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Liu MY, Liu X, Wang CY, Wan QQ, Tian YF, Liu SL, Pang DW, Wang ZG. Inhalable Polymeric Microparticles for Phage and Photothermal Synergistic Therapy of Methicillin-Resistant Staphylococcus aureus Pneumonia. NANO LETTERS 2024; 24:8752-8762. [PMID: 38953881 DOI: 10.1021/acs.nanolett.4c02318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Acute methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is a common and serious lung infection with high morbidity and mortality rates. Due to the increasing antibiotic resistance, toxicity, and pathogenicity of MRSA, there is an urgent need to explore effective antibacterial strategies. In this study, we developed a dry powder inhalable formulation which is composed of porous microspheres prepared from poly(lactic-co-glycolic acid) (PLGA), internally loaded with indocyanine green (ICG)-modified, heat-resistant phages that we screened for their high efficacy against MRSA. This formulation can deliver therapeutic doses of ICG-modified active phages to the deep lung tissue infection sites, avoiding rapid clearance by alveolar macrophages. Combined with the synergistic treatment of phage therapy and photothermal therapy, the formulation demonstrates potent bactericidal effects in acute MRSA pneumonia. With its long-term stability at room temperature and inhalable characteristics, this formulation has the potential to be a promising drug for the clinical treatment of MRSA pneumonia.
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Affiliation(s)
- Meng-Yao Liu
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
| | - Xing Liu
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
| | - Chun-Yu Wang
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
| | - Qian-Qian Wan
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
| | - Yi-Fan Tian
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
| | - Shu-Lin Liu
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
| | - Dai-Wen Pang
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
| | - Zhi-Gang Wang
- State Key Laboratory of Medicinal Chemical Biology, Frontiers Science Centre for New Organic Matter, School of Medicine and College of Chemistry, Frontiers Science Center for Cell Responses, Nankai University, Tianjin, 300071, People's Republic of China
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Pal N, Sharma P, Kumawat M, Singh S, Verma V, Tiwari RR, Sarma DK, Nagpal R, Kumar M. Phage therapy: an alternative treatment modality for MDR bacterial infections. Infect Dis (Lond) 2024:1-33. [PMID: 39017931 DOI: 10.1080/23744235.2024.2379492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
The increasing global incidence of multidrug-resistant (MDR) bacterial infections threatens public health and compromises various aspects of modern medicine. Recognising the urgency of this issue, the World Health Organisation has prioritised the development of novel antimicrobials to combat ESKAPEE pathogens. Comprising Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli, such pathogens represent a spectrum of high to critical drug resistance, accounting for a significant proportion of hospital-acquired infections worldwide. In response to the waning efficacy of antibiotics against these resilient pathogens, phage therapy (PT) has emerged as a promising therapeutic strategy. This review provides a comprehensive summary of clinical research on PT and explores the translational journey of phages from laboratory settings to clinical applications. It examines recent advancements in pre-clinical and clinical developments, highlighting the potential of phages and their proteins, alone or in combination with antibiotics. Furthermore, this review underlines the importance of establishing safe and approved routes of phage administration to patients. In conclusion, the evolving landscape of phage therapy offers a beacon of hope in the fight against MDR bacterial infections, emphasising the imperative for continued research, innovation and regulatory diligence to realise its full potential in clinical practice.
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Affiliation(s)
- Namrata Pal
- Department of Microbiology, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
- Department of Microbiology, Barkatullah University, Bhopal, Madhya Pradesh, India
| | - Poonam Sharma
- Department of Microbiology, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Manoj Kumawat
- Department of Microbiology, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Samradhi Singh
- Department of Microbiology, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Vinod Verma
- Stem Cell Research Centre, Department of Hematology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajnarayan R Tiwari
- Department of Microbiology, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Devojit Kumar Sarma
- Department of Microbiology, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Ravinder Nagpal
- Department of Nutrition and Integrative Physiology, College of Health and Human Sciences, Florida State University, Tallahassee, FL, USA
| | - Manoj Kumar
- Department of Microbiology, ICMR-National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
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Pedersen EC, Lerche CJ, Schwartz FA, Ciofu O, Azeredo J, Thomsen K, Moser C. Bacteriophage therapy and infective endocarditis - is it realistic? APMIS 2024. [PMID: 39007242 DOI: 10.1111/apm.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
Infective endocarditis (IE) is a severe infection of the inner heart. Even with current standard treatment, the mean in-hospital mortality is as high as 15-20%, and 1-year mortality is up to 40% for left-sided IE. Importantly, IE mortality rates have not changed substantially over the past 30 years, and the incidence of IE is rising. The treatment is challenging due to the bacterial biofilm mode of growth inside the heart valve vegetations, resulting in antibiotic tolerance. Achieving sufficient antibiotic anti-biofilm concentrations in the biofilms of the heart valve vegetations is problematic, even with high-dose and long-term antibiotic therapy. The increasing prevalence of IE caused by antibiotic-resistant bacteria adds to the challenge. Therefore, adjunctive antibiotic-potentiating drug candidates and strategies are increasingly being investigated. Bacteriophage therapy is a reemerging antibacterial treatment strategy for difficult-to-treat infections, mainly biofilm-associated and caused by multidrug-resistant bacteria. However, significant knowledge gaps regarding the safety and efficacy of phage therapy impede more widespread implementation in clinical practice. Hopefully, future preclinical and clinical testing will reveal whether it is a viable treatment. The objective of the present review is to assess whether bacteriophage therapy is a realistic treatment for IE.
