All is not lost-
I believed we would face an antibiotics apocalypse - until now
Richard James
For decades my research showed the dangers of new strains of resistance, and this week we heard of another threat. But there’s been a breakthrough
In 2007 I was accused of being a “sensationalist and scaremonger” by the UK Department of Health’s chief nursing officer after I’d said the problem of antibiotic resistance affected thousands of hospital patients – and would get much worse if something wasn’t done.
Two years ago I felt vindicated when England’s chief medical officer stated that “the rise in antibiotic resistance is comparable to the threat of global warming”. And this week we’ve had further evidence of the gravity of this issue with a warning that the world is on the verge of a “post-antibiotic era”. Scientists have discovered bacteria in patients and livestock in China resistant to the antibiotic that is used when all other treatments have failed.
Official recognition of the scale of the problem at least increases the prospects of developing workable solutions that may prevent our current direction of travel. To illustrate what a world without antibiotics would look like, I have a photograph from the pre-antibiotic era in London, in 1932 – it shows children being treated for tuberculosis in three rows of beds outside a building. In those days whether you lived or died was sheer luck – the only treatment was fresh air.
The huge importance of antibiotics within healthcare globally cannot be overstated. A US study in 1999 calculated that the introduction of antibiotics in 1936 caused deaths in the US to fall by 220 per 100,000 within 15 years. All other medical technologies combined over the next 45 years reduced deaths by only 20 per 100,000 people. The euphoria over the healthcare benefits of antibiotics was encapsulated in 1960, when the US surgeon general announced that “infectious disease is conquered”.
So why has this optimism given way to the apocalyptic scenarios that are now commonly expressed? About 25,000 patients a year die in the European Union from an infection caused by a bacteria that is resistant to more than one antibiotic – and on current trends this is predicted to grow to 390,000 a year by 2050.
...... Until last month I was still pessimistic about our chances of avoiding the antibiotics nightmare. But that changed when I attended a workshop in Beijing on a new approach to antibiotic development based on bacteriocins – protein antibiotics produced by bacteria to kill closely related species, and exquisitely narrow-spectrum.
My research over 37 years involved the study of a number of bacteriocins that can kill a range of clinically important bacteria. I – and many other researchers – did not believe they could be useful clinically because injecting a “foreign” bacterial protein into a patient is likely to induce a severe immune response that would make the antibiotic inactive. There were therefore gasps of amazement in Beijing at data presented from several animal studies showing this was not the case.
If you consider a killing domain as a red Lego brick and a targeting domain as a yellow Lego brick, you can make hundreds of different hybrid proteins consisting of one red and one yellow brick to make what I refer to as a series of novel bacteriocin-derived antibiotics (BDAs). In fact, several BDAs have already been designed to kill target bacteria, fungi and even tumour cells.
The ability to use the BDA system to continually make novel antibiotics significantly de-risks the development of antibiotics process and in my opinion offers a significant ray of hope in the present gloom. It is now for governments and health organisations to make sure they make the most of this unexpected breakthrough.
I believed we would face an antibiotics apocalypse - until now | Richard James | Comment is free | The Guardian
