"Lam successfully tested the polymer treatment on six different superbugs in the laboratory, and against one strain of bacteria in mice. Even after multiple generations of mutations, the superbugs have proven incapable of fighting back.
“We found the polymers to be really good at wiping out bacterial infections,” she says. “They are actually effective in treating mice infected by antibiotic-resistant bacteria. At the same time, they are quite non-toxic to the healthy cells in the body.”"
"Professor Greg Qiao, her PhD supervisor, says that Lam’s project is one of the biggest scientific breakthroughs he had seen in his 20 years at Melbourne university."
Unfortunately I don't have the time to look into this specific approach, and I've been away from nanoparticle biology for about 5 years now, but...
In almost all cases where nanoparticles have shown promise to treat various conditions, there remains one huge hurdle: how do you get them into the patient? i.e. Swallow a pill full of nanoparticles, and later that day you'll end up taking a nanoparticle-filled dump. Oral bioavailability is almost nonexistent. The only practical delivery mechanism is IV. For treating cancer, that's fine. Most advanced chemotherapy drugs already are delivered via IV. For an antibiotic, which will see greatest demand in locations with poor health facilities, i.e. with no real means of safely delivering IV drugs to large numbers of people, that's pretty much a deal breaker.
Some bacteria actually use dilute concentrations of ethanol as a substrate - acetobacter converts EtOH to acetate (vinegar). It's the concentration of 72% EtOH 28% h2o that bacteria can not protect against.
The solution is to stop giving one antibiotic at a time. HAART for HIV [1] showed that to prevent resistance you have to give multiple drugs at the same time. The problem of course is each drug you add to the mix the more you increase the risk of bad side effects.
Of course none of this will matter until we can crack down on misuse of new antibiotics in places like India and China. If each new antibiotic developed is stolen and abused then nothing will work.
The new antibiotics are not being misused in the USA - in the main they are not being used at all in the USA which is a big problem for any company thinking of developing a new antibiotic.
Afaik your suggested "solution" is part of the actual cause of the problem.
Too liberal use of broad-spectrum antibiotics, in everything from medicine to agriculture[0], is among the main reasons why we are in this current situation: MSRA infection rates so high, it's considered a pandemic and it's misuse being as bad in the US as it's in East Asia [1].
No, you don't understand his comment, and appear to have boiled this technical subject down to "more antibiotics" vs. "less antibiotics". In particular, using a broad-spectrum antibiotic is very different than using multiple antibiotics.
>boiled this technical subject down to "more antibiotics" vs. "less antibiotics"
Because, once again afaik, that's one of the driving factors for the emergence of MRSA bacteria: Too liberal use of antibiotics, which especially applies in the US.
The suggested solution, of using different kinds of antibiotics, feels like the sledgehammer approach that could just as well make the problem worse. By creating MRSA bacteria even faster, giving them a whole load of antibiotics to mutate resistances to at once vs one at a time.
The BBC Article has a whole paragraph about this dynamic:
"The most important part of this is that bacterial resistance is essentially a numbers game: the more humans try to kill bacteria with antibiotics, and the more different antibiotics they use, the more opportunities bacteria have to develop new genes to resist those antibiotics."
Evolution works on fractions. Bacteria develop resistance because there's always a tiny fraction that survive the onslaught of whatever drug used, that tiny fraction survives and the remaining population is now completely resistant.
This is normally not a problem because the drug kills enough of them that your immune system mops up the rest.
The problem now is that the fraction has slowly become larger and larger until the point that a viable population of survivors remains to pass on their genes.
The way around this is to use multiple drugs that require multiple different mutations to survive. If before each drug left a tiny fraction of population, the intersection of those drugs will leave a fraction of a fraction of a fraction. Not enough to make a viable population that passes along multiple resistances.
In some cases, you can stack drugs in a way that requires bacteria to have three mutually exclusive mutations, so they're dead either way. There is an antibiotic candidate right now that is estimated to be 15,000x more effective because of smart design to require 3 different mutations to survive, but those mutations don't work together.
>The way around this is to use multiple drugs that require multiple different mutations to survive.
Or it might just as well end up beeing the fastest way for creating, even more, MRSA bacteria strains because the harsher the treatment, the more sturdy the survivors we will be.
>There is an antibiotic candidate right now that is estimated to be 15,000x more effective because of smart design to require 3 different mutations to survive, but those mutations don't work together.
