[HN Gopher] No antibiotics worked, so this woman turned to phage...
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No antibiotics worked, so this woman turned to phage scientists
Author : LinuxBender
Score : 130 points
Date : 2022-07-09 16:41 UTC (6 hours ago)
(HTM) web link (edition.cnn.com)
(TXT) w3m dump (edition.cnn.com)
| chasil wrote:
| It appears that commercial sources are already available.
|
| https://mybacteriophage.net/
|
| Anyone with an aggressive bacteriological infection should be
| aware of and consider phage therapy when beginning treatment.
|
| It is also important to pre-treat the selected phage in a
| concentrated solution of the pathogen to allow time for
| adaptation prior to injection.
| uthinter wrote:
| Georgia, the country. It has some of the best research and
| treatment facilities when it comes to phage therapy.
| gnicholas wrote:
| > _But the long illness took its toll: Patterson was diagnosed
| with diabetes and is now insulin dependent, with mild heart
| damage, no feeling in the bottoms of his feet and gut damage that
| affects his diet._
|
| So if he had received the phage treatment sooner, would that have
| lessened these effects? Or are they sure that these effects were
| not caused by the phages themselves? Obviously it's better to be
| alive, even with these effects, but if doctors were choosing
| between several options for a future patient, they'd presumably
| want to know the causal chain.
| elcritch wrote:
| Yes getting the treatment sooner would've prevented damage,
| though how much would be harder to say. According to the
| account, by the time of treatment the bacterium had caused
| widespread damage and the patient had multiple organ failure
| before the treatment.
|
| Phages are also highly adapted to attack bacteria and often
| specific bacteria. It's highly unlikely to affect humans.
| That's easy to show since dirt is loaded with bacterial phages.
|
| Additionally there was significant research in Soviet bloc on
| the safety and efficacy of phage treatment.
|
| I'm hoping phage treatment becomes more common and better. The
| rise of bacterial superbugs is one of the greatest threats to
| modern life, as in we don't expect ourselves or loved ones to
| die routinely from bacterial infections. However that's very
| recent thing in human history. I'd readily wager that bacterial
| diseases have killed far more people than viral infections.
| They're the literal plague.
| pieter_mj wrote:
| There's also the success story of terror victim Karen
| Northshield. She has had about 70 operations after the march 2016
| Brussels airport attack.
|
| In the beginning of her recovery, she survived life-threathening
| bacterial infections with phage therapy.
| Traubenfuchs wrote:
| Why do we keep reading annoyingly insular case reports of people
| with relatively common, but highly multi drug resistant bacteria
| who get saved by phages, while at the same time being afraid of
| the antibiotic apocalypse?
|
| What keeps us from having a register/bank of highly effective
| phages to treat people with those boring old multi drug resistant
| bacteria bacteria?
|
| Why do we keep saving and at the same time ruining peoples lifes
| with fluoroquinolones, gentamicin and other dangerous antibiotics
| instead of just giving them phages?
| coryrc wrote:
| > What keeps us from having a register/bank of highly effective
| phages
|
| The FDA. The only freedom you have in the USA is to die.
|
| Oh, sure, you are allowed to do it entirely yourself and with
| your own funds, but you can't share the burden with people. Yay
| freedom.
| jryb wrote:
| It's super complicated - clinical trials of phage therapy have
| been relatively unsuccessful for one thing, so there's that.
| But additionally: - Bacteria adapt to phage
| infections, just as they do to antibiotics - Many phages
| are very host-specific, so a given cocktail might not even be
| able to target the pathogenic bacteria in question. There are
| phages with broader host spectra, but then they might be able
| to target the rest of your microbiome, which can lead to other
| health problems - Since phages have protein shells, human
| antibodies will target them, and may prevent them from reaching
| the infected tissue. You might also only be able to use a
| particular phage once for this reason.
|
| I could go on, but suffice it to say, there are lots of
| unknowns and lots of complexity. Still, I do have hope for the
| technique in general, and our ability to understand phage-
| bacteria interactions is only getting better now that
| sequencing is super cheap. But I wouldn't bet my life on phage
| therapy working if I needed it today - which is why it's
| generally limited to compassionate use when antibiotics have
| failed.
| treeman79 wrote:
| How on earth did she get approval?
|
| It took me a year of doctor shopping to get an approved treatment
| for a common condition.
