In this single-arm non-comparative trial, 13 patients in an Australian hospital with severe Staphylococcus aureus infections were intravenously administered a good manufacturing practice-quality preparation of three Myoviridae bacteriophages (AB-SA01) as adjunctive therapy. AB-SA01 was intravenously administered twice daily for 14 d and the clinical, haematological and blood biochemical parameters of the recipients were monitored for 90 d. The primary outcome was the assessment of safety and tolerability (that is, pain and redness at the infusion site and systemic adverse reactions, such as fever, tachycardia, hypotension, diarrhoea or abdominal pain and the development of renal or hepatic dysfunction). No adverse reactions were reported, and our data indicate that AB-SA01 administered in this way is safe in severe S. aureus infections, including infective endocarditis and septic shock. Future controlled trials will be needed to determine the efficacy of AB-SA01 but no phage resistance evolved in vivo and the measurements of bacterial and phage kinetics in blood samples suggest that 12 h dosing of 109 plaque-forming units may be a rational basis for further studies. Trial Registration: Westmead Hospital Human Research Ethics Committee HREC/17/WMEAD/275; ClinicalTrials.gov: NCT03395769; Clinical Trials Notification (Australian Therapeutic Goods Association): CT-2018-CTN-02372-1.
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The AB-SA01 genomes have been published4 and are publicly available. Raw sequence reads are available on NCBI under the BioProject accession number PRJNA541589 and additional data is presented in the Supplementary section. Clinical data are subject to privacy constraints under Australian law and requests should be directed to the corresponding author.
Asgeirsson, H., Thalme, A. & Weiland, O. Staphylococcus aureus bacteraemia and endocarditis - epidemiology and outcome: a review. Infect. Dis. 50, 175–192 (2018).
Grubitzsch, H. et al. Surgery for prosthetic valve endocarditis: associations between morbidity, mortality and costs. Interact. Cardiov. Th. 22, 784–791 (2016).
Watts, G. Phage therapy: revival of the bygone antimicrobial. Lancet 390, 2539–2540 (2017).
Lehman, S. M. et al. Design and preclinical development of a phage product for the treatment of antibiotic-resistant Staphylococcus aureus infections. Viruses 11, 88 (2019).
Ooi, M. L. et al. Safety and tolerability of bacteriophage therapy for chronic rhinosinusitis due to Staphylococcus aureus. JAMA Otolaryngol. Head Neck Surg. 145, 723–729 (2019).
Park, L. P. et al. Validated risk score for predicting 6-month mortality in infective endocarditis. J. Am. Heart Assoc. 5, e003016 (2016).
Durack, D. T., Lukes, A. S. & Bright, D. K. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am. J. Med. 96, 200–209 (1994).
Bouchiat, C. et al. Staphylococcus aureus infective endocarditis versus bacteremia strains: Subtle genetic differences at stake. Infect. Genet. Evol. 36, 524–530 (2015).
Australian Group on Antimicrobial Resistance Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP) Annual Report 2015 (eds Coombs et al.) (Commun. Dis. Intell., 2018).
Fabijan, A. P., Ben Zakour, N. L., Ho, J., Lin, R. C. Y., Iredell, J. Polyclonal Staphylococcus aureus bacteremia. Preprint at https://annals.org/aim/article-abstract/2751455/polyclonal-staphylococcus-aureus-bacteremia (2019).
Ginn, A. N. et al. Quantitative multiplexed-tandem PCR for direct detection of bacteraemia in critically ill patients. Pathology 49, 304–308 (2017).
Schooley, R. T. et al. Development and Use of Personalized Bacteriophage-Based Therapeutic Cocktails To Treat a Patient with a Disseminated Resistant Acinetobacter baumannii Infection. Antimicrob. Agents Chemother. 61, e00954-17 (2017).
Lin, R. C. Y. et al. PI3K(p110α) protects against myocardial infarction-induced heart failure. Arterioscl. Vasc. Throm. 30, 724–732 (2010).
Abedon, S. Phage therapy pharmacology: calculating phage dosing. Adv. Appl. Microbiol. 77, 1–40 (2011).
Gorski, A. et al. Phages and immunomodulation. Future Microbiol. 12, 905–914 (2017).
Quan, H. et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am. J. Epidemiol. 173, 676–682 (2011).
Capuzzo, M. et al. Validation of severity scoring systems SAPS II and APACHE II in a single-center population. Intensive Care Med. 26, 1779–1785 (2000).
Lopes, J. A. & Jorge, S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin. Kidney J. 6, 8–14 (2013).
Petrovic, A., Kostanjsek, R., Rakhely, G. & Knezevic, P. The first Siphoviridae family bacteriophages infecting Bordetella bronchiseptica isolated from environment. Micro. Ecol. 73, 368–377 (2017).
Fajardo-Lubian, A., Ben Zakour, N. L., Agyekum, A., Qi, Q. & Iredell, J. R. Host adaptation and convergent evolution increases antibiotic resistance without loss of virulence in a major human pathogen. PLoS Pathog. 15, e1007218 (2019).
Maddocks, S. et al. Bacteriophage therapy of ventilator-associated pneumonia and empyema caused by Pseudomonas aeruginosa. Am. J. Respir. Crit. Care Med. 200, 1179–1181 (2019).
We thank J. Lai and L. Ma at the WIMR core facility, supported by the Westmead Research Hub, the Cancer Institute New South Wales, the National Health and Medical Research Council and the Ian Potter Foundation; the staff at the Pathogen Genomics Unit, Westmead Hospital and Ramaciotti Centre (UNSW) for their technical advice and sequencing support; A. Netluch and P. Fa for pharmacy support; S. Chan, K. Garnham, S. N. Hutabarat, C. Li, C. Robson, A. Ginn, B. Roychoudry, N. J. Rai as well as the staff at the NSW Pathology Microbiology laboratory, Westmead Hospital for their help with data and sample collection, S. Chan for performing the valve-replacement surgeries and B. Bowring for laboratory assistance. We thank staff at Ampliphi BioSciences Coporations (Sydney: S. Branston; San Diego: Z. Kovach, C.-L. Langlais Furr, F. Rosas, S. Lehman, I. Bilinsky and P. Grint) for provision of AB-SA01 and all related product information and certificates of analysis. This work was funded by the National Health and Medical Research Council (Australian Government) and by AmpliPhi Biosciences Corporation. Trial Registration: Westmead Hospital Human Research Ethics Committee HREC/17/WMEAD/275; ClinicalTrials.gov: NCT03395769. ABPH provided the investigational product AB-SA01 and partial financial support for the work carried out at WSLHD and WIMR to treat patients and for the analysis of samples, as investigator-led research sponsored and indemnified by the WSLHD. J.R.I., C.V. and N.B.Z. are supported by grant nos 1104232 and 1107322 from the Australian National Health and Medical Research Council.
No personal financial interest was received by the listed authors or WBTT. A provisional patent has been filed in the United States, dated 4 October 2018. R.C.Y.L., J.R.I., A.P.F. and S. Morales are the inventors (attorney docket no. 054249-512; ‘Bacteriophage treatment and reduction of inflammatory response’). ABPH is the sole proprietary owner of AB-SA01. J.R.I. has previously acted as a clinical advisor to C3J Therapeutics. C3J Therapeutics and ABPH announced a merger on 4 January 2019 to become Armata Pharmaceuticals.
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Petrovic Fabijan, A., Lin, R.C.Y., Ho, J. et al. Safety of bacteriophage therapy in severe Staphylococcus aureus infection. Nat Microbiol 5, 465–472 (2020). https://doi.org/10.1038/s41564-019-0634-z
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