Phages are making a comeback | Hacker News Reader

Phages are making a comeback

motherjones.com

64 pointsjackweirdy29 comments

Summary:

- 68 year old male catches bacterial infection - Acinetobacter baumannii - on vacation in Egypt

- Traditional antibiotics courses don't work

- Wife suggested trying bacteriophages - aka "phages" - which are baceteria-targeting viruses

- Phages are not FDA approved, but can receive "compassionate-use authorization" — effectively an acknowledgment that nothing with an FDA license can save the patient’s life

- 23,000 people a year die from antibiotic resistant bacterial infections and phages are not necessarily on the radar due to their own bio-diversity (single phage for a single bacterium vs mostly catch-all antibiotics)

- The male patient was treated with phages, which worked, and lived

This treatment has always been popular / common in the (former) Soviet Union. Here is an article from 2014 on it: https://gizmodo.com/soviet-doctors-cured-infections-with-vir...

Also interesting is that medicine was never a particularly well paying job in the Soviet Union. At best it would be comparable to a civil engineer today; very much respected, but certainly not earning what a software engineer (or US doctor) would.

Why do you bring up the pay of Soviet doctors? Do you think the technology's introduction to common use was related?

Medicine is not a well paying job in many countries, even in "first world" countries.

My understanding is that while correct that is was the Soviet Union, it was mostly in Ukraine SSR. Could you comment?

Kurzgesagt goes through bacterophages in this video: https://www.youtube.com/watch?v=YI3tsmFsrOg

I think this is the case mentioned by Kurzgesagt in the video, although he doesn't use names, so I can't be sure. Super cool, anyways!

A lot of cystic fibrosis patients I know that have been colonized with bacteria, such as pseudomonas, resort to phage therapy. Typically they do it in Georgia (former Soviet Union state that was very active in Phage Therapy). Many CFers swear by phage therapy. It needs to be individualized, with adaptation to every individual.

Interesting plot twist regarding the former Soviet Union:

"D’Herelle was a restless researcher who seems to have felt undervalued despite being awarded jobs in Paris and Vietnam and at Yale. That insecurity made him vulnerable to an offer he received in 1933 to relocate to Tbilisi in Georgia, home territory of Soviet dictator Joseph Stalin. With a protégé, Georgi Eliava, d’Herelle co-founded the Eliava Institute of Bacteriophages, Microbiology and Virology. Stalin showered the institute with attention and money because it offered something he badly wanted: a scientific achievement that he could portray as a pure product of communism. Antibiotics became the basis of infectious-disease medicine in the West, but behind the Iron Curtain, phages took their place."

"Eliava was murdered in a political purge in 1937, and d’Herelle died in 1949. Their institute dwindled, but it survived the collapse of the Soviet Union in 1991 and the Georgian civil war the following year. When the former USSR opened up to the West, physicians in the United States and Europe learned the Eliava Institute was one of the few places in the world where researchers were still studying and administering phages. That was fortunate timing, because antibiotics in the West were losing their power under the onslaught of antibiotic resistance."

It's interesting to consider how ideology (capitalist vs communist) contributes to different approaches to problem solving. Is there anything about bacteriophages--including their manufacture and use--that actually makes them more "communist"?

> Is there anything about bacteriophages--including their manufacture and use--that actually makes them more "communist"?

I guess the bacteriophage RNA "seizes" the host cell's means of production (ribosomes). ;)

In general patents and making money from them was not a concern in Soviet Union so the science took some different paths over there. Meaning simpler and less expensive treatments for example in medicine. Phages is one example, cold laser treatments is another one. Norman Doidge talks about them in the "Brains's way of healing"

Lack of value of doctor labor and efficent labor in general perhaps? Since phages need a culture first to be sure the right one is selected. You can't just give broad spectrum phages. Which isn't just "laziness" or cutting corners on expensive labor but helpful for patient results so they don't get worse while waiting for results.

If I recall some accounts correctly Soviet doctors often depended upon grey market bribes to afford supplies if they weren't party favored. Phages were self replicating and needed fewer doses per patient if selected properly. However they are highly specific, and the phage banks need updated with every mutation which may happen mid-treatment. They are second in line for a good reason.

I remember reading a semi-biography of an old school doctor that went to med school in the 1930's.

Mentioned being a lowly resident late at night sitting next to a deathly ill patient with pneumonia trying to match antiserum to whatever bug the poor sap had. Nothing, nothing nothing, and then a match. Injecting the patent with the correct antiserum felt like magic.

