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Science in The Media Vs. The Wonderdrug Valley of Death

by on 2021/12/08

This blog was written by Dr Delma Childers from the University of Aberdeen.

Antibiotics were the game-changing wonderdrugs that revolutionized medicine in the early 20th century. In fact, their impact stretches far beyond medicine – antibiotics also revolutionized agriculture and livestock practices to usher in an era of relatively cheap and plentiful food in industrialized nations. However, decades of antibiotic misuse, overuse, a lack of drug discovery investment, and the resilient evolution of microorganisms have led to a concerning state of antimicrobial resistance and to a very real threat of society facing a world where the antibiotics don’t work.

18-24 November was World Antimicrobial Awareness Week which is part of a campaign by leaders at the World Health Organization (WHO) to bring attention to the problem of drug resistance. The WHO have listed antimicrobial resistance as one of the biggest global threats to health, food security, and development. There are two main solutions that current research efforts around the globe are testing: 1) find/design new drugs or 2) adapt current drugs to overcome microbial resistance strategies. A recent study (1) demonstrating an outside-the-box solution has been covered by The Daily Mail and Express. How did the media coverage of this study go?

What did the study show?

Staphylococcus aureus (S. aureus) is a common cause of skin infections, but it can also cause life-threatening bloodstream infections in hospitalized patients and, less commonly, serious lung infections after influenza or COVID-19 infections. Methicillin is a commonly used antibiotic in the clinic, but resistance to this drug has become a major problem. In the 1990s and 2000s, methicillin-resistant S. aureus (MRSA) became more widespread in the community and in hospitalized patients, sparking new waves of concern about the urgent need for effective antibiotics (reviewed in more detail here). 

Victoria Garrido and colleagues took another bacteria, Mycoplasma pneumoniae (M. pneumoniae), and modified it to express new proteins that break up S. aureus communities, or biofilms. Biofilms can disrupt care for patients in hospital and put them at higher risk for developing bloodstream infections. 

Of course, M. pneumoniae can cause respiratory infections in humans, so the study authors first had to delete genes involved in causing infections from this organism. They gave this new strain biofilm breaking tools and tested its ability to eliminate S. aureus biofilms. The authors demonstrated that biofilms made in the lab could be effectively broken up by their modified therapeutic M. pneumoniae strain. Now, I think it’s important to note that biofilm-busting isn’t the same as killing infectious cells. Instead, it’s a bit like a night club turning the house lights on and telling you to go home – the dance floor clears, but a new community soon forms outside in the taxi queue.

There are going to be significant questions about the safety of using a microorganism that is known to cause human infections as a potential therapeutic, although this issue has been overcome before. The Escherichia coli Nissle strain is a harmless version of E. coli that has been undergoing extensive testing as a potential probiotic therapeutic for ulcerative colitis. However, using a known infection-causing microorganism as a therapeutic for seriously ill patients will certainly come under intense regulatory scrutiny.

What did the media say about this study?

This study was covered by 34 news outlets. Many of these outlets talked about a breakthrough ‘living medicine’ to treat drug-resistant infections, including The Daily Mail and The Express. 

The Daily Mail report had a balance of sensational and sound reporting about this study and The Express has several sensational statements. On the sensational side, The Daily Mail suggested that this breakthrough drug can destroy drug-resistant infections and that the strain of M. pneumoniae used in this study has been engineered to be harmless to humans. In addition, The Express claimed that M. pneumoniae targets MRSA. None of these claims were actually tested by the authors – we don’t know that M. pneumoniae kills S. aureus or even MRSA strains of S. aureus, though it can break up biofilms in the lab. Likewise, the engineered strain of M. pneumoniae was not tested for safety on human cells. The strain was tested for safety in a mouse mammary (breast) gland infection model, but how translatable that model is to human respiratory infection isn’t clear.

On the sound side, The Daily Mail interviewed Professor Colin Garner of Antibiotic Research UK and included a quote from him. He said, ‘We need researchers thinking outside of the box like this. The results are very promising and welcome as biofilm infections can cause sepsis and death, particularly in intensive care units. However, there is a long and expensive path ahead to see if the method actually works in patients with resistant biofilm infections.’ This quote brings an important critical viewpoint to the media coverage and highlights the difficult path this treatment still has ahead of it before it can be granted clinical approval.

Are there any wonderdrugs anymore?

It’s a sad fact, but the majority of early drug candidates fail to make it past clinical trials. This phenomenon is so well known that that the period of drug testing between basic bench research and clinical trials has a nickname – ‘The Valley of Death’. While media coverage of early research is encouraging and might aid authors in getting funding to continue the work, there are many additional challenges that will be posed over 10-20 years where these drug candidates might very well fail. Are there any wonderdrugs left to discover? I sure hope so. But until they get through clinical trials, my advice is to take claims of new wonderdrugs with a healthy dose of skepticism. 

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