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It’s been a number of years now that I have become aware of MRSA and superbugs. The moment I read on this is also the moment I have come to be aware of phage th

It’s been a number of years now that I have become aware of MRSA and superbugs. The moment I read on this is also the moment I have come to be aware of phage therapy as a promising path of overcoming this new threat. This article yet again reports on the lack of awareness about bacteriophages in the medical community. I just can’t understand why it is like that. I, an idiot, have heard about it. How do people, who seemingly work with superbugs all the time and understand the threat, not know this thing that is amongst the very first things one is exposed to when one takes a superficial glance at the available literature?

thayne 7y ago
> I just can’t understand why it is like that. My guess is because phage treatments are difficult or impossible to patent, and therefore unattractive to pharmaceutical companies. And pharmaceutical companies are incentivized to push their own treatments on doctors and hospitals.
- whytaka 7y ago
  I can suppose that economic incentives don’t align for its availability in the field but it doesn’t account for the ignorance of the practitioners. Bacteriophages are almost always one of the first things mentioned when the inevitable futility of antibiotics is discussed.
AllegedAlec 7y ago
> This article yet again reports on the lack of awareness about bacteriophages in the medical community. A shortlist of answers: - Bacteriophages are evolutionarily close to viruses. Their proteins will resemble viral proteins, so the body will most likely initiate an immune response against it. - Bacteriophages are really quite specific in what they'll infect. This makes them much less useful as an antibacterial. You'd spend a lot of time and money on making one that would infect your mrsa strain, and mrsa would probably just start the arms race, leaving you back at the start. - Bacteriophages are (evolutionarily close to) viruses, and thus also have the immense mutation rate of those. Even if you were to make one that had all the properties you wanted, it'd probably get rid of most of them because they are evolutionarily disadvantages. - Probably a few other fairly good reasons which my coffee-deprived brain can't think off right at this moment.
- armada651 7y ago
  > You'd spend a lot of time and money on making one that would infect your mrsa strain, and mrsa would probably just start the arms race, leaving you back at the start. Actually developing resistance against bacteriophages requires such invasive changes that most bacteria that develop it lose resistance against anti-biotics. That is why an anti-biotic therapy is often used together with a phage therapy.
  - AllegedAlec 7y ago
    > Actually developing resistance against bacteriophages requires such invasive changes that most bacteria that develop it lose resistance against anti-biotics It requires some huge changes, sure. However, MRSA exists because Staph was able to adapt to be resistant to multiple antibiotics at the same time. There is no reason to assume that it could not adapt to become resistant to the phage used as well as some of the most used antibiotics.
    - esyir 7y ago
      You also get the evolutionary war between the virus and the bacteria. That should help out.
- ddebernardy 7y ago
  Those are all potentially valid reasons to not pay much attention to it as a solution for multi-resistant bacteria. However, none of them explain why medical professionals are not even aware that bacteriophages are a thing, in contrast with laypeople like the parent poster (or myself, and presumably many more on HN since there have been a few articles on this topic over the years).
  - robbiep 7y ago
    The medical profession is aware, they just aren’t scaled up for use in any meaningful sense - essentially to be able to meaningfully fight bacterial infections with phases a hospital or clinic would need to type the bacteria and screen it against potentially hundreds or more phages (even if they are already specific to the bacteria) to find the ones that are going to be most effective. So, there are time constraints, delivery mechanisms and also logistics to overcome. A challenge for a startup?
riahi 7y ago
I don’t think it’s fair to say there is a lack of awareness that bacteriophages-as-concept exist. Most curricula in medical school will touch on these. However, what is more of a realistic lack of awareness is the ability to request bacteriophage therapy for a specific patient. It’s not something that has been thoroughly vetted or solved as a scalable solution because there’s a lot of technical hurdles. The closest approved therapy that is somewhat similar to what phage therapy would involve is CAR-T cell creation, and this is wildly expensive and resource intensive. To give a somewhat comparable example, it’s more like someone saying asking why the average programmer doesn’t know anything about quantum computers as a solution for critical cryptographic problems.
ajuc 7y ago
I think it's like with quantum computers. Average programmer knows they are there, but also knows it's decades before they are usable for everyday stuff.

