Last week, we covered how experimental phage treatments are done in the US.
The main issues with experimentally treating patients with phages are:
a) it’s time-consuming and expensive to prepare phages,
b) the right phages are not always at hand, and
c) it’s currently no one’s job.
To help surmount some of these obstacles, sometimes a phage crowdsourcing effort will begin.
If you’ve been involved in phage crowdsourcing and have any insights to share, we’d love to talk to you. Please reach out to us at [email protected]!
Phages can be crowdsourced?
Phage crowdsourcing was done for Tom Patterson and Mallory Smith.
Phage crowdsourcing tends to start with a physician asking for phages on behalf of a patient in need. As we covered last week, some therapeutic phage-producing companies (like Ampliphi or APT) take on emergency cases like these. Sometimes, however, they need extra help, and this is when phage crowdsourcing comes in.
At this point, emails get sent around to research labs around the world. These labs are asked to volunteer their phages, graduate students, postdocs, technicians, lab materials and time in pursuit of phage testing, isolation, propagation and purification.
Volunteers make the difference
In phage crowdsourcing cases, we at Phage Directory step in and send out a Phage Alert to anyone who’s signed up on our site. The emails then either flood or trickle in, generally depending on the organism.
On one side of the spectrum, we had an E. coli phage alert garner nearly a dozen responses from labs willing to help. On the other hand, about a week later, we had a Burkholderia phage alert go completely unanswered. (As many more people study and understand E. coli phages than Burkholderia phages, this was not necessarily surprising.)
Once we identify labs willing to help, we help get them the info they need. Instead of sending people blocks of text, we like to make personal introductions. Usually, this means introducing them to others who’ve been involved in past crowdsourcing efforts. We also help the patient’s medical team understand how and where to ship the patient’s clinical isolates for phage testing.
Pop-up phage-testing hubs
Some labs are willing to offer up their phages, but are not necessarily in a position to accept clinical isolates or produce phages for a patient. As well, the fewer labs the patient’s bacterial isolate needs to be sent to, the better. For these reasons, we help identify 1-2 labs willing to serve as “hubs”. Other volunteer labs are then asked to send their phages to these selected “hubs”.
The idea is that phage-testing hubs will:
a) receive the patient’s bacterial isolate(s),
b) receive the phages volunteered by other labs, and
c) test their own phages and all received phages to find those that can lyse the patient’s strain(s).
If any phages are identified that can potentially help the patient, the phage-testing hub (or another lab, depending on the capacities of the former) would propagate, purify and send the candidate phages to the medical team, which would administer the phages to the patient.
Who pays for this?
Right now, the costs of preparing emergency therapeutic phage preparations in the US are incurred by the volunteers doing the work: phage-producing companies or research labs. Patients are not charged.
Once phages are shown to be effective in controlled clinical trials (many of which are beginning in 2019, as we wrote about last week, more companies will likely start developing phage products as drugs. Eventually, full FDA approval should follow. With full FDA approval, phage treatments would presumably be covered by insurance companies. However, we are years away from that reality, so volunteers are stepping up now to help patients in need.
How can you help?
If your lab or company is interested in volunteering time, space, phages and/or expertise to this cause, please get in touch with us. If you want to talk to someone who’s been involved previously, ask us and we’ll connect you.
If you’re a medical professional with a patient who might qualify for experimental phage therapy, the Center for Innovative Phage Applications and Therapeutics (IPATH) has eligibility criteria and instructions here on how to proceed.
Thanks for reading!
~ Jessica <>={
