The antibiotics that you gulp down to ward off serious infections could well trace their origins to frog skin, alligators? blood, wastewater treatment plants or algae and micro-organisms found in the seabed.
A government-sponsored initiative that involves nine research institutes, is seeking to tackle diseases like cancer, diabetes, inflammation and infectious diseases by developing antibiotics derived from bacteria found in ecological niches? ponds, seabed, water reservoirs and forest reserves. Researchers from the National Environmental Engineering Research Institute (NEERI) at Nagpur are studying bacteria found in wastewater treatment plants. With antibiotic properties, these bacteria hold the promise to help develop medicines for the treatment of infectious diseases, a department of science and technology official informs.
For much of the 20th century, doctors waged war against infectious diseases, including malaria, tuberculosis, and pneumonia with the best weapon they had?antibiotics. Over the years, use of these drugs not only kept serious infectious diseases under control, saved lives and eased the suffering of millions of people, they also contributed to the major gains in life expectancy witnessed globally.
Unfortunately, these gains are now seriously jeopardised by an alarming development?antibiotic resistance. That is, the emergence and spread of microbes?the collective term for bacteria, fungi, parasites, and viruses?that are resistant to antibiotics like penicillin, streptomycin, gentamicin, ampicillin, amoxicillin and more than 150 others, that have been developed to combat the spread and severity of many of these diseases.
For a layman, it means that a lot of people get sick because they have resistant bacteria and the antibiotics that they are given either don?t work or don?t work well enough to get rid of the infection.
Interestingly, the bacterial infections which contribute most to human disease are also those in which emerging and antibiotic resistance is most evident: diarrhoeal diseases, respiratory tract infections, meningitis, sexually transmitted infections, and hospital-acquired infections. The development of resistance to drugs commonly used to treat malaria is of particular concern, as is the emerging resistance to anti-HIV drugs.
There is no doubt that action in the $25-billion global antibiotics market is set to hot up and efforts to develop next generation antibiotics will intensify in the times to come. In the recent past, several pharmaceutical companies had drifted from developing antibiotics primarily due to the low revenues and the stringent FDA regulations. However, the trend is now changing with the compelling need to address antibiotic resistance.
A pertinent question arises. Use of antibiotics began less than a century ago. Why have bacteria adapted so quickly?
There are a number of factors. The first is that, people who are prescribed antibiotics take just part of their medicine, feel better, and then discontinue to pop the pills. The most resistant bacteria return in full force. Then, even taking antibiotics properly can cause the benign bacteria in a person?s stomach to become resistant. If these harmless but antibiotic resistant bacteria interact with disease causing bacteria, the antibiotic resistance can easily spread to the dangerous bacteria. The threat of antibiotic resistance cannot be easily dismissed as insignificant and rudimentary. World Health Organisation (WHO) predicts that diseases like malaria, tuberculosis and pneumonia could have no effective therapies within the next 10 years. According to the Centres for Disease Control and Prevention, USA, 90,000 Americans succumb to hospital-acquired bacterial infections every year due to resistance to antibiotics. There are growing instances of patients dying in various European countries too, due to drug resistance. Unfortunately in India, the record-keeping methods that hospitals use, tends to mask this growing menace. Though there is no doubt that the damage done by antibiotic-resistant bacteria is much higher here.
?The threat of antibiotic resistance is more severe in India,? informs Anand Bidarkar, vice-president (business development), SIRO Clinpharm. ?With HIV and tuberculosis cases on the rise, it will be a double whammy for India,? he adds.
Says Venkat Jasti, chairman, Suven Life Sciences, ?Though there is a need to develop next generation antibiotics with the existing ones getting resistance, Indian companies are yet to focus on them.?
Currently, Indian companies are meeting some of the unmet medical needs of the masses in the areas of diabetes, oncology and cardiovascular diseases.
According to Dr Reddy?s Laboratories (DRL), respiratory infections are on the rise as the rate of in-patient care is picking up. With the threat of antibiotic resistance assuming alarming proportions, drug companies are increasingly researching for antibiotics in unconventional places.
Italian scientists have successfully isolated antimicrobial agents from frog skin and tested them on strains of multidrug-resistant bacteria that are a growing cause of infections in hospitals. Not only did these agents kill the bacteria directly, they also gave a boost to the host immune system to help clear infections more quickly, informs a Pfizer official.
Scientists have studied alligator?s ability to fight infections as they commonly suffer from deep bite injuries, which should get infected as they live in marshes. But unbelievingly, they combat these injuries very promptly. Recent laboratory tests show that tiny amounts of alligator blood extract known as alligacin, kill many microbes, including Methicillin-resistant Staphylococcus aureus (MRSA), a dangerous antibiotic resistant strain, and help fight HIV.
Researchers in the US have engineered versions of short proteins called antimicrobial peptides to make them more resilient. When the researchers added these agents called peptoids to cultures of bacteria known to cause food poisoning, pneumonia, ear and heart infections, the peptoids destroyed them.
Promising research efforts indicate that synthetic peptides are an attractive complement to the existing arsenal of antibiotics and hold forth immense potential in combating diseases, says Sharon Mathews, research analyst, healthcare, Frost & Sullivan.
If bacteria evolve to become drug-resistant, why not subject them to bacteria-fighting microbes, called phages that evolve along with them? Phage therapy is widely used in Eastern Europe and scientists in the US too are looking at them to solve the problem of antibiotic resistance. When ingested, phages cure infections but leave the rest of the body unaffected.
The message is loud and clear: natural diversity appears to be a novel source for new drugs worldwide. A paradigm shift in infectious disease research has been initiated. ?Primarily, the whole concept of antibiotics originated with bacterial infections and the 1970s, 1980s, and early 1990s saw a boom in the research and development of antibiotics targeting several bacteria. The disturbing rise in serious diseases and infections is currently driving the pharmaceutical and biotechnology companies to focus on new leads to stay ahead of disease causing microbes capable of developing resistance,? informs Mathews.
Recently, the department of biotechnology (DBT) under the ministry of science and technology has initiated a project to tap the global antibiotics market. This public-private-partnership project involves nine institutes, with Nicholas Piramal Research & Development Ltd (NRDL) as an industrial partner.
It envisages a mega-scale screening programme for various environmental isolates and is the first project in the country in which industry and the academia will work together to screen such a large number of bacterial isolates.
Different academic institutes will isolate organisms specific to diverse ecological niches. For each sample, isolation of bacteria will be carried out on 30 different growth media.
According to DBT officials, this multi-institutional effort will generate approximately 7,000 isolates per month, which will be regularly sent to NRDL. A separate microbial repository is being set up at National Centre for Cell Science (NCCS), Pune to maintain the 2,00,000 isolates generated under this project?the largest such facility in the country. Screening will be carried out for anti-cancer, anti-infective, anti-diabetes and anti-inflammation properties. Expectations are that a bank of novel leads with specific potential will soon be developed. This will aid in the long-drawn process of drug discovery.
In the past, medicine and science were able to control deadly diseases and infections through the discovery of potent new classes of antibiotics. And just as we were basking in our misplaced confidence that infectious diseases had been conquered, the threat of antibiotic resistance has raised its ugly head. It seems the war to control dangerous diseases like tuberculosis, HIV and other killer infections is far from over.