| docdeek wrote:
| Very interesting - thanks for sharing. I'm not a scientist and
| the only time I've come across discussion of phages before was in
| the Michael Crichton novel, Prey.
| carapace wrote:
| In a nutshell, it works but antibiotics work better (until they
| don't, eh?), so phage therapy was largely eclipsed in the West.
| However:
|
| > Isolated from Western advances in antibiotic production in
| the 1940s, Russian scientists continued to develop already
| successful phage therapy to treat the wounds of soldiers in
| field hospitals. During World War II, the Soviet Union used
| bacteriophages to treat many soldiers infected with various
| bacterial diseases e.g. dysentery and gangrene.[28] Russian
| researchers continued to develop and to refine their treatments
| and to publish their research and results. However, due to the
| scientific barriers of the Cold War, this knowledge was not
| translated and did not proliferate across the world.
|
| https://en.wikipedia.org/wiki/Phage_therapy
|
| See also https://en.wikipedia.org/wiki/Marine_bacteriophage
| (for fun, or maybe horror? The oceans are _grey goo_.)
| neodypsis wrote:
| That Wikipedia entry mentions that bacteria may develop
| immunity from previous bacteriophage infection.
| robocat wrote:
| > However, due to the scientific barriers of the Cold War,
| this knowledge was not translated and did not proliferate
| across the world.
|
| I would hazard a guess that the reasons are other than
| translation. Keen scientists learn enough of foreign
| languages to read papers in their area of interest - reading
| scientific language in a speciality area is much easier than
| learning a language generally (I personally know scientists
| that have self-taught themselves for Russian, German, French,
| etcetera).
|
| "Many researchers agree that the development of phage therapy
| has stalled because of 'concerns over intellectual property
| protection' and 'lack of a predefined regulatory pathway'
| (Kingwell, 2015)" https://academic.oup.com/phe/article/13/1/8
| 2/5741402?login=f...
|
| > across the world.
|
| Is that an American centric worldview? It makes little sense.
| Maybe the USA and allies, but there is a lot more to the
| world than that, and phages haven't been used. The reasons
| for that are very unlikely to be due to what appears to be a
| simplistic world view.
| carapace wrote:
| I gather phage therapy was seen in Western bloc nations as
| akin to Lamarckian evolution, so even otherwise keen
| scientists tended to dismiss it. And of course, antibiotics
| work really well (until they don't.)
|
| I have no idea how widespread phage therapy was in the
| Soviet bloc nations.
|
| The Cold War distorted a lot of things.
| DonaldFisk wrote:
| Bacteriophages are also in Arrowsmith by Sinclair Lewis, where
| they were used to treat plague.
| eranation wrote:
| > First, Strathdee found an obscure treatment that offered a
| glimmer of hope -- fighting superbugs with phages, viruses
| created by nature to eat bacteria.
|
| > Then she convinced phage scientists around the country to hunt
| and peck through molecular haystacks of sewage, bogs, ponds, the
| bilge of boats and other prime breeding grounds for bacteria and
| their viral opponents. The impossible goal: quickly find the few,
| exquisitely unique phages capable of fighting a specific strain
| of antibiotic-resistant bacteria literally eating her husband
| alive.
|
| > Next, the US Food and Drug Administration had to greenlight
| this unproven cocktail of hope, and scientists had to purify the
| mixture so that it wouldn't be deadly.
|
| > Yet just three weeks later, Strathdee watched doctors
| intravenously inject the mixture into her husband's body -- and
| save his life
| [deleted]
| stareatgoats wrote:
| What an amazing story, one which should give hope to the many
| people that are battling superbugs as we speak. Her (Strathdee's)
| Wikipedia page gives some more background, out of which this
| stood out to me:
|
| "Although phage therapy had been used for one hundred years in
| Eastern Europe, it was not licensed for clinical use in the
| United States or most of Western Europe" [0]
|
| Which indicates (if not proves) that healthcare is one one of the
| casualties of our polarized world.
|
| [0]
| https://en.wikipedia.org/wiki/Steffanie_A._Strathdee#Role_in...
| bsedlm wrote:
| it's really terrible how the caring for one's health aspect of
| the medicine industry has taken a secondary role, the really
| important thing is corporate profit, patients are getting
| treated, but not healed
|
| this is not to say the treatments are not effective, but I
| think it's telling to consider that the reason treatments
| remain effective is to avoid defrauding customers (err.
