Bodier-Montagutelli Elsa, Morello Eric, L'Hostis Guillaume, Guillon Antoine, Dalloneau Emilie, Respaud Renaud, Pallaoro Nikita, Blois Hélène, Vecellio Laurent, Gabard Jérôme, Heuzé-Vourc'h Nathalie
a Université François Rabelais, UMR 1100 , Tours , France.
b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.
Expert Opin Drug Deliv. 2017 Aug;14(8):959-972. doi: 10.1080/17425247.2017.1252329. Epub 2016 Nov 10.
Bacterial respiratory tract infections (RTIs) are increasingly difficult to treat due to evolving antibiotic resistance. In this context, bacteriophages (or phages) are part of the foreseen alternatives or combination therapies. Delivering phages through the airways seems more relevant to accumulate these natural antibacterial viruses in proximity to their bacterial host, within the infectious site. Areas covered: This review addresses the potential of phage therapy to treat RTIs and discusses preclinical and clinical results of phages administration in this context. Recent phage formulation and aerosolization attempts are also reviewed, raising technical challenges to achieve efficient pulmonary deposition via inhalation. Expert opinion: Overall, the inhalation of phages as antibacterial treatment seems both clinically relevant and technically feasible. Several crucial points still need to be investigated, such as phage product pharmacokinetics and immunogenicity. Furthermore, given phage-specific features, appropriate regulatory and manufacturing guidelines will need to be defined. Finally, randomized controlled clinical trials should be carried out to establish phage therapy's clinical positioning in the antimicrobial arsenal against RTIs.
由于抗生素耐药性不断演变，细菌呼吸道感染（RTIs）的治疗愈发困难。在此背景下，噬菌体是可预见的替代疗法或联合疗法的一部分。通过气道递送噬菌体似乎更具相关性，以便在感染部位使这些天然抗菌病毒在其细菌宿主附近聚集。涵盖领域：本综述探讨了噬菌体疗法治疗RTIs的潜力，并讨论了在此背景下噬菌体给药的临床前和临床结果。还综述了近期噬菌体制剂和雾化的尝试，提出了通过吸入实现有效肺部沉积的技术挑战。专家观点：总体而言，吸入噬菌体作为抗菌治疗似乎在临床方面具有相关性且在技术上可行。仍有几个关键点需要研究，例如噬菌体产品的药代动力学和免疫原性。此外，鉴于噬菌体的特定特性，需要制定适当的监管和生产指南。最后，应开展随机对照临床试验，以确定噬菌体疗法在抗RTIs抗菌药库中的临床定位。
