If Antibiotics Don't Cut It? Ancient Phagotherapy Makes A Comeback

Electron micrograph of Bacteriophages
Electron micrograph of Bacteriophages
Raphaëlle Maruchitch

PARIS — After he was in a car accident, Serge Fortuna was left with an infected wound that wouldn’t heal. When his doctors started talking about amputation, he refused and decided to try something else: a trip to the Republic of Georgia for phagotherapy, a treatment that uses specific bacteria-fighting viruses to heal antibiotic-resistant infections. The treatment was a success, and Fortuna now helps others get the treatment.

Later this year, hospitals in France, Belgium and Switzerland will begin unprecedented clinical trials of bacteriophages, viruses that attack bacteria, and will base their research in France. Phagotherapy is an ancient treatment that has already proven its medical potential, and now it is inspiring hope in the fight against antibiotic-resistant bacterial infections.

But it still illegal everywhere except Russia and Georgia. Just 18 months ago, Dr. Alain Dublanchet — a microbiologist, former hospital chief and fervent supporter of phagotherapy — still faced a massive number of obstacles in his crusade to reintroduce the treatment in France legally.

At the time, the French start-up Pherecydes Pharma was starting preliminary clinical trials of phages on animals. Since then, the results have shown “very high efficacy,” says Jérôme Gabard, CEO of the company. Along with two other doctors, Gabard assembled an application for financing from the European Union. Last June the group was given a little over 3.8 million euros to investigate the use of phages against stubborn infections.

The project is called Phagoburn, and it is being rolled out in burn units in public, private and military hospitals. The trials will include about 200 burn patients. Pherecydes Pharma will finalize the virus cocktail, and a Nantes-based company called Clean Cells will produce them.

There will be two versions — against two different bacterial strains — to test on infected burns. “We hope to show that phages are just as effective as the standard treatment, but that they actually clean up infections sooner,” says Dr. François Ravat, one of the project leaders.

On the road toward legalization

The trials represent a big step toward legalizing phagotherapy in Europe, but not the only one. Politicians in France and the rest of the European Union are becoming more comfortable with the idea, and phagotherapy was even included in the European Commission’s Horizons 2020 report.

Meanwhile, Serge Fortuna created a non-profit called Phages of the Future that helps people travel to the Republic of Georgia, where phagotherapy is widely practiced. The organization accompanies patients to Georgia, handles logistics and provides translation services to patients who want to try the treatment as a last resort. They are making their third trip this month.

Why are pharmaceutical companies so interested in this kind of therapy? The phages themselves can’t be patented, because they are living creatures. But Gabard says individual phage cocktails can be patented. “As the Phagoburn project advances, the industry will see that things are changing,” says Ravat.

But Jean-Marc Chatellier is one person who has personally confronted the reality that phagotherapy is still illegal in France. When his mother contracted an antibiotic-resistant infection, phagotherapy was not an option for her in her own country, and a trip to Georgia was not feasible. She died from the infection, at age 73, about a year ago.

For his part, Dublanchet and other phagotherapy supporters accept some patients but limit their use of the illegal treatment. “Establishing protocols for the use of phagotherapy” has become his primary goal, he says. “They should not be allowed to be used completely freely, like was the case with antibiotics,” Dublanchet warns.

For the moment, the biggest problem is that it is difficult to guarantee the stability of the phage cocktails. And for the therapy to be approved, regulators will have to evaluate a stable and ready-to-use mixture.

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Feed The Future

COP26 Should Mark A Turning Point In Solving The Climate Crisis

Slow Food calls for an action plan to significantly reduce and improve the production and consumption of meat, dairy, and eggs by 2050.

A new dawn?

If, as the saying goes, we are what we eat, the same also goes for the animals that end up on our plate. How we feed our own food can have knock-on effects, not just for our own health but also for the planet. We are now aware of the meat and dairy industry's significant carbon footprint, responsible for more than a third of global anthropogenic greenhouse gas emissions.