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Affiliation(s)
- Emilie C Pedersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Johann Lerche
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department for Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Oana Ciofu
- Department for Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Biofilms (ESGB), Basel, Switzerland
| | - Joana Azeredo
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Biofilms (ESGB), Basel, Switzerland
- Department of Biological Engineering, University of Minho, Braga, Portugal
| | - Kim Thomsen
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department for Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Biofilms (ESGB), Basel, Switzerland
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Alt V, Gessner A, Merabishvili M, Hitzenbichler F, Mannala GK, Peterhoff D, Walter N, Pirnay JP, Hiergeist A, Rupp M. Case report: Local bacteriophage therapy for fracture-related infection with polymicrobial multi-resistant bacteria: hydrogel application and postoperative phage analysis through metagenomic sequencing. Front Med (Lausanne) 2024; 11:1428432. [PMID: 39071087 PMCID: PMC11272550 DOI: 10.3389/fmed.2024.1428432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024] Open
Abstract
Fracture-related infections can be challenging, particularly with concomitant severe bone defects and multi-resistant microorganisms. We present a case of a 42-year-old patient with a fracture-related infection following a war injury from a gunshot, resulting in a 12-cm subtrochanteric segmental bone defect and the detection of four different multi-resistant Gram-negative bacteria. Due to antibiotic drug resistance, treatment with bacteriophages was considered. Phage susceptibility testing revealed the activity of a commercially available bacteriophage cocktail (Intesti bacteriophage, Eliava Institute, Tbilisi, Georgia). This phage cocktail was included in a modified two-stage Masquelet technique. During the first intervention, the bone was debrided and samples for microbiological and phage testing were harvested. The indwelling intramedullary rod was removed, and the bone defect was filled with a PMMA spacer loaded with colistin and the bone stabilized with a plate. During the second procedure, the PMMA spacer was removed and a silver-coated angular stable plate was implanted. The bone defect was filled with a fibular autograft and allograft cancellous bone chips. At the end of the procedure, the Intesti bacteriophage cocktail was injected into a DAC hydrogel and this bacteriophage hydrogel composite was then put onto the angular stable plate. Postoperatively the wound fluid was collected over 72 h, and high-throughput metagenomic sequencing was performed. This showed a time-dependent release of the bacteriophages in the wound fluid, with a relatively high concentration after 12 h, decreasing to DNA copies of 0 after 72 h. Furthermore, we have assessed the release of phages from DAC gel and the effect of DAC gel on the phages in vitro. The results showed a stable and rapid release of phages from the DAC gel (~1×103 PFU/mL). The clinical course of the patient showed no relapse of the infection with good bone consolidation of the bone defect after 1 year without the need for any surgical revision. To the best of our knowledge, this is the first case that shows the detection of bacteriophage DNA copies by high-throughput metagenomics sequencing in a patient with a complex fracture-related infection. Successful treatment of this case encourages further investigation of bacteriophage therapy in patients with complex bone and joint infections.
