Advancing Phage Therapy: Insights from Leading Clinicians

Issue 256 | March 15, 2024
12 min read
Capsid and Tail

Credits: Urmi Bajpai

This week, Prof. Urmi Bajpai shares insights (and recordings!) from a phage therapy clinician webinar series she hosted recently, which featured Gina Suh, Chip Schooley, Jon Iredell, Gopal Nath, and Mzia Kutadeladze.

Urgent March 5, 2024

Urgent need for Achromobacter phages for a patient in the USA

Phage Therapy

We are urgently seeking Achromobacter phages for a patient in the USA.

Ways to help at this stage:

  • By sending your phages for testing on the patient’s strains
  • By receiving the patient’s strain and testing your phages
  • By helping spread the word about this request
  • By providing us with names/email addresses of labs you think we should contact

Please email [email protected] if you can help in any way, or if you would like further details/clarification.

Let’s make a difference,
Phage Directory

What’s New

Precisio Biotix Therapeutics has acquired London-based CC Bio. This gives Precisio access to CC Bio’s ZEUS lysin platform, a bioinformatics platform highly complementary to Precisio’s high-throughput screening, engineering, and AI system for creating novel lysins.

Precision AntibacterialsLondon-Based AcquisitionTop Scientists

PrecisionPhage, a new startup based in Finland, has launched Phagenomics, a browser-based tool for phage genome analysis to streamline assembly and annotation for researchers and clinicians.

New companyPhage GenomicsBioinformatics

Milan Gerovac (University of Würzburg) and colleagues published a new paper revealing how phage-encoded proteins, particularly from jumbo phage ΦKZ, target and co-opt P. aeruginosa ribosomes immediately after infection. They make the case that phage genomes represent an untapped discovery space for proteins that modulate bacterial gene expression machinery.

RibosomesResearch PaperPhage-Host Interactions

The CDC has launched an Antimicrobial Resistance Investment Map (interestingly, they are calling it ‘AR’ now — is this our new acronym for AMR?). The map illustrates the allocation of CDC funds in the US and abroad. Explore funding landscape & download data | Get info on funding opportunities

CDCAntimicrobial ResistanceFunding Opportunities

The ADVANcing Clinical Evidence in Infectious Diseases (ADVANCE-ID) Network is offering funding for Phase II or III clinical trials focusing on antimicrobial agents for multi-resistant Gram-negative bacilli infections. Application deadline is March 15.


Latest Jobs

ResearcherHost rangePhage-host interactions
University of Alabama at Birmingham, USA is hiring a Researcher to investigate phage host range, genetic mobilization, and antibiotic resistance in staphylococci and streptococci, involving microbial genetics, biochemistry, and structural biology approaches.
PostdocEvolutionary ecology
Indiana University, Bloomington, USA is hiring a postdoc to conduct research in phage-centric microbial evolutionary ecology.
Research technicianPhage therapy
University of Leicester, UK is hiring a Research Technician to optimize phage production processes, focusing on scaling up phage amplification and purification to meet therapeutic demands within the Centre for Phage Research.

Community Board

Anyone can post a message to the phage community — and it could be anything from collaboration requests, post-doc searches, sequencing help — just ask!

Wondering how phage therapy startups raise money? PhageLab recently raised $11M, and this ‘pitch deck teardown’ blog post goes through the pitch deck they used to convince investors, which slides pack the most punch, and other tips.

Startup FundingPhage therapy

The International Society of Viruses of Microorganisms (ISVM) is calling for applications to organize the Viruses of Microbes (VoM) 2026 conference.

Interested ISVM members should submit their applications by April 30, 2024, to [email protected].

The selection process includes a review and presentation at VoM 2024 in Cairns, Australia. Organizing VoM is rewarding but demands strong teamwork and planning.

Viruses of MicrobesISVMConferenceCall for organizers

The 2nd Symposium of the Belgian Society for Viruses of Microbes (BSVoM) was held on September 8, 2023, at the University of Liège, featuring over 140 researchers from 10 countries discussing phage ecology, diversity, and applications.

The event also launched the “Phage Valley” initiative, promoting Belgium’s collaborative phage research ecosystem.

Summary of the symposium

BSVoMPhage ValleySymposiumRecap report

The BV-BRC Viral Sub-species Classification Workshop, funded by NIAID, will be held in Rockville, MD from April 8-10, 2024.

This hybrid event, in collaboration with the CDC and NCBI, aims to establish best practices for viral sub-species classification.