| patients), not becuase the intention is healing people.
| kosyblysk666 wrote:
| t_mann wrote:
| Thanks for sharing. Multiresistant bacteria are high on my list
| of slow-mo crashes happening before our eyes that no one seems to
| be talking about (compared to eg climate change, which is also a
| slow-mo catastrophe, but at least one that people are talking
| about). And it's always puzzled me how little I hear about work
| being done on phages, which pose an interesting approach to
| tackle the problem (compared to eg quantum computing, where
| commercialization potential seems to be a lot further out).
| Loic wrote:
| At least in France, a series of antibiotics are not allowed to
| be used/sold outside of hospitals. This is to ensure that
| hospitals have some _last resort_ antibiotics in hard cases.
| But even with that, they have issues.
|
| In Germany, where I live at the moment, the risks and issues
| are well known and talked about. I have seen a large reduction
| of the prescription of antibiotics. The younger the MD, the
| less antibiotics are given.
|
| But 80% (maybe even more) of the antibiotics are used by animal
| farming...
| belorn wrote:
| It kind of worries me when people talk about reduction in
| prescription of antibiotics. If we are talking about
| primarily about false diagnoses and prescription of
| antibiotics when there exist equal or better treatment plans,
| then a reduction in antibiotics is good. The day when people
| got antibiotics in order to treat a cold is hopefully over.
|
| The cases that worries me most is however debilitating
| chronic illnesses (where antibiotics is used as a stop gap
| until medical science find a cure), and illnesses which if
| let untreated might turn into a debilitating chronic problem.
| I hope they are keeping a close watch on the outcomes from
| those younger MDs.
|
| Antibiotics in animal farming is obviously terrible. Animals
| should not be allowed to be kept unless it is in an
| environment that is safe and healthy for them. Antibiotics is
| a tool used to fix how poor some large scale farmers treat
| their animals.
| gwerbret wrote:
| > The cases that worries me most is however debilitating
| chronic illnesses (where antibiotics is used as a stop gap
| until medical science find a cure)
|
| Which debilitating, non-bacterial chronic illnesses are
| treated with antibiotics as a stopgap measure?
| Teever wrote:
| not necessarily debilitating, but current treatments for
| rosacea include a low dose prescription of antibiotics
| like doxycycline, basically forever.
| sterlind wrote:
| acne is bacterial but chronic. it's standard practice for
| dermatologists to prescribe long-term antibiotics for
| severe acne, rather than turn to accutane.
| NikolaNovak wrote:
| Controversially but famously, "chronic Lyme disease"
| involves course of multiple super strong antibiotics over
| potentially years. Then things to try to save your organs
| from antibiotics. Then pills to help you digest those.
| Taking 50 pills on regular basis is apparently common
| enough.
| sterlind wrote:
| iirc antibiotics in cows are _not_ principally used as
| medicine. it 's because chronic antibiotic use makes cows
| put on weight faster. I don't know the mechanism.
| voisin wrote:
| > But 80% (maybe even more) of the antibiotics are used by
| animal farming...
|
| This is what needs to be talked about more. Like guns in the
| US, or telecom oligopolies in Canada, it seems animal based
| agriculture gets the "thoughts and prayers" treatment rather
| than any substantive discussion about what harm it is causing
| the planet, human health, and biological safety via
| antibiotic resistance.
| nradov wrote:
| The FDA is actively working on this issue.
|
| https://www.fda.gov/animal-veterinary/safety-
| health/antimicr...
| Terry_Roll wrote:
| It is. https://www.worldanimalprotection.org.uk/sites/defau
| lt/files...
|
| 1ml of sea water will contain billions of phages, but its
| pot luck if you get the right strain.
|
| Another thing not mentioned with antibiotics is man y are
| penicillin based that when metabolised become penicillamine
| which is used to treat copper toxicity or Wilson's disease,
| ie it makes the liver dump copper out of the body. Copper
| is needed to produce Interleukin-2, a naturally occurring
| chemo drug, most effective when injected into tumours, but
| having naturally high levels circulating can be helpful as
| a prevention measure.
|
| Creatine when metabolised becomes creatinine which in
| sufficient qty can kill gram positive and gram negative
| bacteria. If you get 3rd degree burns, the muscles
| catabolise to release creatine and then the creatinine
| helps to keep bacteria at bay with the wounds.
