The W.H.O. Issues a Plea to Governments Across the World to Target 12 Superbugs

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Yesterday, the World Health Organization published its first ever list (below) of antibiotic-resistant “priority pathogens” – a catalogue of 12 families of bacteria that pose the greatest threat to human health.

The 12 bugs on the list are classified as critical, high and medium priority, based on their level of resistance to treatment, their mortality rates, their prevalence in the community, and the burden on the health system they cause.

MRSA is listed as a high priority, i.e. those bacteria that cause a large number of deaths and infections in otherwise healthy people. The US Centers for Disease Control said the same thing in 2013 when it ranked superbugs having the most impact on human health. The CDC Threat Report also used 3 categories – Urgent, Serious, and Concerning – and ranked MRSA’s threat level as “Serious” on the basis that (1) it alone is responsible for about half of the 23,000 deaths caused each year in the US by antibiotic-resistant bacteria, and (2) it causes more than 80,000 serious infections each year.

However, there’s a crucial difference between the WHO and CDC reports: The WHO’s intent is to “spur governments to put in place policies that incentivize basic science and advanced research and development.” Dr. Marie-Paule Kieny, WHO’s Assistant Director-General explains:

Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.

The science community believes that because antibiotic-resistant bacteria are a global issue, that the solution has to be global too; namely, a coordinated game plan that’s bought into by world governments, especially the major players on the global stage.

Which brings us to our problem – the United States, and whether or not they’re willing to play ball.

In 2015 the Obama administration rolled out its National Action Plan for Combating Antibiotic-Resistant Bacteria, a 5-year strategy to address what the president called “an issue of great importance to the public health of America and the world … [i.e.] antibiotics becoming less effective … one of the most serious public health issues we face today.” The plan was quarterbacked by the president’s science advisor, John Holdren, PhD, and the President’s Council of Advisors on Science and Technology (PCAST).

As of today, however, there’s still no presidential science advisor. The Action Plan and PCAST are in limbo. For this and other reasons, US scientists are livid and in an unprecedented move will march on Washington on April 22 to publicly air their concerns.

All of this matters because according to a highly-regarded UK government report, antibiotic-resistant disease will cause more deaths than cancer by 2050.

Yesterday’s report by the WHO was a call to action to prevent that from happening. It was also an admission that it will take a village – a global government village – to address the problem. And that if someone doesn’t want to do their fair share, it will hurt all of us.

The WHO list:

Priority 1: Critical
1. Acinetobacter baumannii, carbapenem-resistant
2. Pseudomonas aeruginosa, carbapenem-resistant
3. Enterobacteriaceae, carbapenem-resistant, ESBL-producing

Priority 2: High
4. Enterococcus faecium, vancomycin-resistant
5. Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
6. Helicobacter pylori, clarithromycin-resistant
7. Campylobacter spp., fluoroquinolone-resistant
8. Salmonellae, fluoroquinolone-resistant
9. Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

Priority 3: Medium
10. Streptococcus pneumoniae, penicillin-non-susceptible
11. Haemophilus influenzae, ampicillin-resistant
12. Shigella spp., fluoroquinolone-resistant

 

 

Minority Report 2: “Pre-Disease”

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KENNEDY SPACE CENTER — This coming Saturday morning at ten o’clock, our friend Staphylococcus aureus will find itself buckled up inside a Dragon Spacecraft about to be launched some 250 miles into space so it can dock at the International Space Station (ISS), shown above.

The U.S.- Russian-manned ISS, which orbits the Earth 15 times a day at a speed of 17,000 mph, serves as a cutting-edge science lab because of its near zero gravity environment — the one where you see astronauts floating around the spacecraft like it’s a Disney ride.

As it turns out this microgravity environment is thought to have a pronounced effect on microbes: that it accelerates their rate of growth and reproduction, and therefore their (genetic) mutation rate. Accelerating an organism’s growth rate is a way of fast forwarding into the future, as if you were aging, say, a human, 20 years in just 365 days.

The idea is to place the Staph into that environment, under experimental conditions, and watch what it does. Specifically, to record all the different ways that Staph becomes resistant to an antibiotic as it morphs into Methicillin-resistant staphylococcus aureus (MRSA). You keep at it until you’ve mapped all of the various pathways Staph bacteria take on their road to resistance, in all its forms.

What the finished resistance map gets you is the ability to predict the future. It goes like this. Imagine, for example, that Big Louis comes to town to stick up a bank. He holes up at a local dive from which he cases the joint, decides when to strike, chooses a weapon, a disguise, a getaway car, and plans his escape route. The day of the robbery everything goes according to plan; the cops are called in and begin to work “backwards,” assembling the clues one by one, day by day, hoping they’ll lead to the guy whodunit before he gets away.

