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<h2><font size="5">Read the interview with Pr. Olivier Epaulard</font></h2> | <h2><font size="5">Read the interview with Pr. Olivier Epaulard</font></h2> | ||
<p><b><i>Did you know about iGEM before I told you about it?</i></b></p> | <p><b><i>Did you know about iGEM before I told you about it?</i></b></p> | ||
+ | <p>No.</p> | ||
+ | |||
+ | <p><b><i>Do you often encounter antibiotic resistant bacteria in your department ?</i></b></p> | ||
+ | <p>Daily. Every day, all the time. They are the result of antibiotics misuse (about 90% of the cases). He estimates that half of antibiotic treatments are wrongly prescribed. According to a study, half of the doctors antibiotic prescriptions are useless. Antibiotic resistant bacteria are enterobacteria in majority. The resistances are due to penicillinase (and other beta-lactamase / enzymes). The number of infections with resistance keeps increasing.<br> | ||
+ | Although rare, there are cases of infection for which no treatment is possible (no antibiotic is able to kill the bacteria which resistant to everything). Some countries like India, Greece, Turkey and some african countries are at a critical stage. They are not anymore trying to manage the use of antibiotics but they are looking for methods to treat patients infected by bacteria resistant to nearly all the antibiotics.<br> | ||
+ | Resistances appear on strains that were sensible to everything in the past. Antibiotics come from mushrooms (penicillium, ...). They are very old molecules, and that explains why bacteria can have facilities to become resistant. | ||
+ | To reverse the process of antibiotics abusive utilisation is very complicated and hard to impulse (in particular concerning the education of the population and of practitioners). | ||
+ | → Analogy with the global warming: The majority knows but it requires strong behaviour changes not realized. Is it too late ? Resistance of Gram bacilli - like <i>Pseudomonas</i> - increases.<br> | ||
+ | Nowadays, more and more people are immunosuppressed (But they would be dead before without treatment. Often, the immunosuppression comes from a heavy treatment) or go through treatments exposing them to bacteria for a long or excessive duration. For example immunosuppression for grafts or surgeries are more and more risky since they are open doors to infections. On another hand, exposition to bacteria is more and more common because of the treatments lengthening. | ||
+ | </p> | ||
+ | |||
+ | <p><b><i>Do cases of Pseudomonas aeruginosa infections represent a large percentage of infections?</i></b></p> | ||
+ | <p>Concerning common infections, we meet rarely Pseudomonas aeruginosa in general but it is present in the hospital infections in the operating rooms for patients that have a catheter in a vein, a contact with material, or a urinary infection.</p> | ||
+ | |||
+ | <p><b><i>Do you know Phage Therapy ? If so, what do you think ?</i></b></p> | ||
+ | <p>Yes. He can not have a precise idea. On paper, he is enthousiast to this idea. Moreover phages seem to be easy to produce. While antibiotics can lead to intestinal flora diseases during their ingestion, phages can avoid that. In the case of chronic infections on prosthesis, to change the material is the only way to cure the infection… The phage therapy could also be a way to clean the medical material. <br> | ||
+ | But he feels like it has been 15 years that he is hearing about phages and that nothing happens. He thinks that there are maybe other problems in the utilization of phages than<br> just the patent problematic, finally a not so important matter according to him. | ||
+ | Indeed, in France modified viruses have been patented, a modified bacterium could be patented, so patenting a living organism is possible,... Hence, why not the phages ? One advantage of the phage is their permanent efficacy on the bacteria. Indeed antibiotics are effective only on growing bacteria. However it is the case for infections such as pneumonia and urinary infections but not long ones like bones infection for which the phage utilization would be very interesting. <br> | ||
+ | Russia and Georgia tell that they produce phages in GMP (good manufacturing practice) but with which purity ? Which vivacity ?<br> | ||
+ | Interesting book: “La Phagothérapie - Des virus pour combattre les infections “ Alain Dublanchet | ||
+ | </p> | ||
+ | |||
+ | <p><b><i>Is it possible to manipulate phages in your service (ours + in general), are there specific safety rules?</i></b></p> | ||
+ | <p>Yes !! No particular problem.</p> | ||
+ | |||
+ | <p><b><i>Is it possible to handle modified E.Coli in your department (problem of horizontal gene transfer)?</i></b></p> | ||
+ | <p>Not any problem, everybody manipulate bacteria with plasmid containing resistance/selection genes. The evacuation system is ok and allow to avoid any crossing and to spread bacteria in the environment. | ||
+ | </p> | ||
+ | <br> | ||
+ | |||
+ | <p><b><i>What are the diagnostic tools available in your service to detect pathogenic bacteria (and for Pseudomonas especially) ? How much time is needed to provide a diagnostic ? With which reliability (specificity and sensibility) ? What is the prices of those devices (price of the machine and price of diagnostic per patient) ? According to you, what are the qualities of a good diagnostic device adapted to the hospitals ?</i></b></p> | ||
