First new antibiotic in 30 years discovered in major breakthrough | Hacker News Reader

First new antibiotic in 30 years discovered in major breakthrough

telegraph.co.uk

198 points_lbaq56 comments

The original paper, from January 2015: http://www.nature.com/nature/journal/v517/n7535/full/nature1...

And a more easily comprehensible summary of it: http://blogs.sciencemag.org/pipeline/archives/2015/01/08/tei...

The most interesting part of this is how the compound was discovered:

> A multichannel device, the iChip, was used to simultaneously isolate and grow uncultured bacteria. A sample of soil is diluted so that approximately one bacterial cell is delivered to a given channel, after which the device is covered with two semi-permeable membranes and placed back in the soil. Diffusion of nutrients and growth factors through the chambers enables growth of uncultured bacteria in their natural environment. The growth recovery by this method approaches 50%, as compared to 1% of cells from soil that will grow on a nutrient Petri dish.

The iChip was originally described in an April 2010 paper (http://aem.asm.org/content/76/8/2445.long), and builds on earlier work from 2002 (http://science.sciencemag.org/content/296/5570/1127), along with advances in microfluidics.

Could antibiotics (especially anti-resistant antibiotics such as this) be used in a phased manner worldwide to help prevent resistant bacteria from gaining a foothold?

Say a couple similarly potent (a few vectors to kill bacteria) antibiotics are found in the next 20-30 years. If the WHO encouraged/mandated that drug A was prescribed for the first 10 years, B for the next, then C before going back to A could we "confuse" the bacteria?

Great question, love to hear the answer on this !

It would help. But when they are patented, the structure is in the open and anyone with good knowledge of synthesis can produce them, e.g. for treating livestock in China or for sale on the grey market in India.

Or for treating livestock, chest pains and flu symptoms in America. Don't forget you'd need the government on side and America's doesn't have a good track record of cooperating with the rest of the world for the global good.

The theory is sound [1], but as in many situations with a lot of different actors, you get some coordination problems. Already many countries have some rules about how and when you can use certain anti-biotics, and some countries completely ignore them, or ignore them when it's profitable (farmers, usually, from what I gather.[2])

Even given the variety of anti-biotics we have now, if they were on a kind of 4 or 5 year rotation schedule that was actually followed, given the reproductive rate of bacteria i suspect that would work anyways, so hoping for coordination would certainly help, a solution that wouldn't require humans being more cooperative would be greatly expanding the diversity of our anti-biotics.

[1] http://science.howstuffworks.com/life/cellular-microscopic/d... [2] https://www.youtube.com/watch?v=xZbcwi7SfZE

Out of curiosity, is there a reason antibiotic cocktails aren't used more often? Cost?

Seems like it would be more productive and play to human nature if we could decrease the cost of cocktails and mandate that they're always used instead of singular antibiotics.

When considering the axis of creating super bugs, cocktails would probably exacerbate the problem, since now you're applying several stressors in parallel. Unless you had like, 5 or so fundamentally different avenues of attack, then you could get, what, 30~ unique combos? Most people don't need anti-biotics more than 10 times in their life? If it they were equally valid in any case, doctors could just choose randomly from the set of cocktails they haven't used on a given patient before. I'm certain a cell biologist would tell me this is a dumb plan for some reason, though.

I think a big part of it is that single antibiotics have been quite effective. So there isn't a developed practice of using cocktails and the interactions and so on aren't necessarily well tested/understood.

The most recent course of antibiotics I took was a combination of antibiotics though, so it's changing.

https://en.wikipedia.org/wiki/Amoxicillin/clavulanic_acid

Once this gets approved for human use it should be put on lock down and be used only in extreme cases of resistant infections. Like a last resort cure to avoid the mistakes of the past and prolong it's usefulness.

Notably, that's one reason there so little investment in antibiotic r&d. The concern is that sales of a new antibiotic could be very limited because of this very concern.

I haven't considered that but its indeed a valid point.

This only means that this research should be done by state funded universities and not left to commercial industries.

That pretty much sums up all large technological shifts. They almost to a T seems to happen when there is a military need for them.

> This only means that this research should be done by state funded universities and not left to commercial industries.

As anybody who has worked in academia for long enough can tell you, state-funded universities are very much a "commercial industry" and are in no way exempt from market forces. There are a few extra layers of indirection, which slow them down, but the end result is the same.

This still requires for some company to produce the drug and get it approved by the FDA.

Unless there's some unforeseen toxicity, I don't think they should make it a last resort drug. Just use when necessary.

