Abstract

Phage therapy is the use of bacteriophages as antimicrobial agents for the control of pathogenic and other problem bacteria. It has previously been argued that successful application of phage therapy requires a good understanding of the non-linear kinetics of phage–bacteria interactions. Here we combine experimental and modelling approaches to make a detailed examination of such kinetics for the important food-borne pathogen Campylobacter jejuni and a suitable virulent phage in an in vitro system. Phage-insensitive populations of C. jejuni arise readily, and as far as we are aware this is the first phage therapy study to test, against in vitro data, models for phage–bacteria interactions incorporating phage-insensitive or resistant bacteria. We find that even an apparently simplistic model fits the data surprisingly well, and we confirm that the so-called inundation and proliferation thresholds are likely to be of considerable practical importance to phage therapy. We fit the model to time series data in order to estimate thresholds and rate constants directly. A comparison of the fit for each culture reveals density-dependent features of phage infectivity that are worthy of further investigation. Our results illustrate how insight from empirical studies can be greatly enhanced by the use of kinetic models: such combined studies of in vitro systems are likely to be an essential precursor to building a meaningful picture of the kinetic properties of in vivo phage therapy.

Highlights

  • The problem of antibiotic resistance has rapidly increased in recent years

  • It has been predicted that certain threshold phenomena, not normally encountered in the pharmacokinetics and pharmacodynamics (PK/PD) of antibiotic therapies, are of central importance in practical phage therapy [9,10,11]

  • The pharmacokinetics and pharmacodynamics are fundamentally interrelated because phages spread throughout bacterial populations much like epidemics spreading through macro-biological populations: infecting susceptible bacterial cells, reproducing and subsequently infecting other susceptible cells

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Summary

Introduction

The problem of antibiotic resistance has rapidly increased in recent years. Diseases that had previously been well-controlled are again becoming serious threats to animal and public health in a variety of contexts [1,2,3]. The recognition of antibiotic resistance as a major health problem has led to renewed interest in alternative antimicrobial therapies, including bacteriophage therapy [4,5,6]. (Phage therapy has steered clear of using temperate phages due to their potential for carrying toxin or antibiotic-resistance genes.) Despite these advantages, development and adoption of phage therapy has been slow. It is important to develop a suitable theoretical framework for understanding the non-linear kinetic properties of phages as ‘‘self-replicating pharmaceuticals’’ [9]. To this end, we test a PK/ PD model of phage–bacteria interactions against in vitro experimental data for a low passage strain of Campylobacter jejuni together with a virulent phage active against this strain

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