|
| It probably also explains why the US military are
| reportedly the only one's to use copper sulphate to debride
| battlefield wounds. Even the WHO dont recommend using it!
| Copper sulphate will dissolve skin though.
|
| Vitamin D also increases creatinine, and because creatinine
| is used for estimated glomular filtration rate kidney
| tests, high levels of creatinine can make you appear to
| have various stages of kidney disease. Medical lab tests
| (human and veterinary) can not tell if you are
| supplementing so dont get an inaccurate diagnosis.
| jryb wrote:
| There are plenty of people/companies working on phage
| therapies, and there are clinical trials happening now [1]. In
| some eastern European countries you can buy phage solutions
| over the counter. It just doesn't get much press - though I'd
| speculate that's because phage therapy clinical trials have
| been pretty lackluster so far.
|
| 1:
| https://clinicaltrials.gov/ct2/results?cond=&term=phage+ther...
| Archelaos wrote:
| Research in the field of phage therapy has traditionally been
| strong in the Soviet Union since the 1920s and in other Eastern
| Bloc countries such as the GDR after WW2. In recent years, the
| area has gained renewed attention in Germany. There exists
| currently an extensive programme of basic research on phages
| funded by the German Research Foundation (DFG). The project Web-
| site is located at: https://spp2330.de/
| jamal-kumar wrote:
| Shout out to the country of Georgia for being the stronghold of
| this since the 1920s [1]
|
| [1] https://eptc.ge/
| blacksmith_tb wrote:
| They've registered an even better domain name I see:
| https://pha.ge/
| bijant wrote:
| Broad Spectrum Antibiotics were superior to Phage Therapy when
| they were first introduced, as they didn't necessitate time
| intensive cultivation of the pathogen prior to administration.
| The high selectivity of Bacteriophages was their main
| disadvantage. Today, with all the knowledge about the
| importance of a healty gut Biome, the potential risk to "good
| bacteria" has to be weighed before administration of
| antibiotics is considered. Fast diagnostic tests, like the use
| of PCR to detect Covid-19, turn Phage Therapies greatest
| Drawback, its selectivity, into its greatest advantage.
| PaulKeeble wrote:
| There are two really interesting parts of Russian medicine which
| the West hasn't really pursued which it should. Phages is one and
| they really are an incredible solution to antibiotic immune
| bacteria, the issue is always finding the right one, there are so
| many different phages and bank of all of them would be enormous,
| 10s probably 100s of thousands.
|
| The second is auto vaccines and Lysates which present dead
| bacteria to the body so it can create an appropriate immune
| response. They are used in Russia for things like Urinary tract
| Infections which in the West are often untreatable with
| antibiotics but they do seem to work. Get the immune system to
| recognise the baddy and work out how to kill it and then in the
| harder to reach places it can be effective. Works fairly well for
| Chronic infections but the issue is identifying the bacteria
| precisely to match and existing mix or collecting the bacteria
| and cultivating and killing it mechanically or with heat so it
| can be injected back into the patient safely in other places in
| the body.
|
| Both techniques were outrun by antibiotics in the beginning,
| antibiotics are a lot easier to administer as you don't have to
| identify the pathogen precisely and its easy to make in bulk. But
| both these more natural solutions are a lot harder for bacteria
| to become immune to and have undergone the evolutionary process
| alongside us and them. I think both are worth serious efforts and
| development.
| chasil wrote:
| Ideally, the bacteria can't become immune.
|
| The virus evolves and adapts with the bacteria, modifying its
| receptors and modes of action as the host survivors mutate,
| which is beyond the capability of a chemical antibiotic.
|
| This is why it is so important to pre-treat the phage in a
| concentrated solution of the target pathogen prior to injection
| into a patient, which allows the virus to maximize infectivity.
| elcritch wrote:
| It seems that'd help make semi "broad spectrum" possible as
| well.
|
| Manufacture a serum loaded with hundreds or thousands of
| phages known to target superbugs and let them decimate the
| bacteria. Choose the survivors. If you could automate the
| last step it could be something any old doctors office could
| do.
| chasil wrote:
| It is important to carefully match the phage with the
| target pathogen. A mismatched phage will not be effective.
|
| This tool can't be used like antibiotics. It requires
| expertise in classification.