Large-scale cattle productions that favor pure profit over more sustainable practices also add to environmental woes through biodiversity loss, deforestation and pesticide use — with some of the world's richest countries contributing disproportionately: The five biggest meat and milk producers emit the same amount of greenhouse gases as the oil giant Exxon.

The good news is that we could meet — if we would — some of these challenges with an array of innovative solutions, as the fields of farming, breeding and nutrition look at ways to shift from centralized intensive agro industry toward a more localized, smaller-scale and more organic approach to production.

Cows fed corn and grain-based diets may grow larger and are ready to be processed at a younger age — but this requires significant energy, as well as land and water resources; in contrast, grass and hay-fed cows support a regenerative farming model in which grazing can contribute to restoring the health of soil through increased microbial diversity. Compared to highly processed GM crops, natural-grass diets with minimal cereals also lead to more nutrient-rich livestock, producing better quality meat, milk and cheese. Farmers have started focusing on breeding native animal species that are best adapted to local environmental contexts.

This new approach to agricultural practices is closely linked to the concept of agroecology, where farming works in tandem with the environment instead of exploiting it. If mowed a few times a year, for instance, natural meadows produce hay that is rich in grasses, legumes and flowers of the sunflower family, like daisies, dandelions, thistles and cornflowers. These biomes become reservoirs of biodiversity for our countryside, hosting countless species of vegetables, insects and birds, many of which are at risk of extinction. Until recently, these were common habitats in meadows that were not plugged or tilled and only required light fertilization. Today, however, they are becoming increasingly threatened: in the plains, where the terrain is used for monocultures like corn; or in hills and mountains, where fields are facing gradual abandonment.

It is worth noting that extensive agriculture, which requires smaller amounts of capital and labor in relation to the size of farmed land, can actually help curb climate change effects through carbon dioxide absorption. Researchers at the University of California, Davis determined that in their state, grasslands and rangelands have actually acted as more resilient carbon sinks than forests in recent years. Through a system of carbon uptake, these lands provide a form of natural compensation, going as far as canceling the farms' impact on the planet, rendering them carbon "creditors."

In the meantime, grasslands and pastures allow animals to live in accordance with their natural behavioral needs, spending most of the year outside being raised by bonafide farmers who care about animal welfare. A recent study by Nature found that allowing cows to graze out of doors has both psychological and physical health benefits, as they seem to enjoy the open space and ability to lie on the soft ground.

Some might worry about the economic losses that come with this slower and smaller business model, but there are also opportunities for creativity in diversifying activities, like agro-tourism and direct sales that can actually increase a farm's profit margin. This form of sustainable production goes hand-in-hand with the Slow Meat campaign, which encourages people to reduce their meat consumption while buying better quality, sustainable meat.

Others may assume that the only environmentally-conscious diet is entirely plant-based. That is indeed a valuable and viable option, but there are also thoughtful ways to consume meat in moderation — and more sustainably. It also should be noted that many fruits and vegetables have surprisingly large carbon footprints: The industrial-scale cultivation of avocados, for example, requires massive amounts of water and causes great hardship to farming communities in Latin America.

But forging a broad shift toward more "biodiversity-friendly" pastoralism requires action by both those producing and eating meat, and those with the legislative power to enact industry-wide change. It is urgent that policies be put into place to support a return to long-established agricultural practices that can sustainably feed future generations. Although no country in the world today has a defined strategy to decrease consumption while transforming production, governments are bound to play a key role in the green transition, present and future.

In Europe, Slow Food recommends that the Fit for 55 package include reducing emissions from agriculture activities by 65% (based on 2005 levels) by 2050. Agriculture-related land use emissions should also reach net-zero by 2040 and become a sink of -150 Mt CO2eq by 2050. But these targets can only be met if the EU farming sector adopts agroecological practices at a regional scale, and if consumers shift to more sustainable diets. If we are indeed what we eat, we should also care deeply about how the choices we make impact the planet that feeds us.

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