+ | <p>The tools available in my service are multiplex PCR (not very efficient), targeted PCR, 16S amplified PCR + sequencing (not the most efficient). Else, the most used is the Gram coloration and then the culture. A response can be given in 24h/48h (or longer: 5 days for some bacteria and 3 weeks for mycobacteria).<br> | ||
+ | There are also cultures identified by MALDI TOF (2h of preparation on ion exchanging resin + growing time of the bacteria). Specificity is excellent and the sensitivity is good. There is also the possibility of identification by biochemical method (enzyme, (quite rare nowadays). | ||
+ | </p> | ||
+ | |||
+ | |||
+ | <p><b><i>If not mentioned previously: Do you have an antibiogram? How long does it take to make a diagnosis?</i></b></p> | ||
+ | <p>We use mainly phenotypic antimicrobial susceptibility tests (not genetic in general, more for virology) which need about 48h to 72h.<br> | ||
+ | Else by PCR (Staphylococcus aureus by PCR → Research of methicillin resistance).<br> | ||
+ | Nothing replace a antimicrobial susceptibility test for now, result in 48h - 72h (including the culture time). | ||
+ | </p> | ||
+ | <br> | ||
+ | |||
+ | <p><b><i>System overview. Do you think at first sight that it meets the security criteria of the service? Other remarks?</i></b></p> | ||
+ | <p>“Are you doing bacterial culture after the transformation or not ?” - “Nope”<br> | ||
+ | Giving a result in less than 10h is interesting, it is less than a bacterial culture so the delay is performant. But the detection PCR need only 2h to give a result… We have to be careful to only extract the bacterial DNA. He thinks the project is interesting. He is not passionate by the identification side but by the therapy side. | ||
+ | </p> | ||
+ | |||
+ | <p><b><i>How are biological waste managed in your service? Is the waste management of our kit manageable in your service? In the hospital?</i></b></p> | ||
+ | <p>They already manage more dangerous waste in the waste treatment process. All the waste is incinerated. Our waste represent nothing problematic for the service.<br> | ||
+ | Example : The universitary hospital center is equipped to manage all the waste from all the infectious and assimilated curing activities. The management of our waste therefore represent no problem for a hospital. | ||
+ | </p><br> | ||
+ | |||
+ | <p><b><i>Did you have any bioethics training during your studies or after your studies?</i></b></p> | ||
+ | <p>A bit but not much. That is more about practice during the job exercise : interactions with bioethical institutions, ethical seminars in medicine with people having ethical formations way more thorough. And of course there is the knowledge of bioethical laws.<br> | ||
+ | He thinks there is not the time to do more during the medicine study program. Anyway doctors do ethics every day (tell or not a disturbing truth, to who let the access to this patient record…). Also in research, every day there are ethics, in the realization of experiences, surveys... | ||
+ | </p><br> | ||
+ | |||
+ | <p><b><i>If no, do you think that bioethics training is missing in your learning?</i></b></p> | ||
+ | <p>No. In reality they do bioethics all the time. Consents, palliative care, accompanying someone's death, bioethical laws: they face ethics every day. The training is clearly not empty on the subject, whether in class or in practice. | ||
+ | </p><br> | ||
+ | |||
</div> | </div> | ||
</div> | </div> |
Revision as of 14:28, 16 October 2018
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ACTORS AND PARTNERSHIPS
It’s impossible to use bacteriophages and to develop a detection device if we don’t know what are the needs and the constraints in hospitals and in medical analysis laboratory. So we need to discuss our project with physicians, specialists and even with the whole population. We also developed partnerships with local research laboratories and companies, to borrow equipment, recover bacteria and bacteriophages, and, most important, ask them for advice.
We discussed with a lot of people to develop our project, to better understand what is useful to implement, create and integrate into our project from their remarks.
GROUND FLOOR: We established partnerships with local companies like Biomérieux and local laboratories like TIMC in order to benefit from their advice/expertise and we had the opportunity to get some of their biological material. Our engineers and researcher partners gave us a lot of recommendations all along the summer and helped us to get an external point of view on our project.
FIRST FLOOR: We visited a medical analysis laboratory and we met the laboratory manager. We discussed with him about the detection system used in his laboratory and about the advantages and limits of our system, if it was used in this kind of laboratory.
SECOND FLOOR: We met with doctors and patients who talked with us about bacteriophages and antibiotic resistance. We discussed with them to know if our detection system could be used in hospitals and what modification we should make in order to improve it. You can have a look at them on the third floor (see our schematic below).
