Making case for phage therapy prescription

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This article was published 26/12/2024 (293 days ago), so information in it may no longer be current.

Amputation is looming for a Concordia Hip & Knee Institute patient. In an effort to save the limb, doctors have partnered with a Winnipeg-based company to try a new joint infection therapy.

Researchers hope this is the next step in a national rollout of phage therapy, an alternative to antibiotics use.

“This person is facing pretty dire consequences … something of a large amputation to their lower limb, which would be very disastrous for them,” said Trevor Gascoyne, chief executive of the institute’s Orthopaedic Innovation Centre.

He wouldn’t give further details about the patient’s situation, citing patient privacy. “We’re hoping that phage therapy can be the answer,” Gascoyne said.

Prosthetic joint infections happen to a “small percentage” of patients. The rate of infection is usually two per cent or less, depending on the joint — for example, hips are less prone to infection than knees, Gascoyne explained.

Still, several dozen Manitobans must be treated for recurrent infections annually, Gascoyne said. Some patients undergo 10 surgeries to no avail.

Antibiotics resistance isn’t common, but it’s increasing at an “alarming rate.”

“The fact that we don’t yet possess medications to effectively fight resistant bacteria is very concerning,” Gascoyne said. “There’s very few options left at that point.”

His interest piqued earlier this year upon reading Ottawa Hospital had successfully used phage therapy on a patient with a life-threatening prosthetic joint infection.

The Orthopaedic Innovation Centre contacted Cytophage Technologies Inc., a Winnipeg-based company behind the therapy.

“It made sense to approach them and see if we could work together on phage therapy for people who need it in Manitoba,” Gascoyne said.

Phages are viruses that kill specific bacteria after binding to them and inserting their own genetic information. Though phages were discovered in the 1910s, they took a backseat to antibiotics, which were more easily used and patentable.

Phages can’t blanketly kill bacteria. Part of Cytophage’s work is modifying phages and finding which phages can kill which bacteria.

Patients receive phage treatments through IV or other direct injection. It’s depends what the doctor prescribes, said Cytophage chief executive Steven Theriault.

Ottawa Hospital was the first to partner with Cytophage on phage therapy. The Concordia Hip & Knee Institute’s patient will be, if all goes according to plan, the second case.

“We’re trying to collect a whole bunch of partners throughout Canada,” Theriault said.

There are four bacteria types wreaking havoc on people with prosthetic joints, leading to infections, Theriault said. Cytophage is lining up patients with different bacterial infections to test its phage fixes.

The Manitoba patient has a different bacterial infection than the treatment recipient in Ottawa, Theriault highlighted. His goal is to see phage therapy used against all four bacteria strains. After that, Cytophage will create a “phage cocktail,” or a drug to treat a spectrum of prosthetic joint infections.

Cytophage is developing the phage therapy needed for its Manitoba patient. Once it’s finished, it will send the data to Health Canada for approval.

Both Theriault and Gascoyne expressed confidence they’ll get a green light from Health Canada. They’re aiming to start treatment of the Manitoba patient in February.

Doctors and Cytophage will check whether the disease comes back in the following months. The Orthopaedic Innovation Centre is working with infectious disease experts at the Health Sciences Centre and Ottawa Hospital, Gascoyne said.

“I’m confident that we’ll put together a very sound treatment protocol,” he added. “It’s simply a matter of time and making sure we minimize risk.

“We want this person back to a healthy, active life, and not having to take daily antibiotics via IV.”

The Orthopaedic Innovation Centre aims to help Cytophage spread its treatment across the country. It’s potentially a “game changer” for antibiotic resistance, Gascoyne said.

However, Cytophage is a small team — 16 staff — and doesn’t have the funding to do more than one patient every three months, Theriault noted.

He turned Cytophage into a publicly traded company in February. The Winnipeg business produces phage products used as antibiotic replacements for animals to stay viable.

Both Cytophage and the Orthopaedic Innovation Centre are swallowing costs to use phage therapy on the Manitoba patient, Theriault said: “We’re trying to push it forward because we see the value behind it.”

Finding funding in Canada has been difficult, he added.

Manitoba’s ecosystem for clinical trials faces “a lot of challenges,” including funding, said the head of the Bioscience Association of Manitoba (BAM).

“I think it’s not often understood that clinical trials are a necessary process to get innovative medicines into our hospitals and our pharmacies,” said Andrea Ladouceur, BAM president.

She pointed to an Innovation Medicines Canada study: Canada ranks last of all G7 countries when looking at the time it takes for patients to access new medicines.

The Manitoba government has a working group assessing the gaps in the province’s clinical trials ecosystem; Ladouceur is a member. She estimates the group will continue for another six months before making recommendations.

She called Cytophage’s partnership with the Orthopaedic Innovation Centre a “landmark opportunity.”

Prosthetic joint infections are just the beginning, Theriault said. He’d like to tackle other areas, like skin ailments and urinary tract infections.

gabrielle.piche@winnipegfreepress.com