Raising awareness of phage therapy among physicians

Issue 56 | December 13, 2019
8 min read
Capsid and Tail

A physician administers phages to a patient with a Pseudomonas aeruginosa-infected femur. Image credit: Dr. Tristan Ferry, via Twitter / © LADYBIRDS FILMS.

This week, Aël Hardy, an MD-PhD student at Forschungszentrum Jülich in Germany, explores physicians’ awareness about phages and how it could be improved. He interviewed two French physicians who recently used phages to treat some of their most desperate patients.

Also in this issue: funds for phage therapy clinical trials and prophage research, phages making nucleus-like structures, new phage diagnostics, a European phage company attempts to overcome regulatory challenges, and more!

What’s New

Two groups have published papers showing how jumbo phages can create nucleus-like structures in their hosts to protect phage DNA from CRISPR-Cas systems. Read Senén Mendoza (UCSF) and colleagues’ paper on how this works for a Pseudomonas phage, and Lucia Malone (University of Otago) and colleagues’ paper on how this works for a Serratia phage. Also check out this article on the subject by Ed Yong with The Atlantic.

ResearchPhage-host interactionsCRISPR

Dr. Thomas Böttcher, head of an Emmy Noether junior research group at the University of Konstanz in Germany has received an ERC Consolidator Grant (around 2 million Euro over 5 years) to study chemical factors that control the transition of phages from a latent to an active state.

Grant FundingProphage biology

The Turner lab at Yale has successfully treated 13 patients with phages so far. Now, the team has been awarded support from the Blavatnik Fund, which helps Yale scientists commercialize their discoveries. The support has made it possible for the team to launch the startup Felix Biotechnology, and to launch a phage clinical trial in partnership with the Yale Adult Cystic Fibrosis Center.

BiotechPhage TherapyClinical Trials

CTV News in Canada has done a feature on phage therapy, which follows a Canadian cystic fibrosis patient as she travels to Yale University for phage treatment.

NewsPhage Therapy

The Dutch phage company Micreos has urged members of the European Parliament to support authorization of its product, Listex, saying the EU’s public health directorate has failed to appropriately regulate the product (which is intended to target Listeria on ready to eat meat).

BiotechFood

Actiphage is a commercially-available, phage-based diagnostic developed by PBD Biotech for detection of live mycobacteria. New paper describing how Actiphage works | Press release

Phage product developmentDiagnostic

The VEGA Symposium will happen March 22-23, 2020 in Oakland, CA. Hosted by the Joint Genome Institute, the goals are to bring together a “Viral Ecogenomics” community to foster discussion on how to capture and characterize uncultivated viruses, understand the role of viruses in natural ecosystems, and explore applications of viral genetic diversity. Confirmed speakers include Jennifer Doudna, Karen Maxwell, Mart Krupovic and more. Earlybird registration ends Dec. 31.

ConferenceViral Ecology

Latest Jobs

Postdoc

Joseph Bondy-Denomy and David Agard at UCSF are hiring a postdoc related to their recent work on how a phage nucleus-like structure shields its DNA from CRISPR.

Research Associate

Danish Malik at Loughborough University is hiring a research associate to work on phage therapeutic process development, including strategies for production, purification, encapsulation and process monitoring.

Community Board

Anyone can post a message to the phage community — and it could be anything from collaboration requests, post-doc searches, sequencing help — just ask!

Phage Directory visits Eastern Canada: a million thanks to all our hosts!

Thanks so much to Sylvain Moineau at Laval University, David Speicher at McMaster University, and Hany Anany at Agriculture and Agri-Food Canada for hosting us these last couple of weeks! It’s been fantastic to have the opportunity to present to your teams and departments on what we’ve been learning from the phage community, and what we’re working toward! And it’s been incredibly inspiring learning about your phage work, plans, ideas and progress. We can’t wait to come back!

Phage Directory

Raising awareness of phage therapy among physicians

Profile Image
MD-PhD student at the Forschungszentrum Jülich (Germany)
Graduate Student
Forschungszentrum Jülich, Jülich, Germany
Twitter @ael_hardy
Skills

Phage-host interactions, Microbiology, Bioinformatics, Molecular Biology

My research focuses on phage-encoded silencer proteins, but I am interested in anything phage-related—from the most fundamental aspects to clinical applications.

