Can A 100-Year-Old Treatment Help Save Us From Superbugs? In 2015, Steffanie Strathdee's husband nearly died from a superbug, an antibiotic resistant bacteria he contracted in Egypt. Desperate to save him, she reached out to the scientific community for help. What she got back? A 100-year-old treatment that's considered experimental in the U.S. Strathdee, an infectious disease epidemiologist, tells us how it works, its limitations, and its potential role in our fight against superbugs. Follow host Maddie Sofia on Twitter @maddie_sofia. Email the show at shortwave@npr.org.
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Can A 100-Year-Old Treatment Help Save Us From Superbugs?

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Can A 100-Year-Old Treatment Help Save Us From Superbugs?

Can A 100-Year-Old Treatment Help Save Us From Superbugs?

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MADDIE SOFIA, HOST:

You're listening to SHORT WAVE...

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SOFIA: ...From NPR.

In 2015, Steffanie Strathdee and her husband, Tom Patterson - both scientists - were traveling in Egypt. They saw the pyramids, the Nile. And then, as she tells it in this TEDx Talk, after dinner one night...

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STEFFANIE STRATHDEE: Tom became violently ill. He vomited all night long. And I thought, oh, gee, he's just got food poisoning. And I pulled out a couple of antibiotic pills that we take with us on our trips. And I gave it to him with some water. Nothing happened.

SOFIA: The next day, Tom kept vomiting. Steffanie called a doctor. He thought, yeah, food poisoning, and set up an IV drip for more antibiotics. But Tom only got worse. At a local clinic, he was diagnosed with pancreatitis - inflammation of the pancreas - and medevaced to a hospital in Frankfurt.

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STRATHDEE: And there, he was diagnosed with something even worse - a superbug; a bacteria by the name of Acinetobacter baumannii.

SOFIA: Scary name, scarier bacteria - it tops the World Health Organization's list of most dangerous superbugs; bacteria that are very hard to treat, often resistant to many antibiotics.

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STRATHDEE: Now, we'll never really know for sure where Tom got his superbug infection, but we do know that it was an Egyptian stream. And we know that by the time he was medevaced home to San Diego, that it was resistant to every antibiotic.

SOFIA: Tom was in a coma. His organs were shutting down. He was on three different drugs to keep his heart beating.

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STRATHDEE: And the doctors told me that Tom was going to die.

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SOFIA: But Steffanie refused to give up. She turned to the scientific community for help.

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SOFIA: I'm Maddie Sofia. Today on SHORT WAVE, what Steffanie found and how it saved her husband's life. It's a century-old treatment that could be a new tool in our war against superbugs.

For months, Steffanie's husband, Tom, would remain hospitalized, fighting for his life and losing.

STRATHDEE: Yeah. I was just really scared out of my mind. But I knew that if I just sat back and waited, then he was going to die. And I needed to know that I'd done every last thing that I could do, that I would leave no stone unturned. So I hit the Internet, and I did what anybody else would do in my shoes. I Googled it.

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STRATHDEE: Well, luckily, you know, there's Google for scientists. And that's called PubMed. And it's this wonderful search engine where you can put in any words and a scientific paper will pop up. And, you know, I punched in words like multidrug resistance and the name of his superbug, which is Acinetobacter baumannii. And up popped - within an hour, I found a paper that mentioned something called phage therapy.

SOFIA: So tell me a little bit about phage therapy.

STRATHDEE: Well, phage are short for bacteriophage. And that's derived from the Greek word meaning bacteria eater. And they are viruses that have naturally evolved to attack bacteria. There's 10 million-trillion-trillion (ph) phages on the planet. It's all a matter of finding the ones that will kill the bacteria that you want to get rid of.

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SOFIA: OK. Real quick, phage 101 - first, like Steffanie said, bacteriophages - the viruses that infect bacteria - are everywhere. Pretty much anywhere you find bacteria, you'll find a phage. We're talking Antarctica, deep sea ocean vents, your butt - I swear that'll make sense later. Second, phages don't actually eat bacteria.

In this case, the phage injects its own DNA into the bacterial cell. Then the virus forces the bacteria to make more and more copies of itself, filling up the cell with viruses. Eventually the bacteria busts open, releasing all those new viruses to go off and kill other cells. It's ruthless.

And so at this point you were thinking, like, oh, maybe these bacteriophages can kill the bacterial infection that my husband has.

STRATHDEE: Yeah. You know, I have this ancient degree in microbiology. So I knew what phages were, but I never even heard that they had ever been used to treat people's bacterial infections. And it turns out that the former Soviet Union had been doing this for decades. And yet, it was still experimental in the West because we didn't have, you know, clinical studies and trials, in particular, to show that they worked.

SOFIA: So what do you do then? Like, how do you get your hands on some phages?

STRATHDEE: Well, when the doctors told me that they were willing to try this last-ditch effort to save my husband, I was really excited. But then I thought, oh, my God, with so many phages on the planet, like, how am I going to find the right ones? I don't know anything about this. So I hit the Internet again. And I made a list of all of the scientists who were studying bacteriophage and the superbug that my husband was infected with. And in the U.S., that was a really short list. I didn't go beyond the U.S. because we didn't have much time left.

And I wrote them all a cold email and said, you know, my husband is dying. If you have phages that could potentially match my husband's bacteria, please let me know. I would love to have you help us. And, lo and behold, you know, somebody from Texas A&M, Dr. Ry Young, responded and turned his lab into a command center.

SOFIA: Yeah. I mean, it was wild - you know, somebody that you've never met with graduate students that you've never met going through this, like, massive, you know, library of phages trying to find the right one to treat that specific isolate of Acinetobacter.

