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Phage Therapy: Current Research and Applications Edited by Jan Borysowski, Ryszard Międzybrodzki, and Andrzej Górski. Norfolk, UK: Caister Academic Press, 2014. 378 pp. $360.00 (Hardcover or Ebook). Hardcover: ISBN 978-1-908230-40-9 Ebook: ISBN 978-1-908230-74-4
Bacterial antibiotic resistance is one of the foremost public health challenges of our time. Even as efforts to identify novel antibiotics and conserve existing drugs have gained new urgency, so too has the need to investigate less-conventional antibacterial strategies. One such approach is phage therapy, or the use of viruses that infect bacteria (bacteriophages) to kill bacterial pathogens. Phage Therapy: Current Research and Applications presents a timely and comprehensive account of phage therapy's biological and historical underpinnings, empirical support, and biomedical potential.
The book is organized into 16 chapters, each approximately 25 pages long. Many chapters contain tables to display key information, and all are accompanied by an extensive reference list. Although some sections are more accessible than others, the book is well-written throughout and has value for specialists and nonspecialists alike.
Chapter 1 introduces important aspects of phage biology and provides context for the rest of the book. Here, we learn that phages can be organized by lifestyle (lytic or temperate), by morphology (as determined by transmission electron microscopy), by host range (most phages only infect a single species of bacteria), and by genome content and organization.
Chapter 2 addresses a question central to successful phage therapy: How does one select a suitable phage? Although the pool from which to choose is enormous (with an estimated global population of approximately 1031, phages are the planet's most abundant and diverse biological entities), a therapeutic phage must be highly efficient at killing a desired pathogen (but only that pathogen), stable inside and outside the body, and unable to transfer virulence genes between bacteria.
Chapters 3 and 4, which discuss the pharmacology of phage therapy and bacterial resistance to phages, respectively, are unusually lengthy and detailed. However, as the authors assert, both topics are essential for rationally designing and implementing phage therapy, as is understanding how phages interact with the mammalian immune system (chapter 5).
Chapter 6, an excellent general overview of phage therapy, should be particularly useful for interested readers who lack the time to read the entire volume. It also marks the book's transition from basic to applied phage biology. The next 4 chapters summarize decades of research into phages' ability to combat bacterial diseases of plants (chapter 7) and livestock (chapter 8), to control bacterial pathogens on food surfaces (chapter 9), and to treat experimental bacterial infections in animal models (chapter 10). In all of these contexts, phages and phage-based products have been consistently safe and typically very effective. Indeed, 4 different phage preparations have already been approved by regulators to reduce bacterial contamination (eg, by Salmonella and Listeria) during food processing and on consumable foods.
Chapter 11 is a must-read for anyone interested in the relevance of phage therapy for human medicine. Although phage therapy fell out of favor in Western countries following the discovery of antibiotics, it remained widely used in Eastern Europe, and for the past several decades, phages have been employed in Poland and Georgia to treat patients suffering from otherwise intractable drug-resistant infections. The authors of this chapter are some of the world's leading authorities on clinical phage therapy, and their review of its highly successful track record to date (in many cases, therapeutic efficacies of 70%–90%, albeit on a relatively small scale) is one of the highlights of the book.
Despite this promise, regulatory and financial uncertainties represent significant barriers to the large-scale clinical testing of phage therapy, a prerequisite for its wider adoption. Chapter 12 compares and contrasts American and European standards for approving and regulating medicinal products and for defining and protecting intellectual property.
The book's final 4 chapters explore several additional ways phages might be used in medicine. Chapter 13 discusses the use of phages and phage products to combat biofilm-based infections, a particular menace in clinical settings. Chapter 14 reviews the use of phage endolysins, lytic enzymes that cleave bacterial peptidoglycan, as novel “enzybiotics” against gram-positive bacteria. Chapter 15 highlights how genetic engineering can improve traditional phage therapy (eg, by expanding host range), and chapter 16 describes how phage particles can be used to efficiently deliver antibiotics to hard-to-reach sites of infection.
All in all, Phage Therapy: Current Research and Applications is a valuable resource for anyone interested in phages' biology and/or biomedical significance. Although phage therapy has not yet made the leap from niche treatment to mainstream medicine in most of the world, this book presents a compelling case that phage-based medicine is an idea whose time has come.
Potential conflict of interest.Both authors: No reported conflicts.
Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.