THIRD FLOOR: All the societies must be implicated in our project. But it is essential for us to be aware of what people know about phage therapy and antimicrobial resistance. It’s important to evaluate people's knowledge and then produce an appropriate outreach.
CLICK ON THE PEOPLE YOU WANT TO HEAR FROM ! Everybody has something interesting to share with you.
Learn how partnerships had influenced our project !
INTERVIEW WITH PIERRE-ALAIN FALCONNET
Medical Analysis Laboratory Manager
ORIADE NOVIALE
38240 MEYLAN
Medical Analysis Laboratory Manager
ORIADE NOVIALE
38240 MEYLAN
![](https://static.igem.org/mediawiki/2018/e/e8/T--Grenoble-Alpes--falcact.jpg)
We presented our system to Pierre Alain Falconnet to see if it could work in the context of a medical analysis laboratory. The system seems totally adapted to the laboratory use. According to him, the operating principles are good. It is still necessary to make specificity and sensitivity tests and to know the processing time of a sample.
The most important is to have an accreditation (COFRAC, CEIVD) because without this, the analysis laboratories will probably not want to have the system.
If the use of phages is regulated by a standard P2 and not P3 or P4, he could even use the machine in his own laboratory.
He offered to help us by giving us test samples.
INTERVIEW WITH PR. MAX MAURIN
![](https://static.igem.org/mediawiki/2018/b/b8/T--Grenoble-Alpes--actors%26partMAxMaurin.jpeg)
Dr. Max Maurin notes that in the last few years, he had to face new therapeutic dead-ends caused by the antibiotic resistance that did not exist before. The issue of antibiotic resistance is, in fact, a major issue that we should urgently address. Pseudomonas is a pathogen that he encounters quite often in his department. It is not too virulent but it has numerous resistance mechanisms. According to Dr. Maurin, phage therapy is a very interesting alternative even if it arises some ethical unsolved issues and can also cause a resistance of the bacteria toward phages. The use of bacteriophages in a medical establishment seems feasible because a few years ago, viruses were already used in the biological laboratory of hospitals.
Overall, Dr. Maurin thinks that our system is very interesting and answers well the given problem. However, some biological risks have to be taken into account such as the dissemination of the system components. If these aspects are well evaluated and handled, the system is very promising. Yet, Dr. Morin thinks that it will be very difficult to play on the sensitivity and the specificity of our system to compete with today’s methods in molecular biology. Among all the different specificities of our system, it is mostly the bacteriophages selection that caught his attention the most.
At last, Dr. Morin thinks that physicians do not have enough ethical formations and are not aware enough of new bioethical laws.
INTERVIEW WITH PR. OLIVIER EPAULARD
![](https://static.igem.org/mediawiki/2018/e/e9/T--Grenoble-Alpes--actors%26partOlivierEpaulard.jpeg)
Each day, Pr. Olivier Epaulard is confronted with patients suffering from diseases caused by resistant bacteria. According to him, a misuse of antibiotics is the cause of 90% of the resistances and one antibiotic treatment out of two is wrongly prescribed. The number of antibiotic resistances does not cease to grow, like the number of immunosuppressed patients. Therefore, antibiotic resistance is a major issue of our century. Pseudomonas is also a pathogen that he encounters quite often in his department. Pr. Epaulard cannot make up his mind on the subject of phage therapy because he does not understand why it is not more developed. The positive aspect of this alternative is that bacteriophages destroy all bacteria - even the inactive ones -, something that antibiotics cannot do. According to him, the use of bacteriophages inside his department would not cause any issue.
Pr. Epaulard thinks that the project is very interesting. He is not overly passionate about the identification aspect but rather by the therapy aspect of the project. The diagnostic tools he uses have already very good specificity and sensitivity. It is going to be hard to compete with them. He verified many aspects of the biology in the system and was pleased with our answers.
Pr. Epaulard thinks that one can learn about bioethics through practice. Therefore, there is no need for more theoretical courses on ethics in a physician formation.
INTERVIEW WITH H.G, PATIENT TREATED WITH PHAGE THERAPY
![](https://static.igem.org/mediawiki/2018/8/8c/T--Grenoble-Alpes--actors%26partHG.png)
After getting infected feet wounds, H.G was treated with antibiotics but the infection was not cured. No antibiotic worked and the infection spread. The only way to treat this patient was to amputate the two legs. H.G had heard about phage therapy and contacted a doctor specialized on the subject. He chose to try phage therapy to cure his wounds. Bacteriophages were applied for a year on the wounds and he is now almost cured.
On the pictures, you can see the state of his left foot before and after the phage therapy.