We’re going to start doing more ‘quick dives’ into topics relevant to the phage community: this week, we’ve chosen diabetic foot ulcers.
We’ll also be setting up a roundtable to bring together those working in this space; see below for details, & email [email protected] if you’d like to take part!
Diabetic foot ulcers are extremely common, and often lead to amputation
Every 20 seconds, someone loses a limb to diabetes, and it often starts with a foot or toe ulcer (wound). Diabetic foot/toe ulcers are extremely common in diabetic patients, and around half get infected, but antibiotics don’t work well. These infections often lead to amputation of the toe, which often leads to amputation of the leg, which often leads to mortality within a few years.
Antibiotics often can’t get to the wound because of poor blood flow in these patients. There’s also the issue of biofilms, which also lead to antibiotic treatment failure. Staphylococcus aureus is a major pathogen associated with these infections, but many other species can be involved.
Diabetic foot ulcers are good candidates for phage therapy
Diabetic foot ulcer infections are considered a good indication for phage therapy — the wounds are accessible, antibiotics don’t work well, and it’s easy to watch progression/healing of the disease. Many consider this a “low hanging fruit” when it comes to picking a clinical indication to go after with phages.
To date, phages have been used to treat diabetic ulcer infections in human and animal studies. See Duplessis et al. (2020) for a recent comprehensive review.
Case reports suggest phages help close wounds and prevent amputation
Randy Fish, a podiatrist in Washington, USA is one of the clinicians who has used phage to treat DFU infections. He used a phage, Sb-1, from the Eliava Institute in Tbilisi, Georgia to treat several patients, and all his patients ended up with closed wounds instead of amputation.
Randomized clinical trials are underway
TechnoPhage in Portugal is starting a Phase I/IIa clinical study to test a phage candidate against diabetic foot infections. They’ll test safety and tolerability, as well as ability of phage to reduce target bacteria (P. aeruginosa, S. aureus, A. baumannii). Results are expected in 2021
PhagoPied is a clinical efficacy study starting soon, sponsored by Centre Hospitalier Universitaire de Nīmes, France in collaboration with Pherecydes Pharma. They’ll test efficacy of standard treatment + phage (targeting S. aureus) versus standard treatment + placebo in treating diabetic foot ulcers, looking at safety, tolerability, and wound healing in 60 patients
University Hospitals of Derby and Burton NHS Foundation Trust announced a clinical trial on ClinicalTrials.gov to test anti-Staphylococcus phages in diabetic foot ulcers, but funding issues have halted this study for the time being
Do you work on diabetic foot ulcers and phages, or want to meet others who do?
We want to identify more people working on phages to treat diabetic foot ulcers, and those dealing with this problem in the clinic. We’re looking at setting up a virtual roundtable to foster collaboration opportunities and see what gaps still need to be filled.
If you’re a clinician who treats diabetic foot ulcers, a biotech professional or researcher working on phages for this problem, a patient dealing with these infections, or if you’re just interested in further discussions in this space, please get in touch by emailing me at je[email protected].
There’s much more to read on this subject; this quick dive was just meant to scratch the surface!
For a recent comprehensive review of topical phage therapy for chronically infected wounds, including but not limited to diabetic foot ulcers, see this one by Duplessis et al (2020).
Thanks to Atif Khan, Sheetal Patpatia and Leon Steiner for contributing summaries for the What’s New section this week!