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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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The Unsustainable Future Of Fish Farming — On Vivid Display In Turkish Waters

Currently, 60% of Turkey's fish currently comes from cultivation, also known as fish farming, compared to just 10% two decades ago. The short-sightedness of this shift risks eliminating fishing output from both the farms and the open seas along Turkey's 5,200 miles of coastline.

Photograph of two fishermen throwing a net into the Tigris river in Turkey.

Traditional fishermen on the Tigris river, Turkey.

Dûrzan Cîrano/Wikimeidia
İrfan Donat

ISTANBUL — Turkey's annual fish production includes 515,000 tons from cultivation and 335,000 tons came from fishing in open waters. In other words, 60% of Turkey's fish currently comes from cultivation, also known as fish farming.

It's a radical shift from just 20 years ago when some 600,000 tons, or 90% of the total output, came from fishing. Now, researchers are warning the current system dominated by fish farming is ultimately unsustainable in the country with 8,333 kilometers (5,177 miles) long.

Professor Mustafa Sarı from the Maritime Studies Faculty of Bandırma 17 Eylül University believes urgent action is needed: “Why were we getting 600,000 tons of fish from the seas in the 2000’s and only 300,000 now? Where did the other 300,000 tons of fish go?”

Professor Sarı is challenging the argument from certain sectors of the industry that cultivation is the more sustainable approach. “Now we are feeding the fish that we cultivate at the farms with the fish that we catch from nature," he explained. "The fish types that we cultivate at the farms are sea bass, sea bram, trout and salmon, which are fed with artificial feed produced at fish-feed factories. All of these fish-feeds must have a significant amount of fish flour and fish oil in them.”

That fish flour and fish oil inevitably must come from the sea. "We have to get them from natural sources. We need to catch 5.7 kilogram of fish from the seas in order to cultivate a sea bream of 1 kg," Sarı said. "Therefore, we are feeding the fish to the fish. We cannot cultivate fish at the farms if the fish in nature becomes extinct. The natural fish need to be protected. The consequences would be severe if the current policy is continued.”

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