4 ms·

What are the practical hurdles and other tradeoffs?

robbiep 3y ago
Bacteriophages are highly specific to different strains, even inside the same organism. So essentially you would need to determine to a high level what specific phage will work on the organism the patient has. This wasn’t really possible until recently (tbh I don’t know if it’s possible now but we’ve got cheap genetics so probably). You’d also need to have a fat library of phages sitting in reserve. So that’s a logistics issue. It’s also a bit unclear how they would work with systemic infections - it’s going to be antigenic injected into the bloodstream, most of my understanding of them is for topical applications which parallels the old eastern bloc experience - that’s still incredibly useful
- christkv 3y ago
  Inhalers for respiratory illnesses could be used as well.
Fomite 3y ago
A few that come to mind immediately: 1) Phage are highly specific - there's really no such thing as a "broad spectrum phage", which means you need fairly intensive diagnostic laboratories + an extensive library of phage. 2) There's some regulatory hurdles - these are less than they once were, and the fecal transplant stuff for C. diff, and the treatments that have come from that, have done a lot of how do we think about regulating a living biological treatment. 3) Phage has mostly been used for wounds and other infections where it's relatively easy to get them "on site". For something like sepsis, which is systemic, or some other infections, it's not clear how to get them where they need to go in the concentration they're needed. The solution that most immediately presents itself, which is just "A lot of phage delivered IV, and then hope they multiply when they reach the right sites" involves being able to grow up a lot of phage, which is a non-trivial problem for a lab. There's purification steps that need to happen, you have to have good enough cultures of the infecting organism to grow the phage, etc. It's a very, very cool technology, but it's also something that's been "on the cusp" since I was an undergrad, and I'm a tenured faculty member now.

Bacteriophages are highly specific to different strains, even inside the same organism. So essentially you would need to determine to a high level what specific phage will work on the organism the patient has. This wasn’t really possible until recently (tbh I don’t know if it’s possible now but we’ve got cheap genetics so probably). You’d also need to have a fat library of phages sitting in reserve. So that’s a logistics issue. It’s also a bit unclear how they would work with systemic infections - it’s going to be antigenic injected into the bloodstream, most of my understanding of them is for topical applications which parallels the old eastern bloc experience - that’s still incredibly useful

christkv 3y ago
Inhalers for respiratory illnesses could be used as well.

Fomite 3y ago

A few that come to mind immediately: 1) Phage are highly specific - there's really no such thing as a "broad spectrum phage", which means you need fairly intensive diagnostic laboratories + an extensive library of phage. 2) There's some regulatory hurdles - these are less than they once were, and the fecal transplant stuff for C. diff, and the treatments that have come from that, have done a lot of how do we think about regulating a living biological treatment. 3) Phage has mostly been used for wounds and other infections where it's relatively easy to get them "on site". For something like sepsis, which is systemic, or some other infections, it's not clear how to get them where they need to go in the concentration they're needed. The solution that most immediately presents itself, which is just "A lot of phage delivered IV, and then hope they multiply when they reach the right sites" involves being able to grow up a lot of phage, which is a non-trivial problem for a lab. There's purification steps that need to happen, you have to have good enough cultures of the infecting organism to grow the phage, etc. It's a very, very cool technology, but it's also something that's been "on the cusp" since I was an undergrad, and I'm a tenured faculty member now.