As corny as it might sound, we really shouldn't underestimate nature like that, it's part of the reason what got us in this mess in the first place. If we can design something requiring 3 different mutations to survive, then sooner or later nature is gonna evolve something with those 3 different mutations. Nature has played this game far longer, and far more successful than we will ever be able to.
That's why imho we need a better approach than "use more types of antibiotics", as that's essentially exactly what we've been doing this whole time.
HIV is a far more formable resistance target than bacteria (in the short term at least). We know what we need to do - develop new antibiotics and stop giving them one at a time. Like the famous quote from Churchill about Americans we will eventually get there after we exhaust all the alternatives.
Edit. When I was a science undergraduate in the early 1990s on my own I came up with HAART (not original of course) from first principles. It seems so obvious that I didn't understand why it was not standard practice (such is the arrogance of youth).
Unfortunately, drug companies have few economic incentives to develop novel antibiotics given the immense costs/risks of human trials and the minimal expected monetary reward. Clinicians reserve the "big gun" antibiotics for the rare cases that need them-- which reduces the cash drug companies get from pushing them through clinical trials.
Compared to other drugs, antibiotics are relatively easy and cheap to discover or "invent" with modern techniques. Getting them through clinical trials, on the other hand, is not cheap.
Many clinicians should be less loose with antibiotics, sure. But, that won't eliminate resistance. Realistically, when superbugs become common, the incentives pharmaceutical companies face will shift. It's just there will be a lot of morbidity and mortality while we're waiting for their drugs to make it to hospital pharmacies.
> Clinicians reserve the "big gun" antibiotics for the rare cases that need them-- which reduces the cash drug companies get from pushing them through clinical trials.
This statement seems to directly contradict what the article says:
"According to Sprenger, “there are no legal instruments to prohibit the use of a new antibiotic.” What that means is if a new antibiotic is released there’s no way to stop the world from overusing it. At current usage levels a new antibiotic, he says, would only have about two years on the market before bacterial resistance to it develops."
If the world overuses a new antibiotic then the pharma company should be swimming in cash. And if the pharma company isn't swimming in cash because people reserve them for rare cases, then it should not be possible for the world to overuse the new antibiotic.
That would work if you could prevent companies in China and India just making it and selling it. The problem right now is this is what happens to each new "last line of defence" antibiotic - by the time it gets used in the west it has been in high use in other countries and resistance is wide spread.
Is it not? I was under the impression that as providers we should provide affordable care as well. For example, theres no reason to throw every test at a patient that has clear signs of a certain bacterial infection.
Maybe cost is less of a factor in life threatening situations.
It would very much surprise me if the net lives were a loss instead of a significant gain, so yes this would be an interesting statistic.
For instance, its because of many of the practices of "Big Agriculture" that world hunger has dropped so massively in underdeveloped countries over the last 30 years. With even a 10% decline in Asia ( since 92 ), thats about 450 million people who aren't living under malnourished conditions who were doing so 30 years ago.
I believe improved nutrition in developed countries can be largely attributed to crops and vegetables (after all, meat is usually an inefficient nutrition source). But antibiotics are being used to produce meat faster.
I'd be surprised if there's a big overlap between antibiotics usage and reduced world hunger.
Obviously there are good practices and bad ones. Giving antibiotics to healthy livestock is one of the worst.
solution: don't eat any meat from countries where this is allowed. Yes this is a bit of a hassle if you happen to live in one of those places but it might be possible to at least find organic meat that isn't given antibiotics when healthy. Buy that.
Or you can grow your own chicken if you live in the country. It's not a very labour intensive task and they also eat most of the vegetable waste from the household.
If a large enough fraction wants antibiotic free meat of course the fraction of producers making it will adjust accordingly. More importantly, as the fraction of producers who do use antibiotics shrinks, so does the resistance for legislation banning it altogether. This is already done in many countries so should be doable everywhere.
I don't buy the ending world hunger bs. It's all about profits and an excuse to continue antibiotic doping of livestock. Indians, Morrocans survive very well on veggies and grains. They also eat very healthy compared to other people in developed countries who eat McDonalds and KFC.
I once called in to an NPR radio show on organic produce to make a similar point about pesticides: that pesticides were a net public health boon because they made fresh produce affordable.
So if anyone is receptive to your argument it ought to be me. But I'm not buying it.
Public nutrition does not require that we sacrifice antibiotic effectiveness for incrementally cheaper meat.
Can't agree more. The craziness is not that we do intensive agriculture, it is that we need it and we still do not question our demographic growth.
