The return of the Phages! Bacteriophage therapy 2.0

Bacteriophages or for short phages, are viruses infecting explicitly bacteria, thus their interest as antimicrobial agents has increased during the last decade as bacterial resistance to antibiotics has risen. Despite the early recognition of their therapeutic potential and the current escalation of multidrug-resistant (MDR) pathogens, the adoption of bacteriophages into mainstream clinical practice is hindered by unfamiliarity with their basic pharmacokinetic (PK) and pharmacodynamic (PD) properties, among others. Given the self-replicative nature of bacteriophages in the presence of host bacteria, the adsorption rate, and the clearance by the host’s immunity, conventional approaches cannot estimate their PK/PD characteristics, and thus, introducing new considerations is required. Furthermore, the multitude of different bacteriophage types, preparations, and treatment schedules impedes drawing general conclusions on their in vivo features. Additionally, the drawback of acquired bacteriophage resistance of MDR pathogens with clinical and environmental implications should be considered. In this seminar, we will explore a historical flashback of bacteriophages and their ongoing research for optimization as well as various considerations of this top technology of modern biotechnology. Currently, available data merit close scrutiny and optimization of bacteriophage therapy in the context of a better understanding of the underlying applied principles is urgent to improve its therapeutic effect and to minimize the occurrence of bacteriophage resistance.

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