Wednesday 6 February 2019

St Feadhbar delivers the cure

Maybe you wouldn't have an enormous expectation of good coming out of the limestone karst country of West Fermanagh. But the patron of the village of Boho, St Feadhbar, has been looking down with compassion on people who go to hospital expecting a cure but leave by the service entrance in a coffin. Nosocomial infections waste far too many people in Ireland and elsewhere. It is the consequence of flaithulach doling out of antibiotics over my lifetime and the accumulation in hospitals of antibiotic resistant strains of a variety of microbial species. Somehow we haven't made enough progress to curtail transmission of pathogens since early adopter of hand-washing Semmelweis was beaten to death in 1865. Did someone mention hand-washing? That's certainly a Blobby thing. If you haven't heard of MRSA, then you really haven't been doing your homework; but you may be excused for not recognising CRE as another nightmare superbug.

But there are more of these hospital-acquired infectious microbes and some bright spark has gathered the the most costly of them together as a memorable acronym ESKAPE: Enterococcus faecium, Staphylococcus aureus as in MRSA, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. that's CRE. Some strains of all these species are resistant to many of the antibiotics of last resort. Go to hospital with catastrophic burns and you may well acquire a Pseudomonas aeruginosa infection. Pray that you don't; because nothing will kill it short of caustic soda or a blow-torch, neither of which is readily available in the Burns Unit.

What to do? Well, we could send out scouts to round up some new antibiotics. It is unlikely that we have plumbed the well of microbial molecules which kill other microbes: heck we only have the sketchiest idea of how many different species there are in any environment, let alone have an accurate inventory of all their biochemical capabilities. Maybe it's as easy as digging up a spoonful of soil and testing its killing-power against a range of bacteria but undirected leaps in the dark are unlikely to receive funding from any grant-giving agency. The discoverers of Eleftheria terrae tilted the process by using an iChip to test unknown bacteria in their native environment. A consortium from Zagreb, Coleraine and Swansea did a literature search to find a most unlikely tale of the curative powers of the soils near St Feadhbar's Well in Co Fermanagh. With an extraordinary level of optimism, some of them went off to Boho with a [sterile] spoon and brought some dirt back to the lab and isolated a strain of Streptomyces; which they proceeded to test against the usual suspects. It slowed the growth of ESKAPE (Enterococcus, MRSAAcinetobacter) and is presumably marked for pre-clinical trials to check whether it will kill those microbes in living mice as well as on Petri dishes in a Croatian laboratory. Clinical trials will also test whether the new therapy doesn't itself kill the lab mice.  The venture may come to nothing in terms of a marketable product [many a slip between cup idea and lip dollars] but it's surely better than sitting on our hands moaning about antibiotic resistance. In particular moaning about how Big Pharma isn't devoting enough resources to these scouting expeditions because they have doubtful impact on the financial bottom line. Crowd-funding these low probability first-finder events? Make a kit and a protocol to test random soil against ESKAPE strains and distribute that to all final year microbiology students in colleges round Fermanagh Europe. You first saw that here.

Note to self: follow up the genome of the Boho Streptomyces for its alkaline tolerance genes. I'm running a bioinformatic workshop at Environ 2019 to show tree-huggers and bee-counters how to hunt through genomes looking for particular biochemical skills: here alkaline shock genes but also phosphate solubilisation genes; heavy-metal tolerance genes; and, of course, antibiotic resistance genes.

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