School of Biological Sciences, Monash University, Clayton, Victoria, Australia
Clin Microbiol Rev. 2019 Jan 16;32(2). doi: 10.1128/CMR.00066-18. Print 2019 Apr.
Antibiotic resistance is arguably the biggest current threat to global health. An increasing number of infections are becoming harder or almost impossible to treat, carrying high morbidity, mortality, and financial cost. The therapeutic use of bacteriophages, viruses that infect and kill bacteria, is well suited to be part of the multidimensional strategies to combat antibiotic resistance. Although phage therapy was first implemented almost a century ago, it was brought to a standstill after the successful introduction of antibiotics. Now, with the rise of antibiotic resistance, phage therapy is experiencing a well-deserved rebirth. Among the admittedly vast literature recently published on this topic, this review aims to provide a forward-looking perspective on phage therapy and its role in modern society. We cover the key points of the antibiotic resistance crisis and then explain the biological and evolutionary principles that support the use of phages, their interaction with the immune system, and a comparison with antibiotic therapy. By going through up-to-date reports and, whenever possible, human clinical trials, we examine the versatility of phage therapy. We discuss conventional approaches as well as novel strategies, including the use of phage-antibiotic combinations, phage-derived enzymes, exploitation of phage resistance mechanisms, and phage bioengineering. Finally, we discuss the benefits of phage therapy beyond the clinical perspective, including opportunities for scientific outreach and effective education, interdisciplinary collaboration, cultural and economic growth, and even innovative use of social media, making the case that phage therapy is more than just an alternative to antibiotics.
抗生素耐药性可说是当前对全球健康的最大威胁。越来越多的感染变得难以治疗甚至几乎无法治疗，导致高发病率、死亡率和高昂的医疗费用。噬菌体治疗，即利用感染和杀死细菌的病毒进行治疗，非常适合成为对抗抗生素耐药性的多维策略的一部分。尽管噬菌体治疗在近一个世纪前就首次实施，但在抗生素成功问世后就停滞不前了。现在，随着抗生素耐药性的出现，噬菌体治疗正在迎来当之无愧的复兴。在最近发表的大量关于这个主题的文献中，本文旨在提供一个前瞻性的噬菌体治疗视角及其在现代社会中的作用。我们涵盖了抗生素耐药性危机的要点，然后解释了支持噬菌体使用的生物学和进化原则、它们与免疫系统的相互作用以及与抗生素治疗的比较。通过查阅最新的报告，只要有可能，我们还会进行人体临床试验，以检验噬菌体治疗的多功能性。我们讨论了常规方法和新颖策略，包括噬菌体-抗生素联合治疗、噬菌体衍生酶的利用、噬菌体耐药机制的利用以及噬菌体生物工程。最后，我们讨论了噬菌体治疗超越临床视角的益处，包括科学外展和有效教育、跨学科合作、文化和经济增长，甚至社交媒体的创新使用，噬菌体治疗不仅仅是抗生素的替代品。
