It might seem strange after the COVID-19 pandemic that has killed millions and turned the world upside down, but viruses could save just as many lives.
In a petri dish in a laboratory in the Georgian capital, Tbilisi, a battle is going on between antibiotic-resistant bacteria and “friendly” viruses.
This small nation in the Caucasus region has pioneered research on a groundbreaking way to tackle the looming nightmare of bacteria becoming resistant to the antibiotics on which the world depends.
Photo: AFP
Long overlooked in the West, bacteriophages or bacteria-eating viruses are now being used on some of the most difficult medical cases, including a Belgian woman who developed a life-threatening infection after being injured in the 2016 Brussels airport bombing.
After two years of unsuccessful antibiotic treatment, bacteriophages sent from Tbilisi cured her infection in three months.
“We use those phages that kill harmful bacteria” to cure people when antibiotics fail, G. Eliava Institute of Bacteriophages director Mzia Kutateladze said.
Even a banal infection can “kill a patient because the pathogen has developed resistance to antibiotics,” Kutateladze said.
In such cases, phagotherapy “is one of the best alternatives,” she added.
Phages have been known about for a century, but were largely forgotten after antibiotics revolutionized medicine in the 1930s.
It did not help that the man who did most to develop them, Georgian scientist Giorgi Eliava, was executed in 1937 on the orders of another Georgian, Lavrentiy Beria, Soviet leader Joseph Stalin’s most notorious henchman and the head of his secret police.
Eliava had worked at the Pasteur Institute in Paris with French-Canadian microbiologist Felix d’Herelle, one of the two men credited with discovering phages, and persuaded Stalin to invite him to Tbilisi in 1934.
However, their collaboration was cut short when Beria had Eliava killed, although his motive remains a mystery.
With the WHO declaring antimicrobial resistance a global health crisis, phages are making a comeback, especially as they can target bacteria while leaving human cells intact.
A recent study said that superbugs could kill as many as 10 million people a year when antimicrobial resistance due to overuse of antibiotics reaches a tipping point. That could come within three decades.
While medicines based on phages cannot completely replace antibiotics, researchers say they have major pluses in being cheap, not having side-effects nor damaging organs or gut flora.
“We produce six standard phages that are of wide spectrum and can heal multiple infectious diseases,” Eliava Institute physician Lia Nadareishvili said.
However, in about 10 to 15 percent of cases standard phages do not work and “we have to find ones capable of killing the particular bacterial strain,” she said.
Tailored phages to target rare infections can be selected from the institute’s massive collection — the world’s richest — or be found in sewage or polluted water or soil, Kutateladze said.
The institute can even “train” phages so that “they can kill more and more different harmful bacteria,” she said.
“It is a cheap and easily accessible therapy,” Kutateladze added.
A 34-year-old US mechanical engineer who had a chronic bacterial disease for six years said that he “already felt improvement” after two weeks at the Tbilisi institute.
“I’ve tried every possible treatment in the United States,” said Andrew, who would only give his first name.
He is one of the hundreds of patients from around the globe who arrive in Georgia every year for last-resort treatment, Nadareishvili said.
With the traditional antimicrobial armory depleting rapidly, more clinical studies are needed so that phagotherapy can be more widely approved, Kutateladze said.
In 2019, the US Food and Drug Administration authorized a clinical study on the use of bacteriophages to cure secondary infections in COVID-19 patients.
Beyond medicine, phages are already being used to stop food going off, and they “can be used in agriculture to protect crops and animals from harmful bacteria,” Kutateladze said.
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