Something old, something new…ways to tackle Antimicrobial resistance

Antimicrobial resistance (AMR) in micro-organisms represents a clear and present danger to global human health. The World Heath Organisation (WHO) first flagged this as a considerable problem as far back as 2009. Professor Dame Sally Davies, the Chief Medical Officer,  reiterated these concerns in 2011 and 2013, suggesting that the threat posed by antimicrobial resistance and infectious diseases was one of the top three global threats to human health along with climate change and terrorism. It has been estimated that AMR costs the EU alone over €1.5 Billion each year. The consequences of AMR may result in us returning to a pre-antibiotic era, where trivial trauma injuries become life-threatening infections again, where surgery will become almost impossible and where transplants and cancer treatment can no longer take place.

We have become blasé about antibiotic usage, we take them for granted, and we do not realise their value in healthcare –  a point exemplified by the fact that the father of antibiotics, Professor Sir Alexander Fleming is the face on one of Scotland’s lowest denomination banknotes. The real problem we face is how to tackle this problem. The UK government has implemented a 5-year Antimicrobial Resistance Strategy, which includes increased research funding and an ‘Antibiotic Guardian’ campaign to cut the un-necessary use of antibiotics to slow the rates of resistance development.

Last week, I attended the Society for General Microbiology’s annual scientific conference in Birmingham that had a particular focus on AMR. Amongst the research presented at this meeting was a remarkable story, which was widely reported in the media (here is a link to the story as it appeared in New Scientist), where researchers were using a 9^th-century Anglo-Saxon recipe for a topically applied concoction that had killing activity against antibiotic resistant bacteria. These findings are the result of an astonishing collaboration between microbiologists Dr Steve Diggle and Dr Freya Harrison and historian Dr Christina Lee at the University of Nottingham. The recipe for the so-called ‘eye salve’ was taken from a recipe that appears in an Anglo-Saxon text called ‘Bald’s Leechbook’ and is comprised of a mixture of onions, garlic, wine and extracts from a cow’s stomach. In the 9^th century the concoction was chilled for nine days and then applied to infections. The researchers from Nottingham showed that when methicillin-resistant Staphylococcus aureus (often just referred to as MRSA) were exposed to the mixture 90% of them were killed, much more than the researchers expected. When examining the salve in more detail the researchers were able to demonstrate that it was the whole preparation that showed the greatest activity, rather than an individual ingredient – raising the prospect that it is a synergistic effect of chemicals from each of the ingredients or that a chemical reaction occurs between the ingredients to create something new during its preparation. This is very interesting work, but the researchers themselves are very cautious and stated that it still in its early stages. However it has been known for a long time that a chemical in garlic called allicin has antimicrobial properties, but translating this activity in to a drug has so far been difficult. Perhaps the preparation of this salve helps to stabilise allicin in some way?

This work is yet to be published or undergo peer-review, but the data presented at the meeting looks to be robust and reproducible. This work has really captured public interest with media stories reporting the work across the world, from Australia to Brazil and India to the USA, generating unique webpage views of over 1 billion people in three days! The key for this work now is for the researchers to find out what the chemical nature of the activity is and to try to develop a more defined version of the salve, yet this is a long way from being administered to patients. This long-lead time from discovery to patient delivery is one of the big problems with antibiotic research, where it can take up to 15 years to deliver a drug to market.

Another particularly exciting announcement at the meeting was the Society for General Microbiology’s announcement of its ‘Small World Initiative’, which is a citizen science project tasked with engaging school children, undergraduates and the general public in the search for new antibiotics. Soil bacteria, called Actinobacteria, make many of the antibiotics we use in the clinic to treat infections but many other groups are also capable of this amazing feat including fungi. The Small World Initiative aims to engage the public through the submission of soil samples, which can be screened for antibiotic producing bacteria and then further characterized to try and find the next new antibiotic. The school and University students will be able to get hands-on experience of the process so they can develop a deep understanding of the process. The project has great educational potential too, opening student’s eyes to STEM subject disciplines and showing how biology, chemistry and mathematics are vital in drug discovery. Excitingly the project is completely Open Access and has a policy on open data to ensure that the person who submits the sample and anyone, anywhere in the world, can view the data obtained in the project. The society is welcoming applications from schools and universities to get involved in this initiative here.

There is clearly a lot of research and development in this area but this will not be an easy to solve problem and quite rightly is being tackled through interdisciplinary approaches, only time will tell if we will be successful.