We already have some very effective, semi-toxic antibiotics like colistin and other peptide-based antibiotics that we use as last resorts.

"use when necessary" is really hard to achieve I think. Will be easier to make a policy to keep the medicine use under control rather than change people's mentality over over-prescribing (includes both doctors and patients - all are guilty)

Most importantly, don't feed it to livestock.

From the article: "Crucially, the scientists believe that bacteria will not become resistant to Teixobactin for at least 30 years because of its multiple methods of attack."

Can anyone tell me what would happen if we instead _only_ used this new antibiotic, or at least used it instead of others as often as possible? If it is indeed so potent that bacteria would have difficulty developing a resistance, could we essentially use that window to let resistances to all the other antibiotics die out?

I doubt that 30 year window. If if were nearly impossible to build a resistance, the bacterium producing the antibiotic would poison itself.

And I am not sure how you'd convince people in underdeveloped countries to use the new and expensive drug only.

The bacteria has had far more than 30 years to develop resistance, and it could do it in stages. We don't know how many other bacteria over the gigayears managed to poison itself.

True, but for one, the antibiotic will be produced and used in really large doses once it enters the market, meaning there are trillions of bacterial cells encountering it, which raises the likelihood of development of resistance. And second, horizontal gene transfer between bacteria means different strains of bacteria can cooperate in defeating it (https://en.wikipedia.org/wiki/Horizontal_gene_transfer)

I feel like reading about cryptanalaysis and entropy.

I'm not sure the resistance to other antibiotics would die out.

Resistances do die out; they typically aren't free to acquire. However, I suppose it's likely that a mere 30 years isn't enough to extinguish all traces, especially since it's impossible to really mandate a world-wide ban on certain antibiotics. So even if resistance is reduced, it's possible it'll to come back quickly.

Not necessary. According to the paper

    "Teixobactin inhibits cell wall synthesis "

Its no more possible that a cell could become resistant, than you or I could become resistant to having our head blown off.

The real mechanism of resistance is in how it inhibits cell wall synthesis. Plus there are general mechanisms such as drug efflux and prevention of drug entry into the cell.

See, it must be specific enough to not kill our cells, otherwise it is worthless.

Does it also inhibit cell wall synthesis of non-bacteria cells? If yes, it's toxic to us. If no, bacteria cell walls could evolve to be more like non-bacteria cell walls in order to avoid this. Two links from the Wikipedia article on Teixobactin about this: http://www.the-scientist.com/?articles.view/articleNo/41850/... http://www.bbc.com/news/health-30657486 (Actually, Teixobactin only works on gram-positive bacteria, not on gram-negative ones which have an extra membrane.)

Only bacteria, plants, fungi, etc. have cell walls. Animals don't have them.

All cells do have a cell membrane, but that's a totally different structure.

Thanks for the correction.

Unsung heroes. Our civilization seems to have an addiction to dancing on the edge of a cliff. Thanks to heroes like these, we can dance a little longer. At least until the hot coals get us.

Dancing on the edge is the economically sensible thing to do. Same reason you only spend so much on earth quake resistance if they only happen once every 50 years. Let the whole city fall down and rebuild is cheaper than an earthquake tax on everything every year.

A better idea is to have 2 cities - one built with earth quake resistance, and the other not - and give people the choice about which one to live in.

Then it shouldn't take more than a couple of earthquake iterations to sort out the gene pool.

The mistake you're making is to assume it's cheaper to build non-earthquake resistant structures. It's actually just another iteration of the cheap boot problem.[1]

[1] http://www.goodreads.com/quotes/72745-the-reason-that-the-ri...

What makes me nervous about this is that the antibiotic resistance paranoia will die out, and we'll just start using more antibiotics again.

It's not unlikely.

But it's not really paranoia, though, as antibiotic resistance poses a real threat.

Just because you're paranoid doesn't mean there really aren't those (diseases) out to get you...

Alternatively -- are you paranoid enough?

(Ah, this is the same old news first published last year, iirc. This was from January. This is from January 2015: http://www.independent.co.uk/life-style/health-and-families/... )

Edit: To see more discussion over the last 18 months, google: teixobactin site:news.ycombinator.com. This seems the biggest story: https://news.ycombinator.com/item?id=8852487

I don't see how what you write is relevant; paranoia is unreasonable by its definition [1], as opposed to rational fear.

