Novel Phage Therapy Saves Patient with Multidrug-Resistant Bacterial Infection

This is huge, though common use of this approach is still a ways off.

Novel Phage Therapy Saves Patient with Multidrug-Resistant Bacterial Infection

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The therapeutic approach, which has been submitted to a peer-reviewed journal, is scheduled to be featured in an oral presentation tomorrow at the Centennial Celebration of Bacteriophage Research at the Institute Pasteur in Paris by Biswajit Biswas, MD, one of the case study’s co-authors and chief of the phage division in the Department ‎Genomics and Bioinformatics at NMRC-BDRD. April 27 is Human Phage Therapy Day, designated to mark 100 years of clinical research launched by Felix d’Herelle, a French microbiologist at Institute Pasteur who is credited with co-discovering bacteriophages with British bacteriologist Frederick Twort.... “To our knowledge, he is the first patient in the United States with an overwhelming, systemic infection to be treated with this approach using intravenous bacteriophages. From being in a coma near death, he’s recovered well enough to go back to work. Of course, this is just one patient, one case. We don’t yet fully understand the potential — and limitations — of clinical bacteriophage therapy, but it’s an unprecedented and remarkable story, and given the global health threat of multidrug-resistant organisms, one that we should pursue.”

The story is fascinating with so many aspects like, one has to be privileged*, connected, very lucky and very unlucky to have this happen. [* I don't mean privileged in a derogatory way, rather it's an important issue I thought worth noting in the story. That this happened to people in such high positions in the medical field at a university hospital also meant research in this experimental treatment has taken a big step forward that might have otherwise taken years longer.]

On the medical side of the story, the man, "Tom Patterson, PhD, a 69-year-old professor in the Department of Psychiatry at UC San Diego School of Medicine," acquired the infection in Egypt. He was medevacked first to Germany then back to UC San Diego hospital's ICU. His infection was resistant to everything but eventually controlled with a drain to keep the pathogen contained.

That would have been a nightmare for the hospital's infection control team. Back to privileged, his wife is an infectious disease epidemiologist and director of the UC San Diego Global Health Institute.

At some point the drain slipped and the bacteria, Acinetobacter baumannii, poured into his abdomen and bloodstream. He lapsed into septic shock and a coma which lasted two months. He was near death.

There was another fascinating turn in the story adding the element that while the FDA regulations are good in many ways, sometimes research is easier in countries without such restricted oversight:

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Strathdee [his wife] began doing research. A colleague mentioned a friend had traveled to Tblisi, Georgia to undergo “phage therapy” for a difficult condition and had been “miraculously cured.” Strathdee had learned of bacteriophages while she was a student, but they were not part of mainstream medical doctrine. She turned to strangers in the phage research community and to her colleague Chip Schooley for help.

And yet another incredible aspect of privilege:

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With dwindling options, Strathdee, Schooley and colleagues went looking for help. They found many researchers willing to help. Three teams possessed suitable phages that were active against Patterson’s particular bacterial infection: the Biological Defense Research Directorate of the NMRC in Frederick, MD; the Center for Phage Technology at Texas A&M University; and AmpliPhi, a San Diego-based biotech company specializing in bacteriophage-based therapies. A research team at San Diego State University, headed by microbial ecologist Forest Rowher, PhD, purified the phage samples for clinical use. With emergency approval from the Food and Drug Administration, each source provided phage strains to UC San Diego doctors to treat Patterson, with no guarantee that any of the strains would actually work. “That’s one of the remarkable things to come out of this whole experience,” said Schooley, “the incredible and rapid collaboration among folks scattered around the world. It was a desperate time and people really stepped up.”

Connections, top researchers, highly motivated for multiple reasons, and Darwin:

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Bacteriophage therapy began March 15, 2016, with a cocktail of four phages provided by Texas A&M and the San Diego-based biotech company AmpliPhi, pumped through catheters into the pseudocyst. If the treatment didn’t kill him, Patterson’s medical team planned to inject the Navy’s phages intravenously, flooding his bloodstream to reach the infection raging throughout his body. As far as Patterson’s doctors knew, such treatment had never been tried before. On March 17, the Navy phages were injected intravenously. There were fears about endotoxins naturally produced by the phages. No one knew what to expect, but Patterson tolerated the treatment well — indeed there were no adverse side effects — and on March 19, he suddenly awoke and recognized his daughter. “One of NMRC's goals with respect to bacteriophage science has been providing military members infected with multidrug-resistant organisms additional antimicrobial options so we were experienced and well-positioned to provide an effective phage cocktail for Dr. Patterson,” said Theron Hamilton, PhD, head of Genomics and Bioinformatics at the Navy’s Biological Defense Research Directorate. “Obviously, we are thrilled with the outcome and hope this case increases awareness of the possibility of applying phage therapy to tough cases like this one.” Subsequent treatment, however, would not be easy. The learning curve was steep and unmarked. There were bouts of sepsis — a life-threatening complication caused by massive infection. Despite improvement, Patterson’s condition remained precarious. Doctors discovered that the bacterium eventually developed resistance to the phages, what Schooley would characterize as “the recurring Darwinian dance,” but the team compensated by continually tweaking treatment with new phage strains — some that the NMRC had derived from sewage — and antibiotics.

The patient has since recovered and returned to work.


Background on bacteriophages:

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Bacteriophages are ubiquitous viruses, found wherever bacteria exist. It’s estimated there are more than 1031 bacteriophages on the planet. That’s ten million trillion trillion, more than every other organism on Earth, including bacteria, combined. Each is evolved to infect a specific bacterial host in order to replicate — without affecting other cells in an organism. The idea of using them therapeutically is not new. Described a century ago, phage therapy was popular in the 1920s and 1930s to treat multiple types of infections and conditions, but results were inconsistent and lacked scientific validation. The emergence of antibiotics in the 1940s pushed phage therapy aside, except in parts of Eastern Europe and the former Soviet Union, where it remained a topic of active research.

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