Bacteriophages against cirrhosis

Alcoholic cirrhosis was proposed to be treated with viruses from wastewater

Natalia Ivanova, News.ru

Researchers from the California Medical University in San Diego for the first time successfully used live viruses (bacteriophages) in the fight for liver health. Viruses were used against pathological bacteria living in the intestines of people with alcoholic hepatitis. They emerged victorious in the battle against the dangerous enterococcus. Interestingly, all four types of phages used in the experiment are inhabitants of sewer pipes, banal "street" viruses, which do not need special conditions to grow on a pharmaceutical scale. However, from the first scientific research to the introduction of a new technique, there is an abyss, and so far the only way for people with severe alcoholic hepatitis and cirrhosis to survive is liver transplantation. 10-20% of alcoholics with experience need such an operation, but the donor resource is extremely limited.

Bet on bacteriophages

Bacteriophages are viruses that infect bacterial cells; most often they multiply inside bacteria and cause their decay. The use of bacteriophages in therapy is not new. Even during the First World War, the Canadian doctor Felix D'errel successfully practiced treating soldiers from dysentery with the help of these viral organisms. Research on this topic was actively conducted in the USSR in the 30s, but then it was forgotten. There is nothing unusual in the use of phages in bacterial infections: phage therapy has helped many times even in severe cases. The uniqueness of the work of researchers from San Diego is that they found a link between intestinal bacterial toxins and the death of patients with alcoholic liver disease (a non-communicable disease), and also showed in mice that even with severe acute alcoholic hepatitis, it is possible to save the patient by using phages as medicine. This is reported by the journal Science (Eva Frederick, Bacterial toxin linked to severe alcoholic liver disease).

With alcoholic liver disease, both the liver cells themselves and the intestinal microflora are damaged. The number of Enterococcus faecalis bacteria increases dramatically. In a healthy person, there are almost none, whereas in patients – more than 5% of the total mass of the intestinal microbiota. The concentration of these bacteria in the intestines with alcoholic hepatitis was 2,700 times higher than their concentration in people who did not abuse alcohol. But the bacterium itself is not terrible: only some of its strains that secrete the toxin cytolysin are dangerous. It aggravates the course of alcoholic hepatitis and cirrhosis. After analyzing the statistics of morbidity and mortality, scientists came to the conclusion that the presence of a large number of E.faecalis in the intestine indicates a high risk of death. They continued the experiment on mice and got extremely interesting results. It turned out that bacteriophages are targeting dangerous E.faecalis, the amount of toxins at the same time drops sharply, and the number of deaths from alcoholic hepatitis is significantly reduced.

Interestingly, for the study, scientists took four different types of phages directly from wastewater. The mice were treated with phages, the bacteria were destroyed, and alcohol-induced liver disease was eliminated.

Potentially, the use of bacteriophage treatment can save about 37% of patients with alcoholic hepatitis. Further research in this direction will be continued at the specially created Phage Therapy Center (IPATH) at the California Medical University.

Severity of the disease

Up to 75% of patients with severe alcoholic hepatitis, the most complex form of alcoholic liver disease, die within 90 days after diagnosis. This condition is most often treated with corticosteroids, but they are not very effective. Early liver transplantation is, in fact, the only medicine today. However, such operations are performed only for a limited number of patients. In the USA, according to the American Liver Foundation, about 8 thousand liver transplants are performed annually, and the waiting list is about 14 thousand people a year.

The situation in Russia

In Russia, severe alcoholic hepatitis and cirrhosis of the liver are among the three main reasons for transplanting this most important organ. Oleg Reznik, a transplantologist at the St. Petersburg Institute of Emergency Medicine named after Janelidze, Professor, Doctor of Medical Sciences, confirmed this fact. Most often, according to him, the reason for liver transplantation is carcinoma (a severe oncological disease); in second place is cirrhosis of the liver as a result of hepatitis B and C; and in third place is alcoholic cirrhosis. According to the doctor, it is impossible to ignore alcoholics: their lifestyle is not a reason for refusing transplantation. They work with such patients because they need a promise to completely abandon the addiction after the transplant, and then the operation is performed.

According to our expert (Marat Saraev, narcologist, Ministry of Health), cirrhosis of the liver has significantly rejuvenated.
Cirrhosis of the liver is the most common complication of alcoholism. We used to see that cirrhosis occurs at the age of 50-60 years. Now the disease has become younger: cirrhosis can be diagnosed at 40, 30, and 25-28. From 10 to 20% of those who go to a drug treatment clinic are people who either already have cirrhosis of the liver, or show symptoms that are harbingers. Very often, patients with alcoholic hepatitis, including acute, began to meet – prolonged alcohol consumption, even in the absence of other diagnoses, very quickly leads to alcoholic hepatitis.

The specialist stressed: there are no drugs that would restore the health of cells. You can prolong the life of a cirrhosis patient, help a person to remove toxins, but it is impossible to turn a sick liver into a healthy one.

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