Antimicrobial resistance (AMR) is one of the biggest threats facing the world but arguably not enough is being done by both pharma companies and governments around the world.
antibiotics
Last year, biopharmaceutical company Helperby announced a collaboration with the University of California to develop the next generation of combination antibiotics.
Here, Reece Armstrong speaks to founder and chief scientific officer of Helperby, professor Anthony Coates, on how the recent collaboration can help combat antimicrobial resistance.
RA: Could you tell me about Helperby’s recent collaboration with UCLA?
AC: Helperby are collaborating with Dr Pamela Yeh and the UCLA. We are concentrating on the use of antibiotics in combinations to target antimicrobial resistant bacteria which are rapidly threatening the efficacy of existing antibiotic therapies. I believe that Dr Yeh’s research on the phenomenon of emergent synergy of combining two or more existing antibiotics and their efficacy against pathogenic Escherichia coli1(E-coli) is an important breakthrough to combat antimicrobial resistance. We will work closely to explore the commercial opportunity of additional, new, combination therapies. The collaboration will include the sharing of data, expertise and research methodology. The work is based on the observation that major disease areas like tuberculosis, AIDS & cancer benefitted from combination therapies but that antibiotics continued to be single molecule therapies.
RA: What do you hope to achieve from the collaboration with UCLA?
AC: Ultimately for there to be more existing data which supports the benefits of combination antibiotics. We want to help other companies to make their antibiotics more effective against resistant bacteria. The ‘one drug, one target’ model has limited viability and there is evidence that combination therapy is the norm in the treatment of many cancers, viral infections such as HIV and tuberculosis treatment. It is a viable alternative to the development of totally new antibiotics that take at least 30 years or more to develop. For there to be more investment in these combined strategies will keep mankind ahead of antimicrobial resistance and is crucial in order to preserve a world where simple infections do not routinely kill healthy people. Finally, I see potential in this being the first long-term renewable solution to the antibiotic crisis
RA: Why is Dr Yeh’s research so important?
AC: Antimicrobial resistance is recognised by the World Health Organisation as most pressing global threats to health. It was previously held that the risks of combining antibiotic drugs often outweighed the benefit because of adverse interactions. But Dr Yeh’s team found the direct opposite, and reported that as more drugs were combined, an elevated frequency of synergy was observed. This is a breakthrough and could be the information we need for a potentially long-term renewable solution to the antibiotic crisis. Without effective antibiotics, much of the success of modern medicine, such as the levels of unprecedented survival rates from major surgery or super effective, chemotherapy treatment, would be totally compromised.
RA: Do you think enough is being done by governments to tackle AMR?
AC: No, I don’t think so. Of the 10 recommendations in Jim O’Neill’s AMR Report (2016)for the UK GOVT, only a minority are progressing fast enough to have a major impact. Jim O’Neill pointed out this lack of progress in 2018 and thinks that his predictions of 10 million deaths per year in 2050 due to AMR may be on the low side if more is not done faster than at present. This is something that I definitely agree with.
RA: Why do you think so many big pharma companies have left the AMR space for developing new therapies?
AC: Most companies favour a focus on more incremental increases in innovation in chronic disease areas, over the more unpredictable leaps needed to keep up with the development of bacterial mutation. The high risk of creating a new chemical entity deters large pharmaceutical operations. This leaves the fight for antibiotic survival, arguably one of the most urgent fields of drug development, to smaller, more nimble biopharmaceutical companies. Due to these reasons there is a lack of investment for wide spread development of combination therapies. Hopefully the fact that research is very much alive in the benefits of combining existing antibiotics to create new super resistant combination therapies means that there will be more financial support.
RA: Do you agree with the sentiment that the UK is a potential global leader for fighting AMR?
AC: Yes, most definitely. Until 2016, the UK was a world AMR leader. Recently, the country has not maintained this momentum, but has the potential to regain its position as a global AMR leader in the future.
RA: What can the general public do to help and has there been enough awareness raised over AMR?
AC: AMR in common bacteria needs new antibiotics or new antibiotic combinations to save patients’ lives. They need to be well tolerable, safe and if possible, prevent the emergence of resistance. Of course, other strategies also play their part: Irrational use of medicines is a serious global problem, good infection control, publicity about AMR, more effective vaccines, less use of antibiotics in agriculture, fast diagnostic testing, more professionals working in the AMR field, more investment for clinical trials and a much higher unit price. Establishment of national committee to monitor impact of antibiotic resistance and provide intersectoral co-ordination is required. Joint efforts from patients, prescribers and individuals to international regulators and policy makers are needed to fight against the globally spreading antimicrobial resistance. Investing in these combined strategies will keep mankind ahead of antimicrobial resistance and is crucial in order to preserve a world where simple infections do not routinely kill healthy people.
RA: Do you think universities, SMEs and biopharma groups like Helperby are having to take on the brunt of the work surrounding AMR?
AC: Yes. Big pharmaceutical companies have moved out of the field. For example, Novartis moved away in 2018. This leaves universities, SMEs and biopharma companies such as Helperby Therapeutics and other companies to bear the brunt of the work to, for example bring new antibiotics, new antibiotic combinations and new diagnostic tests to the market.