September 22, 2023

Hopes phage therapy can provide lifeline to the patient

Scottish surgeons are the first in the UK to use a more than 100-year-old method to successfully treat a joint infection.

It is hoped that the breakthrough can help provide a lifeline for patients with antibiotic-resistant conditions.

NHS Tayside says the orthopedic department in Dundee is the first in the UK to treat a joint infection using phage therapy.

It involved applying specially selected viral cells called phages to kill bacteria.

The treatment was applied to an 84-year-old woman at Ninewells Hospital.

She suffered from a severely infected hip and pelvis and had undergone eight surgeries to clear the infection, as well as a year and a half of antibiotic therapy.

Within two weeks of the phage treatment, her infection was gone. Her wound had healed for the first time since Christmas and the patient was scheduled to return home within eight weeks of therapy.

The procedure was performed by Trauma and Orthopedic Surgeon, Mr Graeme Nicol, with the support of the UK’s only clinical phage specialist, Dr Josh Jones, and Infectious Disease Consultant, Dr Daniela Munteanu.

“What the virus does is it attaches to the cell of the bacteria, it infiltrates it and it multiplies,” Nicol told BBC Scotland. “By doing that, it causes the bacteria to burst itself.

“So in other words, it just destroys whatever bacteria is there — phage comes from the Greek to devour, so it works its way through this infection and clears it from the body.”

Ninewells

Specialists at Ninewells Hospital in Dundee hope their unit can be used as a UK hub for phage therapy

Once the infection is treated, the phages are destroyed by the patient’s immune system.

The patient continued to take antibiotics throughout the process, Mr Nicol told BBC Scotland.

The surgeon said the treatment is not only used on hip infections, but can also work on knees, ulcers, bladders and other areas where phages can be applied directly.

The therapy was first developed in 1919 and was widely used in the early 20th century, especially in the US, where it was widely used in cholera.

But after the discovery of penicillin by Scotsman Alexander Fleming in 1928, the use of phages declined in Western countries because they are more difficult to manufacture and store than antibiotics.

‘Lifeline’

Mr Nicol stressed that while phage therapy is not a substitute for antibiotics, it could be a “lifeline” for patients with antibiotic-resistant infections.

The UK Health Security Agency has warned of a “hidden pandemic” of antibiotic-resistant infections, while the World Health Organization has described them as one of the greatest threats to global health.

Mr Nicol said such cases were a “daily occurrence” in NHS Tayside. “We have patients who are stuck in hospital and given intravenous antibiotics because there is no longer an oral option, because resistance has built up to the point that even more common infections are now becoming more resistant to antibiotics,” he told BBC Scotland.

The surgeon said he hoped the phage therapy would be rolled out in the UK within the next two years, with NHS Tayside producing tailor-made treatments for patients with serious infections.

“The patient doesn’t have to travel here to get the treatment,” Mr Nicol said. “That’s the beauty of it.

“Each center has its own microbiology and infectious diseases department and they can look at it and tell us exactly which bacteria it is.

“From that point on, the lab can just watch here and see if we have a virus that kills that bacteria. And then we can just ship it directly to them.”

He said the “labor intensive” process – which involves finding suitable viruses in the environment and multiplying them in a lab – would require further investment in the UK, but could be streamlined during development.

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