the perfect predator: a scientist’s race to save her
TRANSCRIPT
The Perfect Predator: A Scientist’s Race to Save Her Husband from A
Deadly Superbug
Steffanie A. Strathdee, PhD,Associate Dean of Global Health Sciences,
Harold Simon Professor, Co-director, IPATH@chngin_the_wrld
AMI Images/Getty Images
Disclosures
• My husband and I hold stock in Adaptive Phage Therapeutics.
• All patient photos shown are used with permission.
Career Aspirations
Early Challenges
“Go West Young Woman”!
U.S.MEXICO
MEXICOU.S.
… but following the Road Less Travelled
HIV prevalence in the Americas
0.10.1
0.20.30.30.30.30.3
0.40.50.5
0.60.60.60.6
0.70.90.90.9
1.11.51.51.5
1.92.4
2.52.6
3.33.8
0 0.5 1 1.5 2 2.5 3 3.5 4
BoliviaCuba
NicaraguaMexico
EcuadorCosta Rica
ChileCanada
ParaguayUruguay
BrazilUnited States
PeruColombia
ArgentinaVenezuela
PanamaGuatemalaEl Salvador
Domincan RepublicJamaica
HondurasBarbadosSuriname
GuyanaBelize
Tinidad and TobagoBahamas
Haiti
Adult (15-49 years) prevalence (%)ADAPTED FROM: Report on the Global AIDS Epidemic, UNAIDS, 2006
← TijuanaJAMA 2008
San Diego Tribune, Reuters, CNN
2010: Data informed Mexico’s successful bid for Global Fund
($76 M for HIV Prevention)
Special Issue , IAS 2012
Breaching borders. Steffanie Strathdee and Thomas Patterson track regional spread of HIV.
Painful reality. Many deported heroin users who live in the Tijuana River Canal consider California home.
Bacteria (WHO category) WHO (2017) CDC (2013) ESKAPE (2008-9)
Acinetobacter baumannii, carbapenem-R Critical Serious (MDR) Yes
Pseudomonas aeruginosa, carbapenem-R Critical Serious (MDR) Yes
Enterobacteriaceae, carbapenem-R, 3rd-gen ceph-R (ESBL+) Critical Urgent (carbapenem-R)Serious (ESBL+) Yes
Enterococcus faecium, vancomycin-R High Serious (VRE) Yes
Staphylococcus aureus, methicillin-R, vancomycin-I/R High Serious (MRSA)Concerning (VRSA) Yes
Helicobacter pylori, clarithromycin-R High
Campylobacter spp., fluoroquinolone-R High Serious (drug-R)
Salmonellae spp., fluoroquinolone-R High Serious (drug-R)
Neisseria gonorrhoeae, 3rd-gen ceph-R, fluoroquinolone-R High Urgent (drug-R)
Streptococcus pneumoniae, penicillin-NS Medium Serious (drug-R)
Haemophilus influenzae, ampicillin-R Medium
Shigella spp., fluoroquinolone-R Medium Serious
Clostridium difficile Urgent
Candida spp. fluconazole-R Serious (Flu-R)
M. tuberculosis Serious (drug-R)
Group A Streptococcus Concerning (erythro-R)
Group B Streptococcus Concerning (clinda-R)WHO PPL, CDC, & ESKAPE 18
Uniklinick Antibiogram
Credit: Scott Brundage, Scientific American
Trends in Microbiology, 2013
Early Pioneers
Felix d’Herelle
Bronislaw Fejgen
Giorgi Eliava
Frederick Twort
Nicolai Gamaleya
Charles Hankin
The Phage Hunt Begins…
Texas A&M- Center for Phage TechnologyDr Ry Young
Contacting the FDA….
Dr Robert (Chip) Schooley, UCSD Dr Cara Fiore, FDA
US Navy Biological Defense Research Directorate
The Dosing Dilemma
How much phage to administer?
What routes?
How often?
How long?
Maia Merabishvilli, PhD Carl Merril, MD
Thomas Patterson and Lt Commander Theron Hamilton
Schooley et al, AAC, 2017
Tom’s A.baumannii isolate being attacked by Navy phages
Courtesy of Dr. Robert Pope, National Biodefense Analysis & Countermeasures Center,Dept of Homeland Security
Phage Therapy Patients treated at IPATH
Patient Age Underlying Condition Organism Start Date Outcome
1 67 Disseminated infection A. Baumannii May 2016 Treatment success
2 67 Bilateral lung transplant P. Aeruginosa May 2017 Treatment success
3 74 Open head trauma A. Baumannii June 2017 Treatment success
4 23 CF; pre lung transplant P. Aeruginosa September 2017 Treatment success
5 65 Infected LVAD P. aeruginosa + December 2017 Failure
6 63 Infected LVAD S. Aureus April 2018 Treatment success
7 61 Infected left knee prosthesis S. Aureus March 2019September 2019 First treatment failed, second treatment success
8 83 Infected LVAD P. aeruginosa August 2019 Treatment failure, patient passed away
9 56 Recurrent UTI ESBL E. coli February 2020 Partial success
10 64 Recurrent bacteremia, aortic graft infection P. Aeruginosa March 2020 Treatment success
11 65 Bacteremia ESBL E. Coli July 2020 Outcome pending
12 77 Lung infection P. aeruginosa September 2020 Outcome pending
NIH Funds First Phage Therapy Trial ($12 M) through the Antibacterial Resistance
Leadership GroupDecember 13th, 2019
Design: Adaptive Phase 2 Trial
Enrollment to start in 2022
PI: Robert T. Schooley
May 2019
Conclusions
• A “D” in Calculus is not the end of the world.
• What first appears as the worst ordeal of your life may have a silver lining.
• Importance of the role of privilege in global health.
ThePerfectPredator.com
www.IPATH.ucsd.edu
Acknowledgements
UC San Diego
Rob KnightDoug ConradConstance Benson
Walter Reed ArmyInstitute of Research
Stuart TynerBrett SwierczewskiMikeljon NikolichNelson Michael
Theron HamiltonBiswajit BiswasKim Bishop-Lilly
Ryland YoungJason GillMei LiuCarlos Gonzalez
John Beigel Joseph CampbellJane Knisely
Chip Chambers Vance FowlerPranita Tamma