| anewpersonality wrote:
| Why don't we use machine learning to find phages?
| saiya-jin wrote:
| That would explain why urinotherapy may work. Expose your
| immune system to pathogens that are in place unreachable to it,
| to mount response (multiply antigens that work on them) and
| voila. Just that whole idea is rather hard to swallow...
| adventured wrote:
| You might notice something very peculiar about this story. Here
| are the pieces:
|
| > What she accomplished next could easily be called miraculous
| [bullshit]
|
| > Buoyed by her newfound knowledge, Strathdee began reaching out
| to scientists who worked with phages: "I wrote cold emails to
| total strangers, begging them for help," she said at Life Itself.
|
| > she convinced phage scientists around the country to hunt and
| peck through molecular haystacks
|
| > One stranger who quickly answered was Texas A&M University
| biochemist Ryland Young. He's been working with phages for nearly
| 45 years. Young, a professor of biochemistry and biophysics who
| runs the lab at the university's Center for Phage Technology. "We
| just dropped everything. No exaggeration, people were literally
| working 24/7" ... [that's what happens when I need help,
| university departments drop what they're doing to assist]
|
| > Next, the US Food and Drug Administration had to greenlight
| this unproven cocktail of hope [in a week]
|
| > But the woman who answered the phone at the FDA said, " 'No
| problem.' ... " [like magic]
|
| > And then she tells me she has friends in the Navy [who doesn't]
|
| > Yet just three weeks later, Strathdee watched doctors
| intravenously inject the mixture into her husband's body
|
| > Legal staff at Texas A&M expressed concern about future
| lawsuits ... But Stephanie literally had speed dial numbers for
| the chancellor and all the people involved in human
| experimentation at UC San Diego. After she calls them, they
| basically called their counterparts at A&M, and suddenly they all
| began to work together [suddenly it happened, a miracle]
|
| Ready for it?
|
| > Strathdee was the associate dean of global health sciences at
| the University of California, San Diego
|
| It wasn't a miracle. It was extreme privilege. She had elite
| access and got extraordinarily special treatment and response at
| every step. The phage aspect is very interesting, I've been
| reading about phages on HN for over a decade probably (and in
| that time there has seemingly been relatively little progress in
| their usage in the West). The rest of the story is rather
| disgusting in how it's portrayed in the article vs what's
| actually going on (connections, status, privileged treatment). Oh
| but it was like a miracle - no, no it wasn't.
| DennisP wrote:
| I hope your point is that access to this shouldn't be
| restricted to such privileged people. The legal and regulatory
| barriers could be lifted, and if that happened then companies
| could be started to provide the therapy.
| anewpersonality wrote:
| I got this from the article too. This couple was incredibly
| connected.
|
| But.. they lived and worked in a field for 40 odd years, why
| the hell couldn't they take advantage of it? This isn't like
| Dad getting his frat bro son a job at Goldman.
| ratdragon wrote:
| https://en.wikipedia.org/wiki/Halicin - a recently (2019)
| discovered ATB with "an unusual mechanism of action" has been
| found to be effective against Acinetobacter Baumanii in mice.
| Found using deep-learning.
| yibg wrote:
| Great story and glad about the positive outcome. But also
| highlights the benefits of being well connected. Doubtful a
| couple in a similar situation that were not a professor and
| associate dean at a well known university could've obtained the
| same outcome.
| derbOac wrote:
| Yes, I had the same reaction. Altogether it's inspiring and I'm
| happy to see novel treatments like it when antibacterial
| therapies are desperately needed. At the same time seeing these
| inequities in the system was disturbing to me.
|
| It's not only the special privileges the couple enjoyed -- how
| they received the treatment and another did not -- it's also
| how generating some sort of enthusiasm about a research area
| can require this kind of private string pulling. If one of
| those researchers had submitted a research grant on phage
| therapy would it have been approved?
|
| I liked the article and am not meaning this as a criticism of
| it, the couple, the people involved, or the therapy. It's just
| revealing of structural problems in academics, health care, and
| society.
| hdjjhhvvhga wrote:
| Interesting topic aside, thank you so much for linking to the
| lite version.
| triyambakam wrote:
| I didn't even realize it was CNN
| mirekrusin wrote:
| Whoever came up with lite version at CNN should get standing
| ovation.
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