting to have an effect. That requires testing isolates from a patient's infection to find a match.

Vancomycin-resistant Enterococcus
Dan Higgins / CDC

Once a match is found, the identified phage then has to be grown, purified, and prepared for use in a patient. And that's only part of the lengthy process. Because phages are not approved for use in the United States, an Emergency Investigational New Drug (eIND) application for each individual case has to submitted to the US Food and Drug Administration to get the go-ahead. 

Ultimately, scientists at the University of Colorado found a phage—9184—that had activity against isolates collected from Cole's infection and sent it the Van Tyne lab, where it was propagated and purified. In December 2020, after spending 20 days in the intensive care unit, Cole began receiving three daily doses of the phage in combination with systemic antibiotics.

"And then, within 24 hours, the blood cultures were clear for the first time that month," said Madison Stellfox, MD, PhD, a member of the Van Tyne lab and co-author of the case report.

After being sent home from the hospital, Cole continued receiving antibiotics and the phage therapy through the PICC line under the supervision of Mya and Tina, both of whom work in healthcare. After a few breakthrough infections that were able to be managed at home, Stellfox and her colleagues added another phage—Hi3—to the treatment regimen.

We did a little research, and then we talked as a family and agreed that if it could give us a chance, we would try it.

Mya Cole

For several months, the phage cocktail appeared to be working. Later analysis of bloodstream isolates and rectal swabs by the Van Tyne lab would show that the abundance of E faecium in Cole's gastrointestinal tract—which the antibiotics alone could not tackle—decreased and remained suppressed when she began receiving the combination of the two phages and the antibiotics.

During that time, Cole was free of the bloodstream infections and able to travel. Her improvement enabled her doctors to step-down the antibiotic and phage regimen. Things were looking up.

"You could definitely tell that she was feeling better," Mya Cole said. "She had a lot more color in her face and a lot more personality."

An unforeseen immune response

If the story ended there, it would add to the list of successful compassionate-use cases whereby phages, in combination with antibiotics, have saved severely ill patients who have multidrug-resistant infections and have run out of options. That success has led to an increase in phage therapy requests.

But that's not where the story ends. On day 395 of her treatment, Cole suffered another E faecium bloodstream infection. At the Van Tyne lab, which had been regularly testing samples of Cole's blood serum that were collected by Mya and Tina to see if the cocktail was still working, they began to see a "precipitous decrease" in phage activity.

Lynn Cole and family
Lynn Cole (L), Tina Melotti (C), and Mya Cole (R)

When it became clear that the phage therapy was no longer suppressing the infection, Cole and her family decided to cut back on the treatment. She died of pneumonia in 2022, seven-and-a-half months after stopping phage treatment.

While Cole's infection had not become resistant to the phages or the phage-antibiotic combination, Stellfox explains, posthumous analysis of the isolates suggested that the addition of the second phage triggered an immune system response that may have blocked phage activity against the bacteria and resulted in a return of the recurrent bloodstream infections.

"We did see some binding of antibodies to those phages," Stellfox said. "I think that probably played some role."

Case highlights promise, pitfalls

In the paper, Stellfox and her colleagues note that Lynn Cole's experience may not be generalizable to a larger patient population. But she says the case nonetheless highlights both the potential and the pitfalls of phage therapy, which is being increasingly sought out with the emergence and spread of multidrug-resistant bacterial infections and the weak pipeline for new antibiotics.

One major point for her is that phage therapy is safe: The Van Tyne lab has now treated more than 20 patients with phages they've prepared, including 2 others with the same cocktail given to Lynn Cole, and they've seen no severe adverse events.

"I think it shows that if you take the time to do the matchmaking and find that right phage, [phage therapy] can really have a great role in the future," she said.

The challenge of working with phages, however, is that they are not chemicals with set structures, Stellfox noted. And the field lacks the kind of standardized procedures that exist with antibiotics and other approved drugs.

"They're living entities…they adapt, they change, and that's a great thing about them," she said. "But it can also make things trickier."

The immune system is one place where things can get tricky. That's because little is known about what kind of immune response phage therapy will provoke, says Steffanie Strathdee, PhD, co-director of the Center for Innovative Phage Applications and Therapeutics (iPATH) at the University of California, San Diego. For the most part, the focus has been on the interaction between the bacteria and the phage, with the human immune response the "missing part of the triangle."

They're living entities…they adapt, they change, and that's a great thing about them....But it can also make things trickier."

Madison Stellfox, MD, PhD

Strathdee, who co-authored the book The Perfect Predator, which describes her husband's life-threatening Acinetobacter baumannii infection and the phage cocktail that saved him, says that in the compassionate-use cases where phages are needed to save a patient's life, clinicians don't have the luxury of time.

"I don't think it's any surprise that we're going to see cases where antibody is generated against phage," Strathdee said. "But there's no time to say 'hold on, let's assess the patient's immune system to see if there are pre-existing antibodies directed against the phage.' "

Phage therapy 3.0

But just because phages can generate an immune system reaction isn't a reason to "throw out the baby with the bathwater," Strathdee adds, explaining that there have been some cases in which phage therapy has provoked an immune response that wasn't clinically relevant and the patient improved. In addition, she noted, the limitless supply of natural or genetically modified phages means researchers can source new phages that the human immune system hasn't seen yet.

Ultimately, Strathdee believes that what researchers learn from this case and others, along with clinical trials that are under way, will help inform the next stage of phage therapy, or phage therapy 3.0, as she calls it.

"Now we can get smarter about it," she said. "As phage therapy starts to become more mainstream, this issue of the human immune system and its role in phage therapy will become more important."

As phage therapy starts to become more mainstream, this issue of the human immune system and its role in phage therapy will become more important.

Steffanie Strathdee, PhD

Stellfox hopes the case report will help inform future phage research, and says some of the credit should go to Mya and Tina, whose regular collection of blood serum enabled her and her colleagues to get a better understanding of what happened and present their findings.

"They helped us so much, and we are indebted to them," she said.

Mya Cole says that although her mother knew there was no guarantee that phage therapy would cure her or prolong her life, she wanted people to know about and learn from her experience.

"She was very adamant that even though [a cure] couldn't be guaranteed, she wanted her story and her experiences to continue on, even if she did not, so that it could help other patients," she said.

SEE