[1]: http://www.merriam-webster.com/dictionary/paranoia

You _almost_ got the joke, better than expected for a Norwegian. :-)

For people outside of this mutual admiration society:

This is funny since I'm Swedish -- Swedes/Norwegians used to tell bad "racist" jokes about each others. The level was really low, like "Why don't they use underwear when picking strawberries in Oslo? To keep the flies out of the face."

(I always thought those were extra funny, since a relative of mine got promoted to general major for killing lots of Swedes in war in Norway a few centuries ago. :-) )

Hah!

I got the gist of it, dear svenskejævel, but I mistook your sarcasm for bona fide paranoia ;)

As for intra-Scandinavian relations: I think we can all agree that the Danes are the worst of us - and their language is just ridiculous [1].

[1]: https://www.youtube.com/watch?v=s-mOy8VUEBk

For the non Scandinavians:

Denmark is an old trade nation. When you do business with them, some innocent paragraphs in the contract usually end up with them earning lots more. And they think that is a bit too funny.

At least, that is how the rest of the Nordic countries tend see them.

Also, they are too friendly and too often in a good mood. Weird people, especially my relatives down there. They could almost be called "normal Europeans", or something. Probably get too much sun in the winter.

(Most wars in Europe between two countries weren't France/England, it was Denmark/Sweden. Norway used to fight with the Danes. No one likes the Swedes, not even themselves.)

Edit: I might add that the oil could probably have happened to nicer people, but the Norwegians really deserved a break after a hard history with bad farming and bad neighbours. :-)

Edit 2: Sorry for chatting about irrelevant subjects on HN. Down votes are humbly accepted.

Perhaps, but it is not like there is a significant wave of new antibiotics being discovered now.

I don't quite understand why this is news now. It's been amply published in academic and popular media (including tech-leaning places like http://arstechnica.com/science/2015/01/a-new-kind-of-antibio...). Has there been some new development?

Discovery of teixobactin was announced in early 2015.

It was done using isolation chips to culture Eleftheria terrae (temporary name), a bacterium discovered in 2014.

Why are we as a culture not putting much more effort into bacteriophage therapy? It was big in the USSR but seems to have been ignored by contemporary medicine, despite having at least two major advantages against resistance - physical mode of action, and being capable of evolution itself.

Bacteriophages are neat but we shouldn't pretend like it's totally surprising why they aren't used. For one, they are constantly evolving so it's very difficult to produce a well-defined stable bacteriophage. The version you test in clinical trials is often completely different from the one you'd get treated with a year later.

https://en.wikipedia.org/wiki/Phage_therapy#Safety

But more importantly, your comment is off-topic.

Hardly off topic when talking about the dearth of new antibiotics.

As for constant evolution - just put known samples on ice? (I wonder if it would be possible to use DNA printing to load them with a tested genome?) Regardless though, they are unlikely to evolve towards uselessness, and they can't attack human cells, so, does it matter if they drifted some?

> But more importantly, your comment is off-topic.

I'm just curious, how is it that you see this comment as off-topic? I'm confused.

Bacteriophages are brought up every single time antibiotics are discussed, and always framed as some incredible low-hanging fruit left by the soviets that Americans have stubbornly neglected. I think you really need to keep the discussions more focused than that, especially when the article is about the development and impact of this particular antibiotic.

Otherwise, we end up with the comments for every article touching on city design just rehashing the same arguments regarding car-pedestrian trade-offs ("Did you know that Big Auto had a master plan to kill off the LA street car system!?!?"), and the comments for every article on military jets bemoaning the loss of the A-10 Warthog.

While ycombinator tends to be inhabited by professional and intelligent men and women, they hail from a number of different disciplines and backgrounds. That is to say, Hacker News is not an antibiotics specialist blog/forum, and people would like to converse and learn from others more broadly than you are demanding.

It has nothing to do with training in antibiotics, or anything else biological, as I have none. I have seen the identical arguments rehashed here a dozen times, and they are low quality. (As JulianMorrison's comment, where he does not mention the very first objections in the wikipedia article, and then dismisses them based on laymen intuition when questioned.)

perhaps.

Phages are much more targetted and specific than an antibiotic. They can be developed for specific bacterial targets (e.g. listeria, e.coli, etc) and they are in fact used in the food industry for such purposes, but this same specificity in bacterial targets also seems to mean that they are less applicable in general medical applications.

> The lack of new drugs coupled with over-prescribing has led to bacteria becoming increasingly resistant to modern medicines.

The article doesn't mention meat industry as the biggest consumer of antibiotics.

Quick, to the pig troughs!

"could be available within five years."

Ah, the usual codeword for "this won't happen"

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