The promise of phage therapy

One of the companies I work with as a Blavatnik Fellow is phage therapy company Felix Biotechnology, which is a dream come true for me. Phages are viruses that infect bacteria, a bit like you would get the flu. Except instead of getting the sniffles the bacteria explode, releasing more phage that replicated inside them, Alien-style.

If that freaked you out, I’ve got good news: phage can’t infect human cells, and the better news is that they may even be able to help us. Phages are everywhere and on everything — there are an estimated 1031 phages in the biosphere, which means there are more phages than stars in the universe. And these phages have been engaged in an evolutionary battle with bacteria for more than a billion years, evolving new ways to break through bacterial defenses and use bacterial cells to make more of their own. What this means for us humans is if there’s a bacteria that plagues us, there’s a phage that can plague it. We can use a specific phage to kill a specific bacteria, in a bit of “the enemy of my enemy is my friend” thinking.1

Phage plaques (dark dots) occur when phage have killed all the bacteria in the area. This ability to kill bacteria can be used to combat antibiotic-resistant infections.

This is particularly important now that antibiotics are failing. We have used antibiotics for ~100 years and they worked well, but with every use we selected for bacteria that could survive their use. Now antibiotics fail to cure infections 1 in 10 times, and that number is climbing. And these antibiotic-resistant bacteria continue to spread even when we reduce antibiotic use, because there’s little reason for bacteria to lose antibiotic genes once they’ve gained them. Even if pharma companies were to develop new antibiotics (bad news: they aren’t, and those that are are going bankrupt), there’s evidence that bacteria with resistance to the new antibiotics would appear in less than a decade.

We need new treatment for these drug-resistant infections, and phages have many advantages. Unlike antibiotics, phage can evolve with the bacteria, so we always have a treatment option. Even better, they are narrowly targeted to one species or one strain of bacteria instead of killing bacteria indiscriminately like antibiotics, which we now know can cause additional health problems. But could we use them to do even more? Could we use them to make bacteria less antibiotic resistant, less virulent, and less dangerous?

That’s where Felix Biotechnology comes in. Felix is using evolution to our advantage, harnessing the millennia-old evolutionary battle between phage and bacteria by using phage to make bacteria less dangerous. We achieve this by using phage to target the actual cause of antibiotic resistance, turning an evolutionary advantage into a disadvantage. Bacteria that evolve resistance are then susceptible to antibiotics. This means we could use antibiotics or another phage as treatment in the next infection, an approach that led to our recognition as Startup of the Year at Berlin’s international Falling Walls competition this year. It means there is always a treatment option.

How Felix Biotechnology is “Breaking the Wall of Antibiotic Resistance” at Falling Walls 2019, courtesy of Falling Walls Foundation. You can watch the full Felix presentation here.

There are still many hurdles to developing phage therapy treatments. Many of these hurdles exist because our medical and pharmaceutical systems aren’t set up to deal with antibiotics, not phage. But the threat of antibiotic resistance is so massive, and the promise of phage therapy so great, that I and many others are throwing our effort into supporting development of phage therapy. We hope you’ll join us.2

*

1 This is a generalization. Phages could also make bacteria nastier by gifting them with virulence and antibiotic resistance genes. This is why the sequencing, analysis, and engineering technologies developed in the last two decades are so important — we need to figure out what our phages are and what they can do before we can turn them into treatments.

2 If you’re interested in learning more or want to help, check out the links below and feel free to contact me!

Featured image at top adapted from New Antibiotics—Resistance Is Futile. PLoS Biol 2/2/2004: e53. doi:10.1371/journal.pbio.0020053.

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