thayne 7y ago

> I just can’t understand why it is like that. My guess is because phage treatments are difficult or impossible to patent, and therefore unattractive to pharmaceutical companies. And pharmaceutical companies are incentivized to push their own treatments on doctors and hospitals.

whytaka 7y ago
I can suppose that economic incentives don’t align for its availability in the field but it doesn’t account for the ignorance of the practitioners. Bacteriophages are almost always one of the first things mentioned when the inevitable futility of antibiotics is discussed.

AllegedAlec 7y ago

> This article yet again reports on the lack of awareness about bacteriophages in the medical community. A shortlist of answers: - Bacteriophages are evolutionarily close to viruses. Their proteins will resemble viral proteins, so the body will most likely initiate an immune response against it. - Bacteriophages are really quite specific in what they'll infect. This makes them much less useful as an antibacterial. You'd spend a lot of time and money on making one that would infect your mrsa strain, and mrsa would probably just start the arms race, leaving you back at the start. - Bacteriophages are (evolutionarily close to) viruses, and thus also have the immense mutation rate of those. Even if you were to make one that had all the properties you wanted, it'd probably get rid of most of them because they are evolutionarily disadvantages. - Probably a few other fairly good reasons which my coffee-deprived brain can't think off right at this moment.

armada651 7y ago
> You'd spend a lot of time and money on making one that would infect your mrsa strain, and mrsa would probably just start the arms race, leaving you back at the start. Actually developing resistance against bacteriophages requires such invasive changes that most bacteria that develop it lose resistance against anti-biotics. That is why an anti-biotic therapy is often used together with a phage therapy.
- AllegedAlec 7y ago
  > Actually developing resistance against bacteriophages requires such invasive changes that most bacteria that develop it lose resistance against anti-biotics It requires some huge changes, sure. However, MRSA exists because Staph was able to adapt to be resistant to multiple antibiotics at the same time. There is no reason to assume that it could not adapt to become resistant to the phage used as well as some of the most used antibiotics.
  - esyir 7y ago
    You also get the evolutionary war between the virus and the bacteria. That should help out.
ddebernardy 7y ago
Those are all potentially valid reasons to not pay much attention to it as a solution for multi-resistant bacteria. However, none of them explain why medical professionals are not even aware that bacteriophages are a thing, in contrast with laypeople like the parent poster (or myself, and presumably many more on HN since there have been a few articles on this topic over the years).
- robbiep 7y ago
  The medical profession is aware, they just aren’t scaled up for use in any meaningful sense - essentially to be able to meaningfully fight bacterial infections with phases a hospital or clinic would need to type the bacteria and screen it against potentially hundreds or more phages (even if they are already specific to the bacteria) to find the ones that are going to be most effective. So, there are time constraints, delivery mechanisms and also logistics to overcome. A challenge for a startup?

riahi 7y ago

I don’t think it’s fair to say there is a lack of awareness that bacteriophages-as-concept exist. Most curricula in medical school will touch on these. However, what is more of a realistic lack of awareness is the ability to request bacteriophage therapy for a specific patient. It’s not something that has been thoroughly vetted or solved as a scalable solution because there’s a lot of technical hurdles. The closest approved therapy that is somewhat similar to what phage therapy would involve is CAR-T cell creation, and this is wildly expensive and resource intensive. To give a somewhat comparable example, it’s more like someone saying asking why the average programmer doesn’t know anything about quantum computers as a solution for critical cryptographic problems.

ajuc 7y ago

I think it's like with quantum computers. Average programmer knows they are there, but also knows it's decades before they are usable for everyday stuff.