When thinking about obstacles to a broad use of phage therapy, regulatory hurdles, storing issues or efficacy concerns may come first into one’s mind. Yet, another major barrier is often forgotten: the lack of knowledge or disinterest of the people who are at the end of the phage therapy chain—physicians themselves.

In this issue of Capsid & Tail, I explore what physicians’ (mis)conceptions about phages are, and how we could improve awareness of phage therapy in the medical community. To help achieve this, I got input from two French physicians who recently used phages to treat their most desperate patients, Dr. Alexandre Bleibtreu (Assistance-Publique des Hôpitaux de Paris) and Prof. Tristan Ferry (Hospices Civils de Lyon).

Compassionate phage treatment of a multiresistant knee joint infection at the Hospices Civils de Lyon Hospital (France) - Taken from "Bacteria Killers, the Story of Phage Therapy", directed by Jean Crépu, ARTE, 2019. © LADYBIRDS FILMS
Compassionate phage treatment of a multiresistant knee joint infection at the Hospices Civils de Lyon Hospital (France) - Taken from “Bacteria Killers, the Story of Phage Therapy”, directed by Jean Crépu, ARTE, 2019. © LADYBIRDS FILMS

Phage therapy and the medical community

Analysis of the phage therapy requests to the Queen Astrid Military Hospital (Brussels, Belgium), the largest center for phage therapy in Western Europe, revealed that phage therapy was sought three times more often by the patients themselves than by physicians.

The recent coverage of phage therapy by popular media may certainly have fueled the interest in this new therapeutic alternative. However, physicians, who have to decide whether to initiate a treatment by phages, are often ill-informed about this therapeutic possibility.

Lack of information during medical studies may be one major cause of the general ignorance of the medical community towards phages. In France, phages are for example not even mentioned once in the infectious disease textbook serving as the reference text for medical students nationwide.

Physicians then come to know phages by chance or during additional scientific training (e.g. Master of Science or PhD). This is how Dr. Bleibtreu first came in contact with phages: some isolates of the E. coli collection he was testing during his master’s studies showed atypical growth behavior, which turned out to be caused by phages. “It was surprising, but very far from therapeutics learned during my medical studies and fellowship”, Dr. Bleibtreu explains. “As a result, phages stayed in my mind but as an inaccessible possibility”.

Extensive exposure to science is limited to physicians engaged in academic careers, so this remains a limited way to raise awareness of phages among physicians.

What can be done to improve physicians’ awareness of phage therapy?

As Dr. Bleibtreu points out, “colleagues don’t know phages rather than are opposed to them”.

According to Prof. Ferry, combining cases of patients with homogeneous clinical situations (case series) and then performing clinical trials are paramount to increase awareness of phage therapy among physicians. Importantly, reports published in journals highly regarded within the medical community do a great job at bringing recognition to phage therapy, as did the recent article describing the use of engineered phages to treat a Mycobacterium abscessus infection, reported in Nature Medicine.

We must also underline the role played by pioneering doctors, who fought against odds to implement phage therapy. Tristan Ferry in France, Ard Struijs in the Netherlands, Ran Nir-Paz in Israel, Robert “Chip” Schooley in the US, to name but a few - they all demonstrated that use of phages was possible and could have a positive outcome. These early adopters of phages can then help their peers to introduce phages in their clinical practice, which can have a “snowball effect”.

Final words

Once again, for physicians and regulators alike, clinical trials are key to supporting a broader use of phages in the clinical setting. The current trend is encouraging, as cases accumulate and trials are being developed throughout the world. Only time will tell how fast phage therapy becomes common practice and enters medical textbooks.

Further information

Capsid & Tail

Follow Capsid & Tail, the periodical that reports the latest news from the phage therapy and research community.

We send Phage Alerts to the community when doctors require phages to treat their patient’s infections. If you need phages, please email us.

Supported by

Leona M. and Harry B. Helmsley Charitable Trust

Crossref Member Badge