Author & Scientist, Steffanie Strathdee does Q&A with KU Biology Students

LAWRENCE - Steffanie Strathdee, the Associate Dean of Global Health Sciences at the UCSD Department of Medicine, Co-Director for the Center for Innovative Phage Applications & Therapeutics (IPATH) and author, joined Dr. Eileen Hotze and KU students  enrolled in BIOL400: Fundamentals of Microbiology for a Zoom Q&A about her book “The Perfect Predator: A Scientist’s Race to Save Her Husband From a Deadly Superbug” and a talk recently given on CNN.

The Perfect Predator cover the research & struggles that went into finding a cure for a superbug infection her husband, Tom Patterson, contracted while on a Thanksgiving cruise in Egypt in 2015. The diagnosis came after Tom was hospitalized for severe stomach cramps and was medevacked to Germany where doctors found a grapefruit-size abdominal abscess infected by Acinetobacter baumanni, which became resistant to all available antibiotics. Strathdee tracked down an obscure treatment she hoped would be the solution, bacteriophages. Bacteriophages, or phages for short, are naturally occurring viruses that specifically attack bacteria. Strathdee contacted phage scientists from across the country they were able to find phages to fight the strain of antibiotic-resistant bacteria that was afflicting her husband.

Eileen Hotze had used Strathdee’s book as a discussion board topic for several semesters in the BIOL400 course. The opportunity for the students in the class to meet Steffanie Strathdee came out of a series of messages on Twitter shared between the KU professor and the author. While originally Strathdee agreed to provided autographed copies of her book, she was also “generous and enthusiastic with her time,” and offered to do the Q&A session. “She was very mindful of the student’s education level and spoke to her audience in a direct but relatable way.” Hotze said in regard to the event.

The Q&A took place on October 12th and lasted for over an hour. The BIOL400 students were grateful that Dr. Strathdee was able to speak to them about her research and their future in the scientific field. You can find an excerpt of the Q&A transcript below. [Some of the responses and questions have been edited for clarity]

Q: What advice do you have for future scientists?

Steffanie Strathdee: I would say, expose yourself to a variety of different kinds of science. Global health in particular is very interdisciplinary and integrates policy, as well as engineering and other types of approaches to solving difficult problems. For me I was really bad at bench science, I kept contaminating all my petri plates, so when I realized that public health was an option and then later global health grew out of that, it opened new doors for me.

The other thing I would say is, it's sometimes hard to figure out your career path if you're really interested in science and need to know where the field is going. I think of life as like a little two by two table; you make out a list of the things. ‘What am I good at’, ‘And what makes me happy,’ and so for me, I was not good at some parts of science, but I was good at other parts and thinking about where the field was going helped me decide what path to take.

So right now, Phage Therapy is a really hot topic, and partly it's hot because of advances in Crispr-Cas Gene Editing and Single Cell Gene Editing, which is going to make it possible for us to manipulate phages, to make them better killers of pathogenic bacteria and to choose phages that synergize with antibiotics. I think that the whole field of synthetic biology is very exciting, and it's one that is going to revolutionize the field. But then there's also the ethical side of it too, right? Because if we're manipulating genomes, we are changing nature. Then there's potential downstream effects of that, some of which could be deleterious. I think there's a bioethics aspect to science that is going to become more important down the road.

Q: In your book you said that they injected the Phages into Tom’s bloodstream. Are there ways that you can administer it? Could you take them orally or topically?

Strathdee: All of the above but the best route of phage administration for different kinds of illnesses hasn’t been established yet. But if somebody has a pneumonia-- cystic fibrosis patients often have multi drug resistant bacterial infections that affect their lungs—our team has given phages through a nebulizer that they breathe in. However, in some cases, it actually irritates the lungs more. So, we've done it a variety of different ways. We've injected phages into the bloodstream and found that the phages make their way into the lungs anyway. So, it's a very effective way of delivering phage, especially if someone like Tom has a systemic infection, where the infection is in multiple organs and in multiple body fluids. If someone has a diabetic toe ulcer you can put the phages on topically, or someone has a wound that's infected with MRSA, you can put that on as a bandage. There's some Nanoengineers at the McMaster University in Hamilton, not too far away from where I grew up in Ontario, that are working on impregnating phages into hydrogels, so that they could be administered during surgery to ensure that people getting prosthetic devices like hips and knees aren't going to have a problem with infections. That’s because a lot of implanted hardware is prone to biofilm formation that's really hard for antibiotics to get through.

There's going to be lots of different ways, and some of the clinical trials that are under way now are being designed to figure out what's the best route of administration. The good news is that we haven't seen any safety concerns from injecting phages into people so far.

Q : How much do you think it's going to cost to incorporate Phage Therapy into hospitals and everyday medical care? How much do you think it's going to change our health care system if we are able to incorporate Phage Therapy into everyday treatment for people?

Strathdee: Well, that's a way off, because we have to do the clinical trials first to find out that it's efficacious and just as good or better than antibiotics. The cost is kind of an open question right now. Certainly, phages that can be sourced directly from the environment or natural phages are going to be cheaper. Right? They don't need manipulation, but other phages might need to be genetically modified to kill bacteria, and there are even synthetic phages that are being worked on. Now, those are probably going to cost more because there's more startup costs involved. So, I've heard numbers like maybe ten thousand dollars per patient or something like that. But my view is that there needs to be a sliding scale, because people in lower- and middle-income countries are the ones that bear the biggest burdens of superbug infections, and certainly ten thousand dollars would be unaffordable to the majority of folks living there.

What we would like to have is a giant phage library, so that you can select phages to match a certain superbug, and based on the person's ability to pay or not, that would be determined. I'm going to continue to work on the non-profit side of things. But unless there's a market then big pharmaceutical companies aren’t going to invest resources; luckily several have started to get involved.

So, there's a lot going on in this area. We don't think phage therapy is ever going to replace antibiotics. They're likely to be an adjunct to antibiotics, so we use fewer antibiotics in the future.

Q: What has the biggest setback been in developing Phage therapy and how did your researchers overcome the setback, or how are they working to overcome it?

Strathdee: Oh, there's a lot of setbacks. First, I would say that the biggest one was a political bias against Phage therapy, because it was taken up by the Soviet Union around World War II. It was seen as Soviet Science, Soviet medicine, enemy science, that kind of thing, and [was also looked down upon] because phages were discovered before antibiotics. The science that was done initially on phage was really crude. Some of the phage companies that emerged in the 1920s and 1930s over promised and under delivered. So, those things really cast a pall on the field for a while. The other thing, is that people said, “Well, if bacteria can develop resistance to phage, it's no better than antibiotics, so why even bother.” Well, yes, but there are ten million trillion phages (a nonillion) that are on the planet in the natural environment. If you develop a phage library, you can just keep going back to the well and selecting new phages to match the bacterial mutants that evolve. We need to know a lot more about microbial ecology to source phage, modify the genomes of phage when needed or even create synthetic phage. So, I think a lot of the criticisms that existed early on are surmountable.