How innovation can stem the threat of antimicrobial resistance

Antibiotics are widely regarded as one of humanity’s greatest inventions. But the rise of bacteria which are developing resistance to antibiotics presents an increasing threat to human life. How worried should we be and what role will innovation play?

A medical marvel

Antimicrobials are a broad class of drugs used to kill or slow the growth of harmful pathogens, microbes that cause disease. Antifungals are used to treat fungal infections, and for bacteria we traditionally use antibiotics. 

In just under a hundred years since 1928, when Alexander Fleming discovered penicillin, antimicrobials have fundamentally transformed modern medicine, allowing us to treat a broad spectrum of bacterial infections. 

Their impact is so large it is hard to quantify, but it is estimated that hundreds of millions of lives have been saved by penicillin alone.

A critical threat

The explosion in antimicrobial use has forced microbes to evolve resistance mechanisms to survive. 

Antimicrobial resistance (AMR) is now one of the most important health challenges of modern medicine: this issue is thought to have contributed to nearly five million deaths globally in 2019 — 1.27 million of them directly. As well as compromising life-saving procedures, from wound treatment to caesarean sections and chemotherapy, the World Bank has estimated that antimicrobial resistance could push over 28 million people into extreme poverty by 2050.

Reflecting the importance of research on AMR, a number of major prizes have been announced in recent years to encourage research in the field, including the Longitude Prize and the Trinity Challenge, founded by UK’s former Chief Medical Officer Dame Sally Davies, who has warned that AMR poses as great a threat to humanity as climate change.

Growing resistance

So how has antimicrobial resistance become so prevalent? The answer lies in part in misuse of antibiotics — for example by prescribing them for viral diseases like colds or flu, where they are ineffective. Using the wrong antibiotic for an infection is another, as well as underdosing or not completing the course. Even disposing of unused or out of date antibiotics improperly puts antibiotics into the environment where bacteria are exposed to them. 

Agriculture also plays a role. Small doses of antibiotics help livestock animals grow bigger, faster and healthier. In some countries, the agricultural industry consumes up to 80% of the antibiotics produced. 

All this exposes the bacteria that live on and around us to antibiotics, often at doses too low to kill them, but enough to drive change. And though most bacteria don’t cause us harm, they can pass on this resistance through various mechanisms to bacteria that do. 

Exposure to antibiotics also kills commensal bacteria that live and thrive on our skin and inside our bodies and benefit us in a myriad of ways. We are only just beginning to understand how the bacteria in our gut are linked to our brain for example. 

The AMR crisis is not confined to bacteria. Resistance in fungi is on the rise too, for many of the same reasons. In 2022, the WHO outlined 19 fungal pathogens that pose a significant threat to human health. Recent research suggests the toll of fungal infections could be higher than previously estimated, killing 3.8 million people worldwide each year.

Antimicrobial innovation

After a long period of declining development and investment, there are now a number of new antibiotics and antifungals in the development pipeline. However, the urgency of the AMR crisis means it is an area desperately in need of innovation. 

In 2019, the UK government published its 20-year vision for antimicrobial resistance, with a clear and ambitious goal of ensuring AMR will be controlled and contained by 2040. Within the latest 5‑year national action plan, the government is committed to investing in innovation towards the development of new approaches to diagnose and treat infections within people, animals, food and the environment. 

AI and machine learning are being used to rapidly identify AMR bugs and potential drug candidates, including a new class of antibiotics. Machine learning is also being used for the development of antimicrobial peptides which hold promise for targeting drug resistant pathogens.

Meanwhile, bacteriophage therapy is undergoing a resurgence in research. Bacteriophages are viruses that infect bacteria, and in doing so, destroy them. We can put this to use, modifying phages to infect and destroy specific deadly infections and drug-resistant bacteria. In practicality however, phage therapy still has challenges to overcome before its widespread use as a treatment.

The microbes on and in our own bodies can also help with keeping antibiotics effective. Making sure we have a healthy gut flora microbiome strengthens our ability to fight off infection and may influence drug efficacy, enhancing our ability to target disease-causing microbes. A healthy diet and tailored microbiome supplements, like whole-cell Live Biotherapeutic Products (LBPs), probiotics and postbiotics, can keep the gut microbiome healthy and restore it when depleted. 

Innovative drugs and therapies like these need state-of-the-art facilities and expertise to bring them to reality. That is where CPI can help. We are fully equipped to help develop, optimise and scale-up therapeutic microbiome products, bacteriophage therapies and antimicrobial modalities such as recombinant proteins and monoclonal antibodies.