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Superbug killers find a home at UC San Diego

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What started with a wife’s stubborn refusal to give up on her husband who lay dying of a superbug infection has become a whole new research initiative at UC San Diego.

Today, the university will announce creation of the Center for Innovative Phage Applications and Therapeutics and that resolute spouse will be one of its leaders.

Funded with $1.2 million in seed money, the center is tasked with the formal study of bacteriophages, ancient viruses that have increasingly been shown to hunt down and destroy bacteria, even those capable of resisting the modern antibiotic arsenal.

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It was Steffanie Strathdee, UCSD’s associate dean of global health sciences, who first pushed for the use of bacteriophages as a last-ditch effort to save her husband, Tom Patterson, who picked up an intractable superbug infection during a family vacation to Egypt in late 2015.

Using phages purified and modified by local biotech firm AmpliPhi Biosciences Corp. and the U.S. Navy, Patterson’s medical team was able to bring him out of his coma on March 19, 2016.

Things haven’t been quite the same since.

Strathdee said she still receives emails and calls daily from doctors and patients seeking urgent advice on how to use phages when antibiotics fail.

“We’ve been consulting on cases from the UK, India … I’ve had calls from China, Albania just last week. This is a global problem,” Strathdee said.

Tom Patterson and Steffanie Strathdee photographed in 2017 after Patterson overcame a superbug infection with the help of specially-selected bacteriophages. Strathdee now co-chairs a new phage center at UC San Diego.
(K.C. Alfred / San Diego Union-Tribune )

Phages are not approved for general use by the U.S. Food and Drug Administration, which must grant a separate emergency application for every patient whose doctor wishes to use them to treat a severe infection.

But the new center at UCSD, which will focus on treating complicated urinary tract, medical device, transplant and cystic fibrosis-related lung infections, hopes to change that by conducting clinical trials.

Strathdee will co-direct the center with infectious disease expert and UCSD professor Dr. Robert Schooley, who said that trials are necessary to move phages from relative obscurity toward more general use.

“We need to move from the anecdotes of single patients to rigorous controlled investigation,” Schooley said. “Only through controlled clinical trials will we begin to learn important information like how large a dose you have to give to take care of an infection and how often you have to give it.”

Clinical trials would operate under their own FDA-approved protocols and would not require doctors to seek individual approvals or wait until a patient was in a true emergency, with no other viable treatments available as is now the case with the emergency approval system.

This is why, Schooley said, the new center is focusing on four types of infection that are serious but not usually immediately life threatening. Clinical trials require comparison of patients taking phages to those who are only on antibiotics and also comparison of different-strength doses. Those trials are impossible when patients are so sick that death is imminent.

“In order to do studies that can truly isolate the effect of phages, we need to study healthier patients who are on a stable antibiotic regimen,” Schooley said. “For that kind of work, you need to have patients who have clinical conditions that aren’t pressingly dangerous.”

Those with Patterson-level infections, he said, would continue to seek direct access to phages under the FDA emergency protocols in use today.

It’s unclear how many lives phages have saved in the wider world. Any doctor can request permission from the FDA for emergency approval to use a phage cocktail, but the FDA did not respond to a request for the total number of such emergency approvals it has granted. Phage centers in Russia and Poland have been operating for decades and have wide experience using to the viruses to treat many different infections.

UCSD has now treated six different patients with phages and has had strong results in four cases. Results are still awaiting confirmation in a fifth case and the sixth involved a patient who died of other medical problems before it became clear whether or not the phage treatment worked.

Joel Grimwood of Reno, Nev., is one of those six. He sat Wednesday in a hospital room recuperating from a heart transplant that was only possible because a four-week phage infusion eliminated a persistent staph infection that would not go away with regular antibiotic treatment.

While some might think that having billions of viruses infused into his bloodstream would make a guy nervous, even reluctant, the 65-year-old chiropractor said that when you’re in pain and facing heart failure, innovative ideas come with little extra anxiety.

“Me, I don’t mind an experiment,” Grimwood said. “If it didn’t work, at least they got some data they could work with.”

Having battled heart failure since 2007 and having depleted most of his life savings, Grimwood has set up a fundraising account at gofundme.com/Joel-Grimwood.

His phage cocktail was designed and tested in San Diego by Carmel Valley-based AmpliPhi Biosciences.

Along with the U.S. Navy and Texas A&M University, AmpliPhi is at the forefront of companies capable of using libraries of pre-sorted, screened and tested phages shown to target specific bacteria.

Matt Dansey, AmpliPhi’s business development manager, carries the same resistance concerns that have gradually stolen the effectiveness of many once-powerful antibiotics. Rapidly-reproducing bacteria will quickly develop defenses to phages, and this requires cocktail creators to choose several different attackers right at the outset.

“We’ve learned to make sure we have at least two different phages so we can make sure we hit the infection from two different directions at the same time,” Dansey said.

So far, Strathdee said that no one in the small but growing community of doctors actively using phages to treat patients has reported any serious complications, a fact that clears the way for more extensive clinical trials. It’s exciting, she said, to move from helping her husband to helping many more.

“This is a real need and we’re so excited to be part of the global group that’s moving forward on phages,” Strathdee said.

She and her husband, Tom Patterson, are writing a book “The Perfect Predator,” which is due out in May 2019, and available for preorder at theperfectpredator.org in September.

UCSD will not go it alone in this endeavor. It will partner with like-minded institutions, including the Center for Phage Technology at Texas A&M University, San Diego State University, AmpliPhi and Maryland-based Adaptive Phage Therapeutics Inc.

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paul.sisson@sduniontribune.com

(619) 293-1850

Twitter: @paulsisson

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