Genetically altered viruses save life of infected teenager

Henrietta Strickland
May 9, 2019

"This is a convincing proof of concept, even though it's just a single case study", says infectious disease researcher Eric Rubin of the Harvard T.H. Chan School of Public Health in Boston.

They are the microbial embodiment of the adage: "My enemy's enemy is my friend".

With the standard treatments failing, Isabelle's mother asked Spencer about alternatives-adding that she had read something about using viruses to kill bacteria.

Looking like sinister aliens, they land on the surface of a bacterium and inject their own genetic code. Spencer chose to take a gamble on what seemed like a far-fetched idea: phages, viruses that can destroy bacteria and have a long-if checkered-history as medical treatments.

Image copyright Getty Images Image caption Bacteriophage infect bacterial cells, replicate inside them and destroy the bacterium Why did Isabelle need them?

No previous transplant patient to have been infected with Mycobacterium abscessus at the hospital has survived.

When she was 16, she needed a double lung transplant, but the bacteria were still hiding in her body. But her infection persisted after the transplant, threatening her life.

"The idea is to use [phages] as antibiotics - as something we could use to kill bacteria that cause infection", Hatfull said.

"For some patients, that's within a year despite aggressive treatment".

"She lost so much weight, she was literally like a skeleton", Jo said.

Where did the experimental therapy come from?

Isabelle Carnell (second from right) with her doctor, Helen Spencer (left); phage researcher Graham Hatfull (second from left); and her mother (right).

Jason Gill, a senior scientist at the center for phage technology at Texas A&M University, said phages could have huge potential to tackle drug-resistant infections. Shortly after Isabelle was sent home on a palliative care plan, Hatfull's lab identified a phage that wiped out the infection, and another two phages that could infect it but not kill it efficiently.

Image copyright Nature Medicine Image caption The three phage used to treat Isabelle.

Her case, outlined in the journal Nature Medicine, follows the successful treatment a year ago of a USA patient infected with a drug-resistant superbug and comes as the looming crisis of antibiotic resistance is fuelling a growing interest in phage research.

Isabelle's mum, Jo, noticed the difference within weeks. "For me, all of the time and pain and suffering that I went through, is made worthwhile by the lives that are being saved by phage therapy". Within six months, the surgical wound and skin lesions healed, with no adverse effects, researchers said.

"It's incredible medical science, it's been a miracle", she said. She passed her GCSE in maths, is studying A-levels and enjoys baking and gardening.

She's also learning to drive.

And the family are waiting for a fourth phage to be added to the mix in an attempt to clear her of the infection completely. Some infections, such as the hospital superbug Staphylococcus aureus, are known to be genetically homogeneous enough that a few phages could treat nearly all strains of the infection, raising the prospect of phage therapy becoming routine.

Dr Spencer told BBC News: "It's fantastic really, but also tinged with sadness when I think of all the patients that did not survive as the treatment was not available in time for them".

Technically, scientists can not be certain how effective the phage is without performing clinical trials.

Professor Martha Clokie, a phage researcher at the University of Leicester, also told the BBC: 'I think that this work is enormously exciting.

Doctors have been using phage therapy for almost a century, but it was the first time a genetically engineered phage was used to treat a patient.

Phage therapy dates back a century, but until recently the idea was relegated to fringe medicine in most countries, mainly because of the advent of antibiotics.

One antibiotic can work across a broad range of bacterial infections, while phage-therapy requires finding the precise phages that will attack each infection. Drug-resistant TB strains are an especially tempting target for phage therapy.

What does this mean for other infections?

This is the big question and at the moment there is no clear answer.

Other reports by Click Lancashire

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