The workshop will review current classification schemes and methodologies, fostering a collaborative approach to future pandemic preparedness.


Advancing Phage Therapy: Insights from Leading Clinicians

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UB Lab, University of Delhi, New Delhi, India, Acharya Narendra Dev College
Twitter @urmibajpai

Phage isolation, Molecular Biology, Teaching, Undergraduate research

Seeking collaboration in “Sequencing and bioinformatics; Research exchange opportunities”

What I do: Focus of my research team is:
i) Isolation and characterisation of mycobacteriophages and their lytic enzymes (Endolysins) and Terminases/ATPases; Exploring their anti-mycobacterial potential in collaboration with scientists working on Mycobacterium tuberculosis and NTM

Also interested in finding new methods of phage isolation.

ii) Multi-target therapy for Tuberculosis: Mur enzymes of Muramic acid synthesis pathway in the cell wall biosynthesis of Mycobacterium tuberculosis are the target proteins. Drug repurposing & discovery of new inhibitors by invitro screening using a one-pot assay developed for Mtb Mur enzymes.

Profile Image
Assistant Professor
Banaras Hindu University
Profile Image
Undergraduate Student
Washington University in St Louis

At the end of 2023, the International Bacteriophage Research Consortium (IBRC) & Open Source Pharma Foundation (OSPF), in association with the Indian Society for Bacteriophage Research and Therapy (SBRT), organized a series of talks featuring clinicians from the United States, Australia, India, and Georgia who have experience in delivering Phage Therapy. These talks were held during World Antibiotic Awareness Week (WAAW 2023), which aims to raise awareness about the antibiotic resistance crisis and promote antibiotic stewardship. The talks aimed to provide insights into phage therapy’s latest developments, challenges, and successful case studies to deepen the understanding among clinicians, researchers, and regulatory bodies.

The series featured several notable speakers (click the links below to watch the recordings!).

Dr. Gina Suh, an Infectious Diseases specialist, treated the Mayo Clinic’s first phage therapy patients and is currently heading efforts to create the Mayo Clinic Phage Therapy Program and run phage clinical trials. She shared her experiences with Compassionate Use Cases, including treating prosthetic joint infections, left ventricular device infections, and hepatic abscesses.

Dr. Robert Chip Schooley, a Professor at the University of California, San Diego and co-director of IPATH, discussed Unsettled Issues in Phage Therapeutics, drawing on his experience as the first physician to treat a patient with intravenous bacteriophage therapy in the United States.

Prof. Jonathan Iredell, an Infectious Diseases Physician at Westmead Hospital, Sydney, coordinates nationwide clinical trials related to life-threatening infections. While discussing their end-to-end national program, ‘Phage Australia’, he emphasized the importance of therapeutic phage characterization with respect to their growth curve.

Dr. Gopal Nath, from Banaras Hindu University, pioneered Clinical Bacteriophage Therapy in India. He shared his discernments based on his experience of treating about 200 cases of chronic/diabetic wound infections, ventilator-associated pneumoniae, and cases of septicaemia.

Dr. Mzia Kutateladze, Director of the G. Eliava Institute of Bacteriophages, Microbiology, and Virology and President of the Eliava Foundation, a collection of commercial spin-offs in Georgia, discussed her vast experience in coordinating phage research in the institute. She shared details on the development of phage cocktail products for infections.

The talks sparked discussions on various topics, including specifics on phage purification, storage conditions and viability, dosing intervals, the cost of treatment, scalability, regulatory hurdles, and the overall merits of phage therapy. The participants, including research scholars, scientists, clinicians, professors, start-up owners, and journalists, raised questions and concerns about the efficacy, specificity, and host range of bacteriophages, routes of phage delivery, in vivo vs. in vitro discordance, adaptive human immune response, and regulatory issues.

The common questions and concerns that arose after the talks are categorized and are listed below.

Technical specifics on therapeutic phages

Where are phages sourced from? Are there standard operating protocols for phage preparations? How stable are phage preparations? Does encapsulation or carriers like liposomes make phages more stable? Soil/water samples from nearby farms, animals, wastewater, and sewage are common isolation spots. Essential considerations in phage therapy are universally accepted protocols for phage preparation and purification, both on a small scale and on an industrial scale. The principal criterion for choosing phages for therapy is based on their lytic potential. The shelf life of most phages (at 4 degrees Celsius) is about two years.

