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Markin Abras spoke with Mariam Dadiani, Assistant Physician at the Eliava Phage Institute, to gain unique insight into phage therapy. Markin Abras: Where do phages originally come from? Mariam Dadiani: Phages are naturally produced viruses that are found everywhere in nature and in the human body, they are simply designed to attack certain strains of bacteria. MA: As far as I know, Eliava Phage Therapy Center’s main customers are from Europe, but what about the U.S. market? How has it changed over time? MD: We have always had patients from the United States, but the European clients outnumber the Americans because the main problem is distance. Americans have to take a long flight and stay here for 2 weeks. MA: What are the main reasons patients come to Eliava Phage Therapy Center? MD: Antibiotic-resistant infections continue to be the main cause of referrals, where antibiotic therapy has proven unsuccessful and often impossible. In addition, patients with intolerances and/or allergies to antibiotics also come for treatment with bacteriophages. We have also encountered a number of cases in which, despite susceptibility to antibiotics, antibacterial treatment has been ineffective, presumably due to the possible presence of a biofilm layer characteristic of chronic infections that is known to be difficult for antibiotics to penetrate. The most common diagnoses we deal with are urinary tract infections, lung infections, intestinal dysbiosis, chronic non-healing wounds, etc. MA: In the United States, there is very little information and virtually no licensed medical facilities offering phage therapy and services. Why is that? MD: Because phages are not FDA-approved and there are no international guidelines/protocols, the U.S. has always been skeptical because they view the treatment as “non-traditional medicine.” Funnily enough, phages were first discovered and widely used before antibiotics - even in the United States. Recently, phage therapy has become more important worldwide as antibiotic resistance becomes a major burden on the healthcare system. Eliava Phage Institute provides a treatment to combat multidrug-resistant superbugs, which pose a serious threat and have a high mortality rate. MA: Is it true that some types of phage do not work as well in treating bacterial infections? MD: That depends entirely on the type of phage used. Our phages are sterile filtrates of phage lysates. We have not often seen a strong immune response to phages. Our treatment plan consists of pauses where antibody levels drop. MA: Some phages can cause bacteria to become resistant. What would you tell patients who are concerned about this? MD: The risk of phage resistance is not as great as that of antibiotic resistance, to which there are no longer any alternatives. Our phage collection at the Eliava Institute includes thousands of phages, and we can prepare a customized, individual phage treatment from scratch, tailored exclusively to the patient’s specific strain of bacteria.