Antibiotic resistance fighters: Are bacteria-hunting viruses the key to saving lives?

Led by Alfred Health’s Director of Infectious Diseases Professor Anton Peleg, the team is one of few around the world using bacteriophage or ‘phage therapy’ to treat antibiotic resistant infections in a small number of patients.

“Bacteriophage are small viruses that specifically attack and kill bacteria,” Prof Peleg said. “They do this without attacking our own human cells.”

This important detail is part of what has inspired the team to explore the use of phage in treating antibiotic resistant infections, added postdoctoral researcher Dr Fernando Gordillo Altamirano.

“I explain it as ‘the enemy of my enemy is my friend’,” Dr Gordillo Altamirano said.

Witness to the growing threat of antibiotic resistance, it was Professor Peleg’s search for a potential answer which would act as a catalyst to the formation of the VICPhage initiative in 2022.

“As infectious diseases physicians we are already finding ourselves challenged to help patients who have infections that are resistant to almost all antibiotics,” Prof Peleg said. “This is increasingly becoming a daily or a weekly challenge, so we're looking desperately for new therapies for these bacteria.

“It happened that an amazing opportunity presented itself when Dr Jeremy Barr, a phage biologist at Monash University, and I were able to combine our interests and develop a phage therapy program.”

Since forming, The Alfred and Monash University collaboration has gone on to explore phage therapy for four patients to date, with patients only being considered eligible for the treatment approach in Australia on compassionate grounds.

“These compassionate grounds are when a patient really has no other traditional treatment options,” Prof Peleg explained. “Their infection may be resistant to all traditional antibiotics, or the patient might be intolerant to the antibiotics, and so there aren't any treatment options left.”

“This is still an experimental therapy,” Dr Gordillo Altamirano added. “But it’s something that we can offer those patients where all other options haven’t worked.”

Finding the right phage to respond to a patient’s infection can be challenging, leading members of the team to become ‘bug detectives’ in their search for a solution.

“What we’re trying to do with phage therapy is find a specific phage that can attack the bacteria that's causing infection in a patient,” Prof Peleg said. “Phage are very specific to the bacteria that they target, so there are specific phage that will only target specific bacterial strains.

“What that means is that you've got to hunt for the right phage to kill the bacteria of interest, which can sometimes be challenging and take a little bit of time, but it is a unique part of this therapy.

“It's a biological therapy that needs to interact like a lock and key with a given bacteria.”

Often this means the researchers must expand their searches to a wide variety of places, as microbiologist Dr Jeremy Barr describes.

“Most of the time we search in waste water because that's a huge microbial mixing point, so you've got almost every single bacterium there and you've got lots of phage there,” Dr Barr said. “Some pathogens may not associate with the gut, or with the sewage samples, so we may also go to soil samples or go to agricultural samples to find the right phage.”

Despite the challenges, the unique relationship that forms VICPhage is something that Professor Peleg suggests is a significant asset to the initiative’s ongoing work.

“I think the real strength of our effort is that it crosses from the bedside all the way to the laboratory bench and then back to the bedside,” Prof Peleg said. “Our work starts with a patient who's been referred to us. We then see which bacteria is causing their infection, go and hunt for a phage that can kill and attack that specific bacteria, and then produce that to administer it safely to the patient.

“It really is an exciting collaborative effort between Fernando in our lab, Jeremy at Monash University and I.”

The strength of this collaboration, in part, owes to the urgency of the problem the team are hoping to find answers for. Antibiotic resistant infections are estimated to have been associated with close to five million deaths globally in 2019, and the threat is only continuing to grow.

“The reason phage therapy is so exciting is because of how significant a problem antibiotic resistance is,” Dr Barr said. “And phage offers a potential solution.

“There's a lot of biology that we need to understand to really begin to translate this potential, but trying to find that solution to antibiotic resistance is our motivation for doing this work that we're doing.”

To see the VICPhage team in action and learn more, you can stream Last Chance to Save a Life on SBS television or SBS On Demand on Thursday, 15 February from 8:40PM AEDT.