The long and sinuous road to phage-based therapy of Clostridioides difficile infections

Frontiers in Medicine

Medicine

Andrew A. Umansky¹  Louis Charles Fortier² 

[1] Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada;null;

关键词: Clostridioides (Clostridium) difficile;    bacteriophage (phage);    phage therapy;    endolysin;    diffocin;    avidocin;    phage engineering;   

DOI  :  10.3389/fmed.2023.1259427

 received in 2023-07-15, accepted in 2023-08-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

With the antibiotic crisis and the rise in antimicrobial resistance worldwide, new therapeutic alternatives are urgently needed. Phage therapy represents one of the most promising alternatives but for some pathogens, such as Clostridioides difficile, important challenges are being faced. The perspective of phage therapy to treat C. difficile infections is complicated by the fact that no strictly lytic phages have been identified so far, and current temperate phages generally have a narrow host range. C. difficile also harbors multiple antiphage mechanisms, and the bacterial genome is often a host of one or multiple prophages that can interfere with lytic phage infection. Nevertheless, due to recent advances in phage host receptor recognition and improvements in genetic tools to manipulate phage genomes, it is now conceivable to genetically engineer C. difficile phages to make them suitable for phage therapy. Other phage-based alternatives such as phage endolysins and phage tail-like bacteriocins (avidocins) are also being investigated but these approaches also have their own limitations and challenges. Last but not least, C. difficile produces spores that are resistant to phage attacks and all current antibiotics, and this complicates therapeutic interventions. This mini-review gives a brief historical overview of phage work that has been carried out in C. difficile, presents recent advances in the field, and addresses the most important challenges that are being faced, with potential solutions.

【 授权许可】

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Copyright © 2023 Umansky and Fortier.