Or the they would die anyways. Rarely they would go into shock and die.

Can imagine early antibiotics was so much easier. (big hammer)

From the article it appears phages were championed in the former Soviet Union purely because it was an approach that was not used by the West. Antibiotics apparently were easier to commercialize and phage research dwindled but did not completely die off as the solution phages discussed in the article were found in two separate US facilities (combining the work of others worldwide), at the Navy and Texas A&M.

there are a number of startups that have formed in the last year or two genetically engineering phages to treat disease. resistant bacterial disease is a common target, but given the growth in literature linking the microbiome to diseases from autoimmunity to cancer, there are companies trying to engineer phages to knockout bacteria implicated in non-infectious disease

eligo, locus biosciences, biomx have received venture funding and there are many earlier stage companies as well. engineered phage therapy for cancer will be a field to watch this year

There are some phages being marketed as prebiotics, I have been taking PreforPro[1], which does seem to have generally positive effects on my guts. Of course, that would entirely depend on whether or not any of the bacterial strains it targets happen to be present. But they being actively researched[2] so we should know more eventually.

1: http://www.deerlandenzymes.com/preforpro/the-science/

2: https://clinicaltrials.gov/ct2/show/NCT03269617

Taking any anti bacteria medication on a regular basis will encourage resistance. I can not how that would be considered a good idea.

I don't take it daily, but obviously there's been an ongoing battle between bacteria and phages for millions of years, it is unlikely they'd be selected for too strongly in my gut (assuming the targeted species are even present at any given time).

In the article it is speculated the main patient didn't get better during the initial course of treatment because the bacteria infecting him resisted the multiple phages they used to treat him - they were all variants of the same vector of attack(that worked in the labs on the bacteria in question), and the researchers had to find different phages to continue treatment, so they came across resistant bacteria immediately.

Perhaps this is a superficial comparison, but to me it's odd about the approval difficulty of phages considering that vaccines like the annual flu vaccine also rely on assembling new recombinations of flu strains every year too.

In general why do vaccines seem to be allowed approval to target specific strains only, but antibiotics need to be general purpose as implied by the article?

They don't. We are using vaccine technology from the 1940s. The FDA basically allows something that was developed before 1962 to continue, while anything it considers new (phages) have to go though the impossible FDA regulatory process.

The bottom line is if we didn't have a vaccine for the flu already it would be impossible to create one now.

The vaccine is new every year, some of the technologies for reproducing it are old, but the fundamental vaccine I thought are remixed annually. Otherwise it would not be effective vs constantly mutating wild flu strains.

Edit: added https://www.cdc.gov/flu/protect/vaccine/how-fluvaccine-made....

He's saying that if we hadn't already discovered vaccination before the FDA, then the FDA would have prevented us from using it when we did discover it. Which fits with what I know.

Yes the flu vaccine is updated every year (and occasionally they put the right strain into it), the technology used was developed in the 1940s. It is very crude, but thanks to the FDA no advance is practicable.

You might think this doesn’t matter, but we now know how to make a universal flu vaccine that doesn’t need to be updated each year. Apart from not needing to be jabbed every year, if we get another 1918 epidemic then we will find out how much we will regret not having a new vaccine.

The third method in that CDC link says it was approved in 2013. But I gather that's a new productions/replication method as opposed to a new method of selecting strains? But again, what is the difference between selecting flu strains to combat a given flu season, and selecting phages to combat a given resistant bacteria.

I'm excited for a universal flu vaccine too, and hope that somehow that vaccine gets funded and succeeds.

The difference is the flu virus keeps mutating while with phages you have a large collection and choose the ones that work on the infection the patient has.

The big problem with the flu vaccine is the lead times are so long (6 months) that the vaccine producers need to guess what strains will be circulating 6 months ahead. Since they lack a crystal ball they often get it wrong. The only real advance with the cellular vaccines is for people allergic to egg.

I am not that hopeful that a universal flu vaccine will get funded.

Kurzgesagt video on bacteriophages released a few days ago.

https://www.youtube.com/watch?v=YI3tsmFsrOg

Clickbai title.

The original title was clickbait, yes: "He Was Dying. Antibiotics Weren’t Working. Doctors Tried a Forgotten Treatment". Yea, but for one weird trick, the patient would have died. I'm not sure who hates him, but I'm sure someone does.

Mods or OP thankfully changed it.

The bacteria hate him, obviously

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