The issue with phage therapy is that it has to be targeted.
With antibiotics, they are very broad spectrum so you can throw augmentin at routine infections and it'll usually work.
With phages, you have to be much more specific. Phage X for bacteria Y. It's not necessarily hard figure out what bacteria it is, but it takes time and expensive lab work.
That's true, but I have a thesis for why this might be good for the biotech ecosystem.
A lot of people will dismiss phage therapy on economic grounds, suggesting that you'd need to essentially design a new phage therapy for each individual infection you wanted to treat. But, with the advances we're seeing in microfluidics, diagnostics, gene sequencing, computational biology, laboratory automation, and the theory of precision medicine, that host specificity can turn from a disadvantage to an advantage. We know there are a lot of human-dwelling bacteria we wouldn't want to knock but can't save from a broad-spectrum treatment. With a personalized phage therapy, this isn't as much of a concern, and with the above advances, custom therapeutic design can scale economically.
But here's the most important implication of phage-host specificity for biotech business models. When a biotech company gets approved to roll out custom therapies for each individual patient, that opens the door to solving two important roadblocks to biotech innovation. First, firms could get around the problem where they're subject to regulatory scrutiny based on a naive interpretation of the difference between their manufacturing costs and their sale prices. Second, such a paradigm of treatment could permit biotechs to offer gradations of service and charge based on how finely-tuned your therapy is. This would enable them to much more closely fit the demand curve of patients. They could bring the latest technology to the masses cheaply and relatively quickly, while charging a premium for the cutting edge.
It's not necessarily hard figure out what bacteria it is, but it takes time and expensive lab work.
There are companies out there developing more rapid test panels that will give an answer within minutes or hours, and they charge in the $200 range to test for dozens of pathogens at once.
Someone I know works for such a company, and a lot of the "doctor ran 20 tests for $x000 when they should have just run one" stories in the news are actually about those types of all-in-one rapid tests, and the insurance/hospital doesn't know how to bill it reasonably.
> It's not necessarily hard figure out what bacteria it is, but it takes time and expensive lab work.
Also you may not have time. If the person has meningitis for example, if you wait to try to figure out what bacteria they have before treating, they will be dead.
Broad spectrum antibiotics are great for this kind of thing in that you can start treatment immediately, and once you figure out the bacteria, narrow the treatment to that type of bacteria.
Not just this, but our immune system recognizes phages and removes them from the blood stream quickly. So you would need a lot of phages to see some value
The other side of this is that people get long term side effects from drugs like augmentin.
Muscle tightness can lead to injuries, depression, anxiety, etc. Not to mention it takes a very very long time to restore gut flora to pre-treatment conditions.
With enough money I'm sure they could make very very quick tests for each bacteria type that are commonly targeted.
Time is a huge deal. There's a conflict right now between sepsis guidelines and antibiotic stewardship guidelines on when you should start treating, and having to wait for both the diagnostic and the phage prep is sort of a problem.
This is also why bacteria can develop resistance to antibiotics. You can’t develop resistance against something that is 99.999% effective through design
It is not that bacteria can't become resistant to phages. It is that it is comparatively easy to make new phages to the resistant bacteria. Being viruses, they will evolve with the bacteria they target.
The problem with antibiotic resistance is not the resistance itself, but that we don't seem to find new antibiotics anymore. As a result, once bacteria are resistant to all what we have, it is the end.
We aren’t finding new antibiotics anymore because there are only so many human-safe systemic vulnerabilities to take apart/stop bacteria metabolism biochemically without moving into the genetic arena for further variation. What we are really exhausting are the biochemical differences between our cells and the bacteria cells by wiping out things that make the bacteria unique. This is really bad because it drives additional compatability with the human body while eliminating ways for our immune system to tell them apart as well. We have been driving the evolution of bacteria toward this since we discovered penicillin. What we need is to introduce new genes blocks into wild bacteria that make them susceptible to artificial compounds we create while also conferring a survival and even reproduction advantage to them over bacteria that lack the implanted gene blocks. This would balance out the evolutionary force of the artificial compound vulnerability. I’m fully expecting the Jurassic Park chaos mettling with nature speech but we have precious few options when completely resistant strains of new lethal bacteria inevitably emerge.
There are presumably a finite number of chemicals that are of the right molecular size to get where they need to go, kill a reasonbly broad range of bacteria, and don't harm humans. We may have found them all already.
Interestingly, in several phage-treated patients, the bacteria then had increased susceptibility to antibiotics. Combination therapy is a remarkable thing.
With antibiotics, they are very broad spectrum so you can throw augmentin at routine infections and it'll usually work.
With phages, you have to be much more specific. Phage X for bacteria Y. It's not necessarily hard figure out what bacteria it is, but it takes time and expensive lab work.