What do bacteriophages do

Phages: bacteria eater from Georgia as the medicine of tomorrow

Tanja Diederen from near Maastricht in the Netherlands has been suffering from hidradenitis suppurativa, a chronic skin disease in which the hair roots become inflamed and painful - often in intimate areas such as armpits and chest.

In August 2019, the now 50-year-old made a radical decision: she stopped taking antibiotics, which were becoming weaker and weaker, and traveled to Georgia for two weeks to undergo treatment with bacteriophages.

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3900 euros out of pocket

Such phage therapy is not yet approved in almost all Western European countries. She paid 3,900 euros out of pocket for this, in the hope that the unconventional therapy would help her.

Radical decision: The treatment with bacteriophages helped Tanja Diederen

Bacteriophages (or phages for short) are viruses that fight against the reproduction of their host bacteria. Bacteriophage therapy involves ingesting a single, isolated type of phage orally. These cling to their bacterial counterparts in the patient's body in order to survive.

The phage reverses the polarity of the bacterial cell in such a way that from now on it produces more phages, fills up more and more with phages and finally bursts. The released phages cling to other bacteria until all bacteria are destroyed.

Journey into the unknown

"It tastes a bit like mushrooms," remarks Tanja Diederen as she takes her morning dose of phage. "When I went to Georgia, I was very nervous and excited at first, but above all disappointed with the treatment here in Holland," she says.

After antibiotics stopped working, her doctor suggested taking biopharmaceuticals, genetically engineered drugs. He had never heard of bacteriophages.

Diederen decided instead to look on her own for treatment options using bacteriophage that she had heard about on a television show.

Doctor had never heard of phages

She came across the Georgi Eliava Institute in Georgia, which has been researching bacteriophages since 1923 - just a few years after their discovery. Georgia developed into the global center of phage therapy.

During the Cold War, antibiotics were difficult to obtain there and in the whole of the Soviet Union. Treatment with phages was the best way to cure infectious diseases. The Eliava Institute now has one of the world's largest therapeutic collections of bacteriophages.

Tanja Diederen stayed in treatment for two weeks, after which she traveled back to the Netherlands with a large suitcase full of phage jars. Since she's been taking two different phages and putting on a cream every day, she's been feeling better.

She has more energy again and the small sores on the chest and armpits have decreased. Only the major inflammations continue to come and go, but not as severe as they used to be.

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"It doesn't feel illegal to me"

Every three months Diederen drives to Belgium, 15 kilometers away, to pick up a new ration of bacteriophages from Georgia for 500 euros - the health insurance pays nothing. Belgium is the only Western European country where phages are allowed. In the Netherlands, as in all other countries, they can only be used in individual cases to save lives or relieve severe pain.

Communication with the Georgian doctors was difficult for Tania Diederen, she always needed a translator.

The attending physician is solely responsible for this. "It doesn't feel illegal to me," says Tanja Diederen. "I'm one hundred percent sure that this medicine will help a lot of people."

Like antibiotics, bacteriophages can also lead to resistance in the bacteria. Their great advantage, however, is that they are always one step ahead of the bacteria and can overcome resistance. In addition, they are always directed against a specific type of bacteria and thus leave beneficial bacteria, for example in the intestines, undamaged.

Before phage treatment, it must therefore always be determined which bacteria are actually causing the disease. The phages are then made individually for each patient - often in Georgia.

Bacteriophages are allowed in Belgium

Such individual medication does not meet the applicable regulations for pharmaceuticals in any Western European country. The effort would be too great to have every single phage formulation approved by the authorities.

This is different in Belgium: since last year, this process has been legally circumvented by issuing a certificate for the phage ingredients required by the scientific health institute in collaboration with doctors, patients, manufacturers, pharmacists and the Belgian Federal Medicines Agency. Pharmacists are then allowed to use them to manufacture bacteriophages, taking certain guidelines into account.

Prof. Dr. Jean-Paul Pirnay from the Queen Astrid Military Hospital in Brussels

"We used the existing legal framework and added the bacteriophages," says Dr. Jean-Paul Pirnay, who researches bacteriophages at the Queen Astrid Military Hospital in Brussels. Around 30 patients have already been treated with phages here. Currently, the military hospital is the only place in Belgium where bacteriophages are made.

Useful addition to antibiotics

"We need pharmaceutical companies that make the phages," says Pirnay. "A hospital cannot produce all the phage for an increasing number of patients." However, a clearer legal framework would be needed for the industrial production of phages, and research is not yet ready either. "I believe phages will not replace antibiotics. Both will be used together to make antibiotics more effective."

Tanja Diederen would like to continue her treatment in Brussels in the future. Communication with the Georgian doctors was difficult for her, she always needed a translator. "I really hope phage will be allowed in Europe soon. Going to Georgia is quite difficult and expensive."

Germany and the Netherlands are currently conducting pilot studies to determine whether it would also be possible for them to prescribe bacteriophages individually. And France has already imported Belgian phages and consented to their use.

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