STRATHDEE: Well, they did have a phage library, but they only had a couple of Acinetobacter phages. And so they went to what's called environmental samples. And Dr. Young asked me if I knew what that was. And I'd done my homework.

SOFIA: (Laughter).

STRATHDEE: And I knew that he meant sewage. I mean, are you kidding me?

SOFIA: (Laughter).

STRATHDEE: So - because, you know, if you have a bacterial infection in your gut, you know, people are going to be pooping out a lot of bacteria and what preys upon them...

SOFIA: Right.

STRATHDEE: ...The perfect predator - bacteriophage. So literally, you know, his phage were found in sewage samples, barnyard poop.

SOFIA: So wait. So they actually went back out and isolated more phages for this treatment.

STRATHDEE: Yeah.

SOFIA: Oh, my goodness.

STRATHDEE: They had a whole bunch of environmental samples - a couple - a thousand, I think. We even had help from the Navy. The U.S. Navy Medical Research Center in Frederick, Md. - they have a biodefense lab. And they offered to hunt for phage as well. And so they found four phages that matched.

SOFIA: Yeah. OK, so there's this huge collaborative effort that's between you and, you know, scientists in academia, scientists in the military. Your doctor's gotten, like, special permission from the FDA to have this experimental treatment. And so you've got these phage cocktails, right? And you basically inject them directly into the site of the infection.

STRATHDEE: That's right - a billion phages per dose every two hours, if you can believe it.

SOFIA: I mean, it's wild. And so, OK, talk to me about why it's so important that you have a lot of different types of phages.

STRATHDEE: Well, if you can imagine that bacteria and bacteriophage have been coevolving for 4 billion years, they're intent on one another. It's almost like one has a sword and the other one has a shield. And they're just developing resistance all the time. So if you only have one phage and you're injecting that into somebody to try to kill their superbug, that bacteria could become resistant very quickly.

SOFIA: Right.

STRATHDEE: I mean, they're multiplying, say, every 20 to 30 minutes. And so you need to have phage that are going to tackle different components of the bacteria - so one, say, goes in a door and the other one that goes in a window. And so if you have these phages that are attacking different parts of the bacteria, the bacteria is going to be less able to develop resistance.

SOFIA: OK, so you found, hopefully, the right phages for the job. How long did it take before he started feeling better?

STRATHDEE: Well, we started the phage therapy on March 15 with the Texas phages. And we put those into the tubes in his abdomen because that was the closest to the site of the infection. Two days later, we injected the Navy phages, which were thought to be more potent or virulent, into his bloodstream. And three days later after that, he woke up, lifted his head off the pillow and kissed his daughter's hand. I mean, everybody in the ICU freaked out.

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SOFIA: It would be nine months in all before Tom could leave the hospital and go home. Eventually, he fully recovered, thanks, in no small part, to phage therapy. Nowadays, phage treatments seem to be gaining some traction in the U.S., but it has its challenges. Like Steffanie said, bacteria can become resistant to phages very quickly. Then there's the issue of drug delivery. Sometimes, it can be hard to get the phages to the exact area of the infection.

Plus, a lot of phages only infect a specific type of bacteria, which is good because it leaves all the other good bacteria alone but bad because, in some cases, it can be hard to find the right kind of phage for the job. So lots of challenges, but lots of promise, too. After this experience, Steffanie even started working in phage therapy.

So, you know, in your mind, what would you say is, like, the No. 1 thing that is keeping phage therapy from being, like, a common treatment option in the States?

STRATHDEE: The most important thing that phage therapy needs now is to undergo clinical trials because we lack the data from anything more than case studies to show the FDA that it could be efficacious on a broader scale. And it's going to take time for that to happen. And thankfully, the National Institute of Health has funded their first phage therapy trial.

We're going to be enrolling patients here in San Diego through our center, the Center for Innovative Phage Applications and Therapeutics. And so that's very exciting. When we have the data from clinical trials, then the FDA can decide whether or not to license it alongside antibiotics.

SOFIA: Yeah. Yeah. You know, I wonder, Steffanie, like, you're obviously - you know, you're a human. You're, obviously, the wife to this man who's going through this. And you're also a scientist, you know, trying to figure out a scientific mystery. I just can't imagine what all of those different intersections of identities were like when you were going through this experience.

STRATHDEE: Well, to me it felt something like a kaleidoscope. I had the wife me. I had the scientist me. I had the caregiver me. And I didn't realize it at the time, but I was suffering from PTSD and so was my husband and his daughters. But when he was treated and he finally recovered, it was kind of like that kaleidoscope - you know, when you fold the little, you know, scope and all of those little fragments of glass, you know, make one mosaic, and it's beautiful. That's really what my world is like now.

And we met many people that have had their lives saved from phage therapy, some as a direct result of my husband's case. And it's just such an immense privilege to be able to see that happen.

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SOFIA: Steffanie Strathdee is co-director of the Center for Innovative Phage Applications and Therapeutics, which was founded in the UC San Diego School of Medicine. She's also written a book about her experience. It's called "The Perfect Predator." Steffanie says it's now been optioned for a movie.

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SOFIA: This episode was produced by Rebecca Davis, edited by Viet Le and fact-checked by Emily Vaughn.

I'm Maddie Sofia. We'll see you back here tomorrow with more SHORT WAVE from NPR.

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SOFIA: Who would play you if you could pick?

STRATHDEE: Oh, wow. (Laughter) Oh, my pick would be Charlize Theron, absolutely.

SOFIA: I mean, what can't she do? You know what I mean? What can't she do?

STRATHDEE: Hey, Charlize, if you're out there, call me up.

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