Cleveland Clinic experience with a lung transplant patient
With the emergence of extensively drug-resistant bacterial infections and the recognition of other limitations to traditional antibiotics over the past few decades, bacteriophage therapy (BT) has reemerged as a strategy for the treatment of bacterial infections. Pharmacological antibacterial therapies eclipsed this century-old therapy in decades past, but now the use of lytic phages to kill infections is on the rise. In Cleveland Clinic’s Respiratory Institute, we are employing this strategy with difficult-to-treat infections and are collaborating with other institutions to advance the study of this treatment.
The basics of phage therapy
Bacteriophages are viruses that infect bacteria. They are ubiquitous, present in high concentrations in environmental sources, including sea, swamp and sewage waters. Present wherever bacteria reside in high concentrations, they are the next stratum of the human microbiome, infecting bacteria of the human digestive tract and other niches.
Much like viruses that infect human cells, bacteriophages are comprised of RNA or DNA and viral proteins and vary in their genetic diversity and complexity. Bacteriophages can be lysogenic or lytic. Lysogenic phages integrate into the bacterial cell chromosome. Lytic phages infect the bacterial cell through attachment to specific receptors, replicate and assemble in the cellular cytoplasm, lyse the cell and release their progeny which are then able to infect additional targeted bacteria. Lytic phages are used almost exclusively in BT, since the intended result is destroying bacterial cells through lysis (Fig. 1)
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