Some fire-brand ecologists want to go back to "traditional" ways outside of the paths of modern intensive agriculture but fail to realize that traditional agriculture both have a higher ecological footprint and is much more labor intensive.
If you want to lower the impact of intensive agriculture, promote contraception and demographic decrease.
> If you want to lower the impact of intensive agriculture, promote contraception and demographic decrease.
You don't need to promote demographic decrease (you might need to do something about the Catholic church, though ...). All you really need to do is improve the opportunities for women.
Once women have opportunities and don't need to worry about 4 of 5 children dying, suddenly they don't want to be pregnant so often.
Many of the most advanced countries are already under replacement level. I believe the US would be, as well, if it weren't for immigration.
Well, I think we still need to promote the merits of bringing the population down because when you read about countries arriving below replacement level, it is almost universally presented as a negative thing and government try to fight that by giving natalist incentives.
No, couples who decide to have more children are not helping society. They are draining its resources. If you want kids, have only one and give her/him all the education and resources you can.
If you consider resource scarcity as an engineering problem, then removing consumers is only one solution. The other is to just increase the amount of resources available.
Re parents with many kids are draining resources - this holds true for countries like India, but certainly not regions like Europe. Here, farmers are paid by the EU for letting fields lie fallow, because there is only so much produce that is consumed in the EU. Also, consider the amount of food thrown away by supermarkets, which could be used if we were content with eating crooked looking cucumbers. An argument might be that those extra kids still deplete scarce resources by proxy, e.g. oil.. but as we are slowly transitioning to solar and wind power, this might almost entirely go away.
We can't increase the population forever,in unless we go full Culture-tech, and even then it's not "forever."
Meanwhile, while it looks as if most continents are going in the right direction, we need to stop the extremest religious/political warrior movments prevalent in North Africa, Middle East and South East Asia.
Eg. In Somalia, a lot of men want 20 kids, and while I can't personally understand why, it's encouraged by religious leaders. It's apparent that Somalia itself won't sustain that in only a generation. This can only lead to conflicts, presumably with richer regions. There are so many pear-shaped scenarios to go to from there, but I leave to your own imagination what a highly industrial neighbouring region could come up with if cornered.
Hint: that region have only minor concerns about locking down the borders, setting up incentives that leads to that whole ships filled with people and kids drowing. Ther might be some public lamenting but no policy changes.
Thankfully you don't get to decide how many children others should breed. They did that in China and the next thing you know, there's a >5% imbalance between sexes.
Your comment is a huge non-sequitur. The article is about antibiotics. The top-level comment is about antibiotics. Nothing of what you said applies to antibiotics.
> "That’s because the process of developing any new drug is extremely expensive and the potential profit in an antibiotic after that massive investment is relatively low. ... At current usage levels a new antibiotic, he says, would only have about two years on the market before bacterial resistance to it develops."
Seems to me that the patent system, meant to encourage invention, is seriously broken in the case of antibiotics. So stop using it. Set up a bounty system instead. Pay drug companies directly for developing new antibiotics. Without the pressure of having to sell them quickly we can instead use them more strategically, even holding some in reserve.
So, I thought genetic mutations were random. If that's the case, why does the amount of antibiotics prescribed matter? Won't these mutated bacteria excel regardless?
Simplified, to survive one antibiotic, you need only mutate to resist that one antibiotic. To survive n antibiotics, you need to mutate to resist n antibiotics _at once_. Being vulnerable to just a single of them will kill you.
If the chance to get the right mutation to resist one antibiotic is, say 0.01 (1%). Then the chance to mutate to resist three antibiotics at once is 0.01^3, thats 1e-6 (0.0001%).
I'm going to ship you a item. Luckily I have multiple copies of the item. I ship using UPS, Fedex, and USPS. You'll probably get three copies, but to get no copies of the item I'm shipping you something has to go ridiculously wrong in three different companies.
* Genetic drift vs fixation. As bacteria reproduce and die, the relative frequency of genes tends to remain fixed in the absence of selection. In layman's terms: if 0.0000001% of bacteria in a population have antibiotic resistance, they will likely all die before passing it on. If 10% have resistance, there's a much better chance of it sticking around. The more antibiotics prescribed, the more you enrich the population for resistance, the greater chance it sticks.
* Many antibiotic resistance genes put bacteria at a disadvantage relative to the same bacteria without resistance. If antibiotics are not present, then resistance will eventually be selected against and disappear. Overprescription of antibiotics ensures that this doesn't happen.
