Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
J Orthop Res. 2023 May;41(5):1097-1104. doi: 10.1002/jor.25432. Epub 2022 Sep 7.
Bacteriophage therapy is a promising treatment for periprosthetic joint infections (PJIs), particularly given these agents have innate abilities to degrade the biofilm matrix and lyse bacteria within. However, many aspects of this therapy are poorly understood causing treatments to lack uniform effectiveness and reproducibility, which is in part a consequence of several inherent limitations to using bacteriophages to treat PJI. Herein, these limitations are discussed as are additional translational research that needs to be conducted to advance this therapeutic. These include determining if bacteria causing PJIs are polyclonal, consequences of bacteriophage attachment receptor phenotypic variations and ramifications of bacteriophage activity when bacteria interact with in vivo macromolecules. Only with the realization of the current limitations and subsequent knowledge gained from translational research will the potential of bacteriophages to reduce the morbidity and mortality in PJI be fully elucidated.
噬菌体疗法是治疗人工关节假体周围感染（PJI）的一种有前途的方法，特别是因为这些药物具有内在的降解生物膜基质和裂解细菌的能力。然而，这种治疗方法的许多方面还没有被很好地理解，导致治疗缺乏统一的有效性和重现性，这在一定程度上是由于使用噬菌体治疗 PJI 存在几个固有的局限性。本文讨论了这些局限性，以及需要进行哪些额外的转化研究来推进这种治疗方法。这些研究包括确定引起 PJI 的细菌是否为多克隆的，噬菌体附着受体表型变异的后果，以及当细菌与体内大分子相互作用时噬菌体活性的影响。只有认识到目前的局限性，并从转化研究中获得相应的知识，噬菌体才能充分发挥其降低 PJI 发病率和死亡率的潜力。