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Affiliation(s)
- Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - André Gessner
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Maya Merabishvili
- Laboratory for Molecular and Cellular Technology (LabMCT), Queen Astrid Military Hospital, Brussels, Belgium
| | - Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | | | - David Peterhoff
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology (LabMCT), Queen Astrid Military Hospital, Brussels, Belgium
| | - Andreas Hiergeist
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Ho P, Dam LC, Koh WRR, Nai RS, Nah QH, Rajaie Fizla FBM, Chan CC, Aung TT, Goh SG, Fang Y, Lim Z, Koh MG, Demott M, Boucher YF, Malleret B, Gin KYH, Dedon P, Moreira W. Screening of the PA14NR Transposon Mutant Library Identifies Genes Involved in Resistance to Bacteriophage Infection in Pseudomomas aeruginosa. Int J Mol Sci 2024; 25:7009. [PMID: 39000118 PMCID: PMC11241198 DOI: 10.3390/ijms25137009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Multidrug-resistant P. aeruginosa infections pose a serious public health threat due to the rise in antimicrobial resistance. Phage therapy has emerged as a promising alternative. However, P. aeruginosa has evolved various mechanisms to thwart phage attacks, making it crucial to decipher these resistance mechanisms to develop effective therapeutic strategies. In this study, we conducted a forward-genetic screen of the P. aeruginosa PA14 non-redundant transposon library (PA14NR) to identify dominant-negative mutants displaying phage-resistant phenotypes. Our screening process revealed 78 mutants capable of thriving in the presence of phages, with 23 of them carrying insertions in genes associated with membrane composition. Six mutants exhibited total resistance to phage infection. Transposon insertions were found in genes known to be linked to phage-resistance such as galU and a glycosyl transferase gene, as well as novel genes such as mexB, lasB, and two hypothetical proteins. Functional experiments demonstrated that these genes played pivotal roles in phage adsorption and biofilm formation, indicating that altering the bacterial membrane composition commonly leads to phage resistance in P. aeruginosa. Importantly, these mutants displayed phenotypic trade-offs, as their resistance to phages inversely affected antibiotic resistance and hindered biofilm formation, shedding light on the complex interplay between phage susceptibility and bacterial fitness. This study highlights the potential of transposon mutant libraries and forward-genetic screens in identifying key genes involved in phage-host interactions and resistance mechanisms. These findings support the development of innovative strategies for combating antibiotic-resistant pathogens.
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Affiliation(s)
- Peiying Ho
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
| | - Linh Chi Dam
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
- Signature Research Program in Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Wei Ren Ryanna Koh
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
- Department of Medicine, National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Rui Si Nai
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
| | - Qian Hui Nah
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
| | - Faeqa Binte Muhammad Rajaie Fizla
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
| | - Chia Ching Chan
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
- Thrixen Pte Ltd., Singapore 048619, Singapore
| | - Thet Tun Aung
- Immunology Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.T.A.); (Z.L.); (M.G.K.); (B.M.)
| | - Shin Giek Goh
- Energy & Environmental Sustainability Solutions for Megacities (E2S2) Program, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 117576, Singapore; (S.G.G.); (K.Y.-H.G.)
- Department of Civil & Environmental Engineering, National University of Singapore, Singapore 117576, Singapore
| | - You Fang
- Energy & Environmental Sustainability Solutions for Megacities (E2S2) Program, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 117576, Singapore; (S.G.G.); (K.Y.-H.G.)
- Department of Civil & Environmental Engineering, National University of Singapore, Singapore 117576, Singapore
| | - Zhining Lim
- Immunology Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.T.A.); (Z.L.); (M.G.K.); (B.M.)
- Singapore Centre for Environmental Life Science Engineering (SCELSE), Singapore 637551, Singapore;
| | - Ming Guang Koh
- Immunology Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.T.A.); (Z.L.); (M.G.K.); (B.M.)
- Singapore Centre for Environmental Life Science Engineering (SCELSE), Singapore 637551, Singapore;
| | - Michael Demott
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
| | - Yann Felix Boucher
- Singapore Centre for Environmental Life Science Engineering (SCELSE), Singapore 637551, Singapore;
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Benoit Malleret
- Immunology Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.T.A.); (Z.L.); (M.G.K.); (B.M.)
| | - Karina Yew-Hoong Gin
- Energy & Environmental Sustainability Solutions for Megacities (E2S2) Program, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 117576, Singapore; (S.G.G.); (K.Y.-H.G.)
- Department of Civil & Environmental Engineering, National University of Singapore, Singapore 117576, Singapore
- Environmental Research Institute, National University of Singapore, Singapore 117576, Singapore
| | - Peter Dedon
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
| | - Wilfried Moreira
- Antimicrobial Resistance Interdisciplinary Research Group (AMR IRG), Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 117576, Singapore; (P.H.); (L.C.D.); (W.R.R.K.); (Q.H.N.); (F.B.M.R.F.); (C.C.C.); (P.D.)
- Immunology Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.T.A.); (Z.L.); (M.G.K.); (B.M.)
- Singapore Centre for Environmental Life Science Engineering (SCELSE), Singapore 637551, Singapore;
- Life Science Institute, National University of Singapore, Singapore 117456, Singapore
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Iredell J, Sinclair H, Khatami A. Personalized bacteriophage therapy for difficult-to-treat infections. Nat Microbiol 2024; 9:1401-1402. [PMID: 38834777 DOI: 10.1038/s41564-024-01712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Jonathan Iredell
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia.
- Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia.
- University of Sydney, Sydney, New South Wales, Australia.
| | - Holly Sinclair
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Ameneh Khatami
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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