Underappreciated phages

Opinions on bacteriophages are divided. Some expect the world of them, others don’t believe in them, and the vast majority have simply never heard of them. In his latest book Viruses as Medicine, science journalist Rinke van den Brink admits that he long belonged to that last group. That changed in 2014, when he had just published a book on the dangers of antibiotic resistance and emeritus professor Jacques Scheres explained to him that an alternative to conventional antibiotics existed. Reason enough to dig deeper into the subject and interview several dozen phage experts. The result is a vivid portrait of a field that had seemed all but forgotten, but which in recent years — at least within a small circle — has been undergoing a considerable revival.

Personalised medicine

For those who didn’t already know: bacteriophages are viruses that attack bacteria. They inject their own DNA so that the bacterium begins producing new phages until it literally bursts, aided by phage enzymes that dissolve its cell wall. In this way, phages multiply exponentially until nothing remains of a bacterial colony but a heap of slime.

Crucial to this process is the fact that phages bind to highly specific proteins on the cell wall. They are therefore particularly well suited to personalised medicine: culture the bacteria from a chronic infection and test phage cultures from an extensive ‘phage bank’ against them until one takes the bait. In acute infections there is no time for this, and one must make do with phage cocktails that hopefully contain something effective — though the likelihood of that is relatively slim.

Phages were first deployed at the beginning of the last century, against dysentery and later against wound infections. But with the arrival of penicillin, which worked far more predictably, they were utterly eclipsed. In the Soviet Union, which gained access to antibiotics considerably later, phages remained popular for longer. One research institute, in the Georgian capital Tbilisi, has continued to this day and now functions as a sort of Mecca for desperate patients suffering from infections.

In the Netherlands, phages were put back on the map in 2017 by television programmes about that Georgian institute. But current laws and regulations genuinely don’t know what to make of them. Here, phages may only be used in individual patients when absolutely nothing else works. Belgium has progressed further, and a ‘Phage Valley’ is even beginning to emerge there, particularly since the Queen Astrid Military Hospital managed to secure formal approval for the ‘magistral’ preparation of phage cultures in hospital pharmacies.

Anecdotal

Those who know their way around the subject will understand that phages are entirely at odds with Western medical practice. The success stories are numerous but predominantly anecdotal, the failures are poorly documented, and the scientific understanding of the underlying biochemistry is extremely limited. But now that antibiotic resistance threatens to spiral wildly out of control, every alternative deserves attention.

Viruses as Medicine is written at a level suited to readers of C2W | Mens & Molecule, and despite its many explanatory footnotes may prove difficult for lay readers to follow. But anyone who deals with infections in a professional capacity ought to read it. Not necessarily to become an instant phage enthusiast, but at the very least to be properly informed.