Creating systems to safely scale phage therapy, from Phage Directory to Phage Australia
Jessica C. Sacher 1,2,3*, Jan Zheng 1,2,3, Stephanie Lynch 1,3, Nouri Ben Zakour 1, Ali Khalid 1,3,4,5, Holly Sinclair 1,3, Ruwani Dissanayake 5, Joey Lai 1, Ruby C.Y. Lin 1,3,4, Ameneh Khatami 6,7, Jonathan Iredell 1,3,4
- Westmead Institute for Medical Research, Sydney, Australia
- Phage Directory LLC, Atlanta, Georgia, USA
- Westmead Hospital, Western Sydney Local Health District, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Australian Genome Research Facility, Westmead, NSW, Australia
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Phage Directory was founded to help patients access phages by crowdsourcing them from labs worldwide. Over the past six years, we've helped cultivate a community of labs and researchers who share phages and expertise, leading to hundreds of phages shared on behalf of 50+ patients and their physicians, and resulting in at least four successful patient treatments. The first of these was in Australia, which led us to spend the last two years working with the Phage Australia team to help implement a new phage therapy system from the ground up. Their newly accepted STAMP protocol provided a unique framework to collect phage and bacterial data and combine it with clinical outcome data, where each patient would receive their own set of phages.
In 2022 we moved to Australia and began helping build a system for preparing and tracking safe phage preparations in a way that satisfies local and national regulators. We have realized that while the phage community has spent decades collectively published methods on handling the physical aspects of phage therapy, such as phage isolation, characterization, sequencing, diagnostics, production, purification, and quality control, and has collectively amassed thousands of phages against dozens of pathogens, one challenge that has remained overlooked has been managing the information flow, timing, and communication requirements of the phage therapy process. For even one patient, it can require 150+ hours of work to manage phage screening results and therapeutic batches, track patient treatments and outcomes, and coordinate between labs, clinics, and ethics committees while keeping all stakeholders informed at each step and ensuring accurate capture of information throughout the process.
To address these challenges, we've developed phage information management and exchange tools, such as Phage Atlas, and are now exploring the use of large language models like ChatGPT to rapidly extract insights from unstructured lab data to speed up the process even more. Looking ahead, we aim to build tools that can help any phage lab scale their phage therapy process to more patients safely, without overwhelm and without substantial investment. Our goal is to make phage therapy more accessible and scalable, so that effective infection control can become a reality for more patients in need.