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Bacteriophages had serious problems that made them unsuitable for mass deployment. For example, you need to isolate a strain suitable against an infection, and

by yyyk 5y ago

Bacteriophages had serious problems that made them unsuitable for mass deployment. For example, you need to isolate a strain suitable against an infection, and that's a process which was difficult to scale. Another problem is that as far as the body is concerned, the phage is an infection too and it turns out the body can be effective at getting rid of phages. Lastly, resistances also occur against phages.

aaaaaaaaaaab 5y ago
But new phage strains would evolve head to head with the resistant bacteria, right? With antibiotics you have a fixed molecule, which becomes useless if the bacteria develops resistance.
- t_mann 5y ago
  That's the classical argument pro phages. It's probably not easy to pick a clearly better one, @yyyk seems to have more insight than I do, but I did read an article pointing out that research on bacteriophages in the west only really took off after the cold war.
- yyyk 5y ago
  Yes, but you can't rely on that on a natural setting. Sometimes the body does get rid of a disease, right? Same thing with bacteria-phage relationship - and the resistant bacteria can then spread (while the better phages are difficult to harvest back from the body, and may not be as effective against the original strain). I think a more personalized medical system can do a lot of good with phages given modern tech, but most medical provision systems would have difficultly deploying it, and certainly no one was able to back when it was developed. AFAIK, the ability to easily scale, transport and deploy antibiotics was what led to antibiotics being chosen over phages just about everywhere.
sandworm101 5y ago
https://xkcd.com/1217/ https://xkcd.com/1217/ The joke is about cancer cells but is equally applicable to bacteria. Just because something is very very good at killing bacteria doesn't mean that it can also become a practical medicine.
Fomite 5y ago
It's been awhile since I've gotten to use my "Why phage aren't quite as awesome as it seems on first glance", from the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup). 1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library. 2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert. 3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it. There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale.

by yyyk 5y ago

aaaaaaaaaaab 5y ago

But new phage strains would evolve head to head with the resistant bacteria, right? With antibiotics you have a fixed molecule, which becomes useless if the bacteria develops resistance.

t_mann 5y ago
That's the classical argument pro phages. It's probably not easy to pick a clearly better one, @yyyk seems to have more insight than I do, but I did read an article pointing out that research on bacteriophages in the west only really took off after the cold war.
yyyk 5y ago
Yes, but you can't rely on that on a natural setting. Sometimes the body does get rid of a disease, right? Same thing with bacteria-phage relationship - and the resistant bacteria can then spread (while the better phages are difficult to harvest back from the body, and may not be as effective against the original strain). I think a more personalized medical system can do a lot of good with phages given modern tech, but most medical provision systems would have difficultly deploying it, and certainly no one was able to back when it was developed. AFAIK, the ability to easily scale, transport and deploy antibiotics was what led to antibiotics being chosen over phages just about everywhere.

sandworm101 5y ago

https://xkcd.com/1217/ https://xkcd.com/1217/ The joke is about cancer cells but is equally applicable to bacteria. Just because something is very very good at killing bacteria doesn't mean that it can also become a practical medicine.

Fomite 5y ago

It's been awhile since I've gotten to use my "Why phage aren't quite as awesome as it seems on first glance", from the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup). 1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library. 2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert. 3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it. There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale.