Biotech and the New Era of Germ WarfareEvery year, a deadly illness kills 100,000 Americans, more than the combined deaths from AIDS and breast cancer, and it costs the nation $30 billion.
It is a cruel irony that the victims typically are stricken in hospitals where they are surrounded by doctors and millions of dollars in medical technology.
The U.S. Centers for Disease Control and Preventionreports that of the 35 million people who are admitted to hospitals each year, 2 million patients come down with infections while they are there.
And, two out of every three of those cases will involve infections that are immune to at least one drug.
Harvard Medical School infectious disease expert Robert Moellering was recently quoted on Forbes.com1as saying, “More and more bugs are becoming dangerously close to untreatable.”
Three reasons explain why super-bugs are proliferating:
Doctors have over-prescribed antibiotics for decades, even giving them to patients with non-bacterial infections like colds.
This shortsighted practice has encouraged bacteria to mutate into strains that resist all of the current drugs.
Today, standard antibiotics can successfully treat just 40 percent of hospital staph infections.
That’s down from 98 percent 30 years ago.
The pipeline for new antibiotic drugs is nearly empty.
Between 1982 and 1992, pharmaceutical companies won approval for 30 new antibiotics.
Since 2000, the number has dwindled to seven.
The reason is that antibiotics are just not as profitable a business as blockbuster drugs that control cholesterol or heartburn.
Hospitals have become lax in preventing the spread of infections.
Because of the heavy use of antibiotics that destroy less-dangerous strains of bacteria, hospitals are prone to drug-resistant bacteria, or “super-bugs.”
The problem becomes worse when poor hygiene is practiced by doctors and nurses who fail to wash their hands after they treat patients, and by maintenance personnel who fail to wash restroom faucets and doorknobs.
It all adds up to a perfect environment for breeding super-bugs.
The most worrisome of these is called community-acquired methicillin-resistant Staphylo-coccus aureus, or MRSA.
Unlike other dangerous staph infections, MRSA isn’t confined to hospital wards.
It has been spreading across the country, transmitted from person to person on playground swings, on locker room towels, on computer keyboards, or on airplane tray-tables.
What makes MRSA more than just a regular staph infection is that it isn’t stopped by normal antibiotics, such as amoxicillin or cephalexin.
Also, according to a Time2 magazine article called “Surviving the Killer Bug,” MRSA and other bacteria swap small strands of DNA that cause two changes in the bug:
First, the bug becomes increasingly resistant to antibiotics; and second, the person who is infected with it becomes even more susceptible to other infections.
MRSA is sweeping through areas of California, Texas, Illinois, and Alaska, and is taking hold in New York and Philadelphia.3
The Centers for Disease Control and Prevention reports that 130,000 people are hospitalized with MRSA every year.
In Canada, according to CBC News, it is infecting previously healthy adults and children in provinces across the country.
According to a report by the British Broadcasting Corporation,4 MRSA is now cited as the underlying cause of 36 percent of deaths in England and Wales.
The bug is already carried by 30 to 40 percent of the population on their skin and in their noses, without causing any illness.
It isn’t until MRSA finds a pathway into the body, such as through a cut or scratch, that it can cause an infection.
According to Time,5 that’s what happened to Jewaun Smith, a 9-year-old boy in Chicago who scraped his knee while riding his bicycle.
Within a few days, the infection spread from his knee and throughout his body, eventually eating holes in his lungs, before doctors stopped it.
The last resort in cases like Smith’s is treatments with vancomycin, which is given by IV for several weeks.
Usually, vancomycin gets rid of the infection, but lately researchers have noticed a frightening development:
A few new strains of MRSA have emerged that are immune to vancomycin, and scientists fear that they will soon have no defenses left to prevent an MRSA epidemic.
Based on this disturbing trend, we offer the following five forecasts:
First, hospitals will place a top priority on preventing the spread of MRSA and other bugs.
Part of this will be a response to growing patient awareness of this crisis.