The mutations might be random but not every mutation is fit to survive any given environment. As such only "the fittest bacteria"* with "the best mutations"* survive in the end. So it's not as random as it might appear, it's actually quite focused.
for that given environment
That's why antibiotics should generally be used as conservatively ass possible because overkilling bacteria does nothing but accelerate the evolution of the few surviving into "super bacteria" that much faster by giving them a harsh environment they can adapt to.
This article seems to exist in lalaland. Implementing antiobiotic stewardship in China and particularly India will not succeed, at least in the next ten years.
The world has had success with eliminating CFCs from refrigerants, banning leaded gasoline, eradicating iodine deficiency, dramatically increasing crop yields, eradicating polio, scaling up electrification, plumbing, internet access, etc etc. The idea that we can set a goal like this is completely conceivable.
A lot of the low hanging fruit involves banning the use of antibiotics on healthy farm animals, and at least with the largest producers who raise and slaughter the majority of animals I think this could be achieved.
> The entire world minus the United States of America and Syria is on board with climate change.
As is much of the USA, even if not the federal government. 12 states and Puerto Rico in the US Climate Alliance, another 10 states and numerous local jurisdictions expressing official support for the Paris Accords outside of the Alliance.
> Until recently antibiotics in the US actually listed animal growth as an indication for use on antibiotic labels and a prescription was not required for farmers to obtain them.
Less monoculture, smaller farms, no use of antibiotic for animals. Pure form of greed, they feed them antibiotics pro-actively.
I wonder if an increase in antibiotic-resistant organisms will lead to a resurgence in table manners and resistant clothing (e.g. gloves). Many of these rules were designed to reduce the spread of pathogens.
(This is not to ignore the fact that quite few were designed for social exclusion as well)
This article essentially says that in the best-case we can only slow antibiotic resistance. Is there anyone working on things to actually render the bacteria less effective at survival (perhaps using the same evolutionary principles that got them resistent in the first place)?
People have tried this and it doesn't work. The problem is mobile genetic elements like plasmids and transposons. What happens is the antibiotic resistance genes cluster together and so the selection for one selects for all the others. Even if you go back to an antibiotic that hasn't been used for decades the resistance hangs around. Bacteria really are formable.
I am amazed by how many people take antibiotics for no reason. I have a partner since a year and she used to go to the doctor every time she had the flu. And the doctor, to be on a safe side - prescribed antibiotics every time.
When I showed up I encouraged her to stop taking any antibiotics and build up defence system by taking vitamins and adjusting some bad habits. The first time she had flue it was bad, she had it for 3 weeks and was forced in the end to take antibiotics. Since then she was not sick even once (usually she would be sick every 3 months). Her health improved, her defences are strong and whenever she starts feeling bad she just jumps into the bed for 2-3 hours and get out feeling good. Her bode learned how to defend on her own.
This is a somewhat strange story re: "the flu" and I'm guessing that's why it's been downvoted.
The flu is a virus and antibiotics have no effect on it. There is a yearly vaccine for the flu and the CDC recommends all adults take it, although it usually only protects about 40-70% of the time due to the large number of flu strains in circulation. The flu is a deadly disease and even a person in good health (taking vitamins, etc) in the prime of their life can be killed by it, which is why vaccination is recommended.
This article, like much of the debate about antibiotic resistance, is fatally flawed by its anthropocentric viewpoint.
The thing to understand about antibiotic resistance is that we humans are but foot soldiers in a global war that has been raging for literally billions of years! Plants killing bacteria, bacteria killing fungi, viruses killing bacteria, bacteria killing viruses, even bacteria killing other bacteria; this conflict rages on with or without our input constantly. Almost all of our current antibiotics are natural products or derivatives thereof, taken from the plants and fungi that have been fighting off bacteria much longer than we have. Increasingly, we're finding that the antibiotic resistance that arrises in human pathogenic bacteria is not the result of novel mutations (as this article suggests), but rather the adoption of a pre-existing resistance trait from one species that has nothing to do with humans into one that does. In a teaspoon of dirt there are more different species of bacteria than have ever caused diseases in humans, all of which are in a constant struggle for survival, many of which have developed highly specialized weapons and defenses with which to fight this war.
We've been fighting bacteria with antibiotics for just about 100 years, and we're already losing!
