The Monash-Alfred Phage Therapy Network

Featuring Prof Allen Cheng, Dr Simon Corrie, Dr Jeremy Barr and Prof Anton Peleg,  

Allen Cheng and Anton Peleg are Infectious Diseases physicians at The Alfred and clinical researchers at Monash University. When they are called in to consult, then things are starting to look pretty grim for the patient. Simon Corrie is an engineer that is developing better diagnostic tools to assist physicians at point-of-care treatment decision making, while Jeremy Barr is a Bacteriophage biologist developing the next generation of therapeutics to treat drug-resistant infections. This team is working towards real-world solutions to improve the outcomes of seriously ill people in hospitals

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Professor Allen Cheng is one of the more recognisable faces in Victoria’s fight against the coronavirus pandemic but it is not the most dangerous health threat he is trying to prevent.

The infectious diseases specialist at The Alfred hospital in Melbourne is working with a team of experts to try and slow antimicrobial resistance (AMR).

The problem of antimicrobial resistance is that some bacteria, fungi, parasites and viruses have evolved the power to resist the drugs, or antimicrobials, that are used to try and kill them.

It’s a global crisis that’s become so bad that superbugs are predicted to kill 22,000 people across Oceania (Australia, New Zealand, Polynesia, Micronesia & Melanesia)  (1) year by 2050, dwarfing the number threatened by the coronavirus pandemic.

Prof Cheng says a lot of his work is pretty basic, getting people to wash their hands, and making sure people with infections don't transmit them to other people. 

“The other part is to try and reduce antibiotic use, to make sure that when we're using products they are used properly, that they only use the best-targeted antibiotic.”

Prof Cheng is also looking at alternative therapies with the aid of Centre to Impact AMR in Melbourne - a multidisciplinary team of experts trying to find solutions to the deadly problem.

One of those is Dr Simon Corrie, an innovative chemical engineer, whose expertise is clever new or repurposed tests.

He’s helped clinicians by developing new tests to identify different types of bacteria.

This is critical as fungi, and types of bacteria all need to be tackled with different kinds of drugs.

Dr Corrie thinks people have the idea that diagnostic tests are just there - and clinicians just chose one when they need it.

In some cases that's true, with one example the throat and nasal swab test used for Covid-19, that’s otherwise known as a PCR or polymerase chain reaction test.

“That's a really robust technology. But that's kind of it in terms of pandemic preparedness,” Dr Corrie says.

He said there have been no funding grants this year in Australia for Covid diagnostics outside of specific groups who have been evaluating commercial tests.

“That's not coming up with new tests, that’s evaluating and triaging what we have got to make improvements.”

He thinks it would be useful to be able to do tests outside of a laboratory but says there are very few that allow you to do that with any accuracy.

“So the take-home message is that developing novel diagnostics, new diagnostics, is still important because we want to be able to move some of these tests outside the lab say even into an ambulance or a person’s home … so it keeps people out of hospital. “

Dr Corrie is also working with biomedical researchers to enhance their work on alternative therapies for when antibiotics fail.

“We certainly do see, occasionally, infections that we just can't treat with antibiotics at all,” Prof Cheng said.

“So that's where things like phage therapy and new antibiotics and techniques are really promising, because, even though they might be at an early stage at the moment, they are a potential new pathway in trying to treat these sorts of really difficult infections.”

Phage therapy is the use of bacteriophages, which are viruses that kill bacteria.

Bacteriophage on the surface of a bacteria

Phage therapy is a centuries-old technology that is still used today in some countries overseas. But within Australia, phage therapy can only be used as a compassionate last resort.

“If a phage could be tailored to a particular bacterium or if there was a way of deploying them, that would be really advantageous,” Prof Cheng said.

It’s research in progress at Dr Jeremy Barr’s lab at the Centre to Impact AMR.

He and his team swung into action to prepare an emergency phage treatment last year when a patient with an untreatable bloodstream infection at The Alfred hospital in Melbourne ran out of options.

Professor Anton Peleg sent out a call for help and shipped a sample of the patient’s superbug to the Barr lab at Monash University hoping they could find bacteriophages that would kill the bacterial infection.

One of the best places for finding phages is at a sewage plant, from where the lab gets a regular scoop.

This sewage soup will be full of hungry bacteriophages they can test to see if one, or more, of these viruses will become active against the superbug and try to destroy it.

“We will do some high-level screens of phage activity and its safety, and then we produce a therapeutic preparation, that would be cleaned, sterilized and checked, that we could pass back to the hospital, who could then administer that therapy,” Dr Barr said.

“In this particular case we got to the stage where we were just ready to produce and make the phage therapeutic but unfortunately the patient took a turn for the worse.

Prof Peleg says they will try again.

“I think we'd be fairly progressed if COVID wasn't around.

“Our goal and our hope is that by having the phage and the antibiotics, they might work synergistically together to kill off the bacteria, and the other hope is that maybe the phages even might make the bacteria more susceptible to the antibiotics.”

Dr Barr says he is talking to Dr Corrie about ways they might be able to speed up the process.

“Right now it takes us anywhere from three to five days to produce a personalized therapeutic,” Dr Barr said.

The team agrees that AMR is only getting worse, so innovation is required at all stages of patient care.  From rapid diagnostics that require less infrastructure and informs treatment options, through to a wider range of alternative therapeutics, are but a few needs required to tackle the AMR threat now and in the future.

(1) May 19, 2016 – Tackling Drug-Resistant Infections Globally: final report and recommendations

Contact: Kerry Dunse

Phone: +61438293427

Email: kerry.dunse@monash.edu