Monophage Vs Phage Cocktail preparations. Clinicians favoured broad host range fixed cocktails, especially for infections like UTIs. An intimate knowledge of the local microflora allows for the development of phage cocktails in advance.

Antibiotic-phage and phage-phage synergy: How do phages behave differently in a cocktail? Can the synergies be predicted in vitro? Are there practical guides for the in vivo amplification effects of phages? The importance of phage banks and informed decisions on sourcing phages from the established biobanks vs. preparing customized phages; the need for mobile phage libraries or to rely upon established centres for procuring phages.

Endolysins. Phage-encoded lytic enzymes as recombinant proteins hold promise as enzybiotics. Being proteins, endolysins don’t amplify; hence, the production and therapy cost was considered higher than that for phages. Also, their PK and PD would be different from phages.

The technical specifics related to phage therapy

Delivery routes and dosing in phage therapy. Phage administration was acknowledged to be complicated. Depending on the anatomy of the infection, the dose and route of administration must be carefully chosen. Initially, endotoxins in phage preparations disallowed clinicians from using routes other than oral/topical; however, the modes are now expanding. Are there alternative delivery methods, such as aerosolization or targeted nanoparticles, that could improve phage delivery to specific infection sites, especially in cases involving intracellular pathogens like Mycobacterium sp.? The need to develop a rational framework was considered necessary.

Dosing: Monitoring pre-clinical trials usually indicates 2-3 doses as sufficient in less severe cases. While some clinicians preferred higher titres (10^9-10^10pfu/ml) of phages in fewer dosages, the other speakers preferred lower (~10^5 pfu/ml) titres but more frequent dosages.

Patients’ response to the phage treatment

Immune response to Phage Therapy: The queries on immune response were among the highest. Although the speakers did not consider it a major impediment, the probability of neutralizing antibodies negatively impacting the therapy wasn’t ruled out, especially in chronic infections. They were of the opinion that this response is still to be understood entirely.

Phage resistance: In mono-phage therapy, resistance can develop quickly, but with multiple phages, resistance can be delayed or may not occur during the course.

The practice of monitoring parameters during treatments, especially in cases where the release of endotoxins is anticipated, assures the safety of the treatment. The Bates-Jensen wound assessment tool is one such tool, and the monitored parameters include temperature, blood pressure, and oxygen saturation.

Genetically engineered phages

Engineered/modified phage therapeutics: How can synthetic biology approaches be leveraged to engineer phages with enhanced therapeutic properties, such as increased host specificity, prevention of lysogeny or resistance to bacterial defenses? What ethical considerations are associated with genetically modifying phages for therapeutic purposes, and how can we ensure responsible and transparent research practices? What are the environmental implications of using phages for therapy, including releasing genetically modified or introducing non-native phages into ecosystems?

Clinical trials

Deliberations on clinical trials attributed under-dosing, loss of phage viability, inefficiency of pre-prepared cocktails, lack of personalized preparation, etc., to the unsuccessful trials. All the panelists emphasized developing and implementing carefully structured clinical trials to assess the safety and effectiveness of phage therapy across various infection types, including optimizing concurrent antibiotic therapy in combination with phage therapy. The factors that would require thorough consideration are study design, criteria for selecting participants, defined endpoints, and comprehensive follow-up evaluations to ensure the production of reliable clinical data. A less emphasis on pre-clinical studies as a pre-requisite for using phages in clinical trials and human medicine appears to be a welcome step.


Despite the challenges and limitations discussed, the guest clinicians in the series expressed profound optimism and confidence in phage therapy as a potential solution to the antibiotic resistance crisis. They also highlighted the importance of interdisciplinary research approaches and collaboration, which can address complex challenges and drive innovation in phage therapy. However, given the value therapeutic phages hold, Material Transfer Agreements (MTAs) and the procedural delays for sharing phages and their products were identified as some of the crucial constraints in fruitful collaborations. They emphasized the need for standardized protocols for phage preparation and purification, the development of phage banks, and carefully structured clinical trials to assess the safety and effectiveness of phage therapy.

To sum up, the queries such as “What is the cost of the treatment?”, “Why can’t phage therapy be given early in patients’ illness?” “Why does phage therapy fail in some and succeed in others?” “By when can phage treatment become commercially available?” conveyed growing interest, acceptance, and somewhat impatience among the participants.

More resources

  • Here is the UB Lab YouTube Channel Link it has YouTube links to all the talks organized in the past, not just five from this series.
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