The idea that management of distribution or development of novel agents will be sufficient to prevent bacterial infections into the indefinite future is laughable on its face for any semi-serious student of evolution.
No, antibiotics have won us an important battle, but the war is far from over. New antibiotics will help, but each new one will hold off fewer infections, with more serious side-effects, lasting ever less time before resistance takes over. We'll never see the sort of success with antibiotics in the future that we have in the past. Interesting alternatives, like bacteriophage therapy, stool transplants, and other means of grooming our natural bacterial flora will go a bit further.
Ultimately, though, the incontrovertible truth of nature is this: the only lasting alternative to conflict is cooperation (a.k.a. symbiosis). Fortunately, for reasons we still don't fully understand, organisms in conflict naturally evolve to a cooperative state...given enough time. Unfortunately, evolution is very slow, and there is no rule stating that there won't be casualties (i.e. extinctions) along the way.
So, as uncomfortable as it may be to many, there really is only one long-term hope that humanity has for permanently stemming the tide of infectious agents in less than an average lifespan's time: genetic engineering. Luckily, we are developing new tools for this all the time. Yes, they pose great danger, but so did fire the first time humanity harnessed it to provide warmth and a way to cook food (coincidentally enough, yet another of our small victories in the war against disease).
“Consider going to back to an era when a minor accident like a scrape could lead to death.”
That a bit of hyperbole, people don't take antibiotics for minor scrapes - soap and water is the prescription. quite often when the minor scrape is life threatening, its something like MRSA. which leads me to think of the stories of people in the past dying of minor scrapes: maybe its been around for longer than we think.
after all of the scare tactics, much of the drug resistance where it matters has been appropriate use. TB, gonorrhea, etc. These diseases didn't become drug resistant because people were taking antibiotics for the flu or use in agriculture.
It's not, actually. Minor scrapes could lead to death doesn't mean they always did. Same is true today. Most scrapes won't lead you to need antibiotics, but if you start to get very ill after your scrape, you will get treated with antibiotics and live. 100 years ago you might have died - from cutting yourself while gardening, for example.
thats exactly what i said, they could lead to death but they usually dont. Maybe I have to walk you through it:
1) its very rare a cut needs antibiotics
2) if an infection is severe from a 'minor scrape', the prior for it being something like MRSA is much higher
3) minor scrapes in the past also rarely needed antibiotics
4) rare stories of people dying from minor scrapes in the past might have been MRSA
2) in 2017, yea. in the past, the prior for it being MRSA is essentially 0
3) thats because vaccination predates antibiotics
4) nope
your statements amount to "i have no clue how evolution works". bacteria are single cell organisms that dont just suddenly exist into the world being resistant to antiobiotics, which were specifically developed to kill those organisms off.
vaccinations have nothing to do with the conversations about drug resistant bacteria. get that through your head, maybe even write it down and say it out loud.
MRSA existed pre 2017, which it was in fact discovered in the early 1960s.
While I understand that MRSA is probably emerged from antibiotic use, I am open minded enough to consider it could have predated modern use of antibiotics.
bacteria in the world weren't suddenly under threat once antibiotics came along. they have been fighting the fight for 3 billion years. In fact, Penicillin is a natural occurrence used to fight bacteria before humans stumbled upon it.
All of the ways our antibiotics are used to fight bacteria have been something bacteria have been dealing with since they existed.
as far as I know, the vaccination for tetanus is not under threat from antibiotic resistance of people taking penicillin from the flu. - or even being under any resistance threat at all.
the hyperbole part is trying to sell a world where a minor scrape leads to death. SURE, its possible (but very unlikely) that could happen, but that could happen under any circumstance anyways.
Combating multidrug-resistant Gram-negative bacteria with structurally nanoengineered antimicrobial peptide polymers https://www.nature.com/articles/nmicrobiol2016162
An article for non-expert: http://www.telegraph.co.uk/health-fitness/body/does-this-25-...
"Lam successfully tested the polymer treatment on six different superbugs in the laboratory, and against one strain of bacteria in mice. Even after multiple generations of mutations, the superbugs have proven incapable of fighting back.
“We found the polymers to be really good at wiping out bacterial infections,” she says. “They are actually effective in treating mice infected by antibiotic-resistant bacteria. At the same time, they are quite non-toxic to the healthy cells in the body.”"
"Professor Greg Qiao, her PhD supervisor, says that Lam’s project is one of the biggest scientific breakthroughs he had seen in his 20 years at Melbourne university."