But what if, instead, the instant Big Louis hits town the cops know he’s there. They run his M.O. and learn everything within minutes: where he’s holed up, the crime he’s planning, his disguise, weapon, getaway plan, whether he has an accomplice, and so on, thus allowing them to scoop Big Louis at any point prior to the planned bank job.

 

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Where do the cops get all this information? This is the futuristic part: From having recorded not just every crime Big Louis has ever committed, but from having also recorded every crime he will commit over his lifetime. As if an experimenter had placed Big Louis in a time machine, pressed fast forward and recorded all of his future criminal behavior.

That, of course, is science fiction. But putting Staph aureus into a microgravity environment and accelerating its rate of growth and reproduction, recording each genetic change, plugging those changes into a data base, creating algorithms from that data that allow you to predict what Staph will do based on any given presenting genetic profile, and ultimately developing an antibiotic that targets that genetic profile, isn’t science fiction – as of this novel space experiment.

The project is led by Harvard’s Dr. Anita Goel, MD, PhD, whose one-of-a-kind resume is worth taking a look at. She admits that the space bug experiment is proof of concept. For example, they’re experimenting on 2 strains of Staph, yet there are hundreds, not to mention all the other different species of bad bugs that are out there. It’s as if, back to our crime analogy, they’re experimenting on Big Louis and his frequent accomplice, Little Ronnie Dinsdale, but leaving out the rest of the criminal underworld — Tony Soprano, Don Corleone, and so on — each with their own unique M.O.’s.

But here’s the thing. If the experiment works with either strain of Staph, then it means it will work with other disease microbes as well. And then … what about cancer cells?

Just 15 years ago we were introduced to the concept of “Pre-Crime” in the Tom Cruise film Minority Report. Pre-Crime was the name of the specialized police unit that arrested criminals based on foreknowledge of future crimes provided by psychics called “precogs.” Now replace psychics with scientists, have your foreknowledge based on microgravity enhanced “fast-forwarded” observations of the genomic changes in a superbug, and replace Pre-Crime with “Pre-Disease,” and we have Dr. Goel’s current work.

She chose to study Staph because MRSA kills more Americans every year than the combined total of emphysema, HIV/AIDS, Parkinson’s disease, and homicide. Worldwide, drug-resistant infections kill more than 500,000 people each year and by 2050 that number will exceed 10 million.

But if this notion of “Pre-Disease” intervention works we’ll have a different world. In fact, that’s what Dr. Goel said, with characteristic dry wit, in her 2010 TEDMED Talk: “Our aim with this is humble: We want to do nothing less than to revolutionize healthcare globally by enabling real time point of care diagnosis.”

Stay tuned.

 

 

 

 

 

 

Bugs on steroids: the antibiotic effect

Imagine prescribing steroids to people so we could build stronger antibiotic-resistant germs – “superbugs” – that grow and reproduce quicker than they otherwise would. Ridiculous, right?

Well, a study reported this week in the American Academy for the Advancement of Science tells us that’s exactly what we’re doing when we take antibiotics, i.e. they have a pronounced steroid-like effect, not on us, but on the bad bugs we harbor.

In the study, researchers exposed E. coli bacteria to 8 rounds of doxycycline treatment over four days and found that the bug – which can cause severe stomach pain, diarrhea and kidney failure in humans – had “increased antibiotic resistance with each treatment.” The E. coli also “reproduced faster than before encountering the drugs and formed populations that were three times larger [and] … [t]his was only seen in bacteria exposed to antibiotics.”

Therefore, say the researchers,”[b]acteria have a remarkable ability to rearrange their DNA and this can stop drugs working, sometimes in a matter of days” (my emphasis). And further: “It’s often said that Darwinian evolution is slow, but nothing could be further from the truth, particularly when bacteria are exposed to antibiotics.”

In fact, we can now literally watch this rapid evolution and spread of mutant superbugs thanks to a first-of-its-kind video produced by Harvard scientists that went viral on YouTube with some 25 million views. Here it is, with a nice voice-over explanation:

Here’s the takeaway. No one disputes that antibiotics are necessary and even lifesaving – but only when appropriately prescribed by a physician. The inconvenient truth, however, is that we horribly misuse and overuse them. For example, antibiotics cannot cure the common cold, are almost never needed for bronchitis, are not recommended to treat many ear infections, and are typically not needed to treat a sinus infection (sinusitis).

As Roy Kishony, one of the Harvard scientists involved in the video reminded us in an interview with STAT last December, “Every single antibiotic that has been introduced medically so far, bacteria found ways to evade it … every single one.”

So why help out the bugs even further by giving them “steroids”?

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