The first Canadian study using phages to treat superbug infections is underway with scientists reporting a preliminary but encouraging initial success story.
“You are considered clinically and biologically clear,” Victoria Marshall said as she read a text message from her doctor about the results of her latest tests.
It brought her to tears.
“Good, I can have my life back. It was really hard.”
The 72-year-old retired librarian began suffering from urinary tract infections when she was 65. It is one of the most common infections in the world affecting about one in four women in their lifetime. Marshall suffered from pain and an almost constant burning sensation that made her run to the nearest bathroom.
“There would be a very sharp burn most of the time, urgency and occasional wetness,” he told CTV News. “I couldn’t leave the house for more than an hour at a time, not knowing where a bathroom was.”
But her UTI couldn’t be killed by any of the half dozen antibiotics she was prescribed.
It was a treatment-resistant e-coli infection, also known as a superbug infection. Even potent intravenous drugs failed to kill the bacteria and caused her side effects such as nausea and body pain.
With no effective way to stop it, the infection traveled up her urinary tract to one of her kidneys that had to be removed. Victoria feared that the other would also be at risk.
“Eventually, it was like we ran out of options. There was nothing else. It’s scary,” she told CTV News.
In May, Marshall became patient number one in the first Canadian study using phages for treatment-resistant UTIs led by Dr. Greg German, an infectious disease physician at St. Joseph’s Hospital, part of Unity Health in Toronto.
He had long been fascinated by phages as a potential tool in fighting the growing spectrum of antibiotic-resistant infections.
“(The phages) shoot to kill and they … have a natural ability to go to the source, make more of themselves and continue to be there while the infection is still there,” said Dr. German.
SMART BOMBS
Phages exist wherever bacteria are found: in water, soil and wastewater, and they act as viral smart bombs. They target bacteria and inject their DNA to produce more phages until the bacteria explode, ejecting billions more phages that seek out new targets.
The clinical trial used three phage strains that were selected because they targeted Marshall’s e-coli infection strain. They were collected and purified in a lab at Baylor College of Medicine in Houston, Texas, where they are also studying phages for UTIs.
It’s a form of personalized medicine, says Dr. German. “They’re all targeted against E. coli … Drug-resistant E. coli that we couldn’t get rid of any other way. Unless they were on daily IV antibiotics. And that’s not a long-term solution,” he said. added.
Phage therapy is not currently available in Canada, but it was a French Canadian scientist, Felix d’Herelle, who co-discovered it in 1917.
Billions of phages were infused into Marshall’s bladder, sponged onto her vaginal area, and Marshall even drank some of them, to transport them throughout her urinary tract. Compared to the weeks of antibiotic therapy, he calls the phages his “unique treatment”.
“I started feeling better in about 48 hours,” Marshall said.
When doctors saw bacteria levels start to rise again shortly after treatment, they administered a mild antibiotic that hadn’t worked before. Doctors suspect the phages may make treatment-resistant bacteria more vulnerable to standard antibiotics.
“I felt like a new woman,” said Marshall, whose confirmed tests show she is still infection-free a month later. Prior to phage therapy, Dr. German says they would see a return of Marshall’s infection within a few days.
From left: Jiten Jain, pharmacy manager at St. Joseph’s Health Centre; Victoria Marshall, patient researcher; and Dr. Greg German, Physician at the Chronic Infection Clinic (Photo provided by Dr. Greg German)
“We’re excited about the progress so far. And we’re looking to see how the data comes together and we get insights from our collaborators to show that the infection is truly gone,” he said, adding that the research is in early stages.
He presented Marshall’s case at an ongoing Viruses of Microbes phage scientist meeting in Tbilisi, Georgia.
“I’m very excited to see this moving forward in Canada, the time has come,” said Steffanie Strathdee. She directs the Center for Innovative Phage Applications and Therapeutics (IPATH) at the University of California at San Diego.
Strathdee, a Canadian scientist, also harnessed the power of phages to save her husband, Tom Patterson, from a near-fatal superbug infection documented in her book “The Perfect Predator” and featured in a CTVW5 documentary.
IPATH also connects patients suffering from treatment-resistant infections and their doctors, with the scientists who harvest the phages. The group has already treated dozens of people and is consulting with many international cases, including people with respiratory infections and people with hip or knee replacements that have led to difficult-to-treat infections.
CANADIANS INTERESTED IN THERAPY
Dr. German says he’s also getting calls from Canadians with superbug infections, wanting to try phage therapy.
While available on compassionate grounds in the United States and parts of Europe, Canadian regulators require a formal clinical trial to determine safety. That’s why he says his phase one study is so important. It will now test 200 more women with treatment-resistant UTIs in Ontario to begin with, hoping to have phage safety results for Health Canada within two years.
“Everything we’ve seen in our global experience with phage therapy indicates that it’s safe and is ready to move to the next step,” Strathdee said.
Marshall, meanwhile, keeps a diary of his symptoms and any side effects, of which he says there was only temporary tiredness. She’s not only sold on phages, even at this early stage, she’s also an advocate for women like her who suffer without solutions.
“I would like to tell people not to be afraid of it. It’s easy. Minimal side effects. Great result.” she said.
CANADIAN DISCOVERY
Phage therapy may not be available in Canada, but it started here over 100 years ago.
French-Canadian scientist Felix d’Herelle co-discovered these micro killers in 1917. Early studies showed that they were very good at controlling epidemics of dysentery and typhoid plague.
But phages were abandoned in favor of antibiotics, which could be mass-produced and were much more profitable. Eventually, D’Herelle moved to the Soviet Union to continue his work. And phages were relegated to the margins of mainstream medicine.
Over the years, bacteria have evolved and now many are resistant to our wonderful antibiotic drugs. Patients around the world are developing treatment-resistant infections after joint replacements, organ transplants and cancer therapy.
A recent report predicts that superbugs will claim the lives of nearly 400,000 Canadians over the next 30 years.
And the World Health Organization warns that we are entering a post-antibiotic era where even a simple skin infection can kill.
NOTE:
Although men also get UTIs, they are much more common among women and other people with vaginas, in part due to a shorter urethra, which makes it easier for bacteria to enter the urinary tract.
You can watch Avis Favaro’s report on CTV National News tonight (July 4) at 11pm. The Avis documentary “Super Bug Killers” broadcast on CTVW5 can be viewed in our video player at the top of this article.
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