11 July 2019

Phage Therapy (PT), the therapeutic use of lytic bacteriophages to treat pathogenic bacterial infections, has been around for a century, although development of such treatments was all but abandoned following the discovery of antibiotics. This abandonment was due to several technical and logistical complications, subsequent controversy due to its poorly documented use, and the variable success of PT (Lin 2017). However, the global threat of antibiotic resistance that has emerged in the last few decades has generated renewed interest in PT as an alternative therapeutic approach to antibiotics (Altamirano 2019).

Whilst advances in biotechnology have improved the potential for PT, information on its immunomodulatory effect, and the potential for horizontal gene transfer, indicate that we need a better understanding of the interactions between phage, bacteria and the human host, before phage therapy could become a reality (Lin 2017). While the renewed interest in PT is becoming more widespread, the question is whether it can become a reality or not.

This topic was nicely summarised in a recent article published in the “Viruses” journal, where the author solicited opinion from experts in the field on the hurdles to PT becoming a reality (Brüssow 2019). Various hurdles and knowledge gaps considered to be impeding the progress of PT are discussed, along with suggestions for future research, and make interesting reading. The author concluded that exploring alternatives to conventional antibiotic therapy doesn’t need further justification and that PT is unquestionably a potentially interesting approach to the antibiotic resistance problem.

Dr Richard Bax, Senior Partner at tranScrip Partners LLP commented “Phage therapy, along with vaccines, antibodies and probiotics, offer the possibility for pathogen-specific therapy and such approaches could transform our understanding. However, as ever, investment is needed now to validate clinical proof of concept which includes active engagement and investment by the pharma/biotech industries.” (Czaplewski 2016).

Lin DM, Koskella B, and Lin HC. Phage therapy: An alternative to antibiotics in the age of multi-drug resistance. World J Gastrointest Pharmacol Ther. 2017 8(3): 162–173, DOI: 10.4292/wjgpt.v8.i3.162.
Altamirano FLG, Barr JJ. Phage Therapy in the Post-antibiotic Era. Clinical Microbiology Reviews. 2019, 32 (2) e00066-18, DOI: 10.1128/CMR.00066-18.
Brüssow H. Hurdles for Phage Therapy to Become a Reality—An Editorial Comment. Viruses, 2019; 11:557, doi:10.3390/v11060557
Czaplewski L, Bax R, Clokie M, Dawson M, Fairhead H, Fischetti VA et al. Alternatives to antibiotics-a pipeline portfolio review. Lancet Infect Dis. 2016 Feb;16(2):239-51. doi: 10.1016/S1473-3099(15)00466-1. Epub 2016 Jan 13.