Among the companies that are offering new products to help in this prevention campaign are iKey, the maker of a computer keyboard used by hospitals.6
Studies show that the average keyboard contains 3,300 germs per square inch, compared to just 49 germs per square inch on the average toilet seat. iKey’s cleanable medical keyboards feature silicon rubber keys for easier cleaning.
This helps to prevent healthcare professionals from spreading germs when they enter data before and after treating patients.
Second, despite the magnitude of the threat, the Trends editors expect new drugs to keep the super-bugs at bay, at least for the next several years.
Pfizer is one of the last big companies to continue its pursuit of new antibiotics to fight the drug-resistant bacteria.
It has assigned 150 researchers to the problem, and its goal is to develop six new antibiotics for clinical trials by the end of 2006.7 The best hope for now is Pfizer’s Zyvox, with projected sales of $780 million in 2006.
Third, as other big pharmaceutical companies ignore the need for new antibiotics, small biotech firms will fill the void.
For example, Paratek Pharmaceuticals is testing an enhanced tetracycline that appears to work on bacteria that have resisted older drugs.
Theravance, a biotech firm led by the former CEO of Merck, is combining existing antibiotics to build stronger drugs.
Forbes.com8 reports that Theravance is in clinical trials on a compound based on vancomycin, called telavancin, which could cut the time to stop a staph infection from nine days to three.
Fourth, in some cases, innovative approaches to treatment will prove to work more successfully than new classes of antibiotics.
For example, one reason why super-bugs are so deadly is that the overuse of antibiotics destroyed the less toxic bacteria in many people, which wiped out the competition and allowed the more potent bugs to take control.
So, one novel approach being tested by ViroPharma is to “infect” people with harmless strains of bacteria that preempt the environment needed for the worst strains of bacteria to survive.
Studies on hamsters showed that getting a “harmless bacterial infection” prevented 90 percent of the test subjects from getting a “toxic infection.”
Fifth, beyond 2010, our best hope lies in genetically engineered weapons against MRSA and other super-bugs that by-pass the problems we have with antibiotics.
According to the BBC,9 researchers at the University of California at San Francisco have sequenced the genome of USA300, one of the most virulent strains of MRSA.
The team is working backwards from USA300 to the more benign version of the staph infection, in hopes of discovering a drug that will reduce the severity of the infection.
Meanwhile, other scientists are targeting the process by which bacteria communicate with one another.
In a phenomenon known as “quorum sensing,” bacteria produce signal and receptor molecules as they grow.
As the number of bacteria in a host increases, the stronger the signals become.
When the bacteria can sense they have reached “critical mass,” they go on a rampage.
Scientists in the U.S. and in Europe are working to block the communication between bacteria, either by shutting off the signal molecule or by preventing the receptor from getting the message.
If either strategy works, the bacteria will not be able to spread the signal to attack, and they could be rendered harmless.
References list :
1. Forbes, June 19, 2006, “Germ Warfare,” by Robert Langreth and Matthew Herper. ⓒ Copyright 2006 by Forbes, Inc. All rights reserved.
2. Time, June 26, 2006, “Surviving the New Killer Bug,” by Christine Gorman. ⓒ Copyright 2006 by Time, Inc. All rights reserved.
3. For more information about MRSA, visit the Vanderbilt University Medical Center website at: www.mc.vanderbilt.edu
4. For more information about MRSA deaths in The United Kingdom, visit the BBC website at: news.bbc.co.uk
5. Time, June 26, 2006, “Surviving the New Killer Bug,” by Christine Gorman. ⓒ Copyright 2006 by Time, Inc. All rights reserved.
6. For information about iKey’s infection-control keyboard, visit the PR Newswire website at: sev.prnewswire.com
7. Forbes, June 19, 2006, “Germ Warfare,” by Robert Langreth and Matthew Herper. ⓒ Copyright 2006 by Forbes, Inc. All rights reserved.
8. ibid.
9. For information about the work being done to target antibiotic-resistant germs, visit the BBC website at: news.bbc.co.uk
