The discovery of the most powerful agents in the fight against various bacteria – antibiotics – changed the medicine of the twentieth century. At the same time, recently more and more information is spread in the world about resistant bacteria that cannot be properly treated with antibiotics. Problems with overuse and uncontrolled use of antibiotics are often discussed. In this situation, the world community has recently attracted the attention of a treatment that uses bacteriophages – natural viruses that “eat” bacteria.

Before spread of antibiotics, bacteriophages were considered as a reliable and effective treatment for bacterial infections. For example, during one of the most important battles of Stalingrad, in the course of the World War II, the epidemic of cholera became widespread; The Soviet army was giving bacteriophage drugs to its soldiers and local population and thus managed to stop the spread of the epidemic. There is an opinion that this fact played a crucial role in the victory of the Soviet Army during this battle.

A bacteriophage is a virus, which means “bacterium eater” in Greek. The word “virus” may scare some readers, but bacteriophages are only bacterial viruses; they live in all environments: they live in water as well as in the human digestive system.The size of a bacteriophage ranges from a few tens to several hundred nanometers. They detect the relevant bacteria and infect them: phage injects its DNA into the host cell and consequently, new phage particles begin to form. After that, certain phage proteins kill the bacteria and new, large numbers of phages emerge from the disrupted cells. These new bacteriophages, in turn, find the following targets, or new bacteria. This activity of bacteriophages plays an important role in regulating the number and types of bacteria in the environment.

A certain mecca for the treatment of bacterial infections by use of bacteriophages is G. Eliava Institute of Bacteriophages, Microbiology and Virology, located in Tbilisi, the capital of Georgia. The history of this institute is long and glorious. In short, it is also called the Eliava Institute.

It was founded in Tbilisi in 1923 by a Georgian physician, George Eliava, with the support of the French researcher Felix d’Herelle, who pioneered the discovery and study of bacteriophages. The institute became the center of research, development and production of bacteriophages in the USSR. Since Georgia gained independence, the Institute has become an institution of independent Georgia and is still an active scientific and research center.

We addressed questions about the study of bacteriophages to the director of the institute, Doctor of Biological Sciences Mzia Kutateladze. According to her, there are currently about 60 researchers at the institute. The institute is a scientific-research organization, but Eliava Phage therapy Center, where up to 20 doctors participate in practical treatment, is also associated with the Institute.

The doctor emphasizes the safety of phage therapy. “Phage therapy is safe and generally does not cause side effects.” One of the reasons for the safety of phage therapy is that bacteriophages are common in all environments and humans live with different bacteriophages from the first day of life.

The safety advantage of phage therapy lies precisely in the high specificity of the functions of each type of bacteriophage.

In other words, certain types of bacteria are affected by a specific type of bacteriophage. That is why “a particular species of bacteriophage purposefully selects a specific species of bacteria and destroys it.” (These words are from the video “Everything about phage therapy” – editor’s note).
This means that phage therapy does not destroy the beneficial bacteria that keep the body in balance, but only acts on certain bacteria that the doctor selects as a target.

That’s why, depending on the symptoms of the disease and the health status of the individual patient, it is possible to make a kind of cocktails consisting of different bacteriophages for individual consumption and using them for effective treatment.
This is facilitated by the collection of more than 1000 species of bacteriophages created by the institute since the 1930s.
In this way the institute can individually compile specific “cocktails” of the world’s rarest, the most valuable bacteriophages.
According to M. Kutateladze, several types of bacteria are often involved in the infection. Identifying the bacteria that cause the problem plays an important role in the treatment. It is worth to say that the strength of the Eliava Institute lies precisely in the fact that the Institute conducts accurate analysis of the pathogens of infections to select the appropriate type of bacteriophages.

When they learned about the Eliava Institute, many patients with serious diseases from Europe and the United States come to this Georgian institute. In recent years, the numbers of patients has grown steadily. According to Mzia Kutateladze, due to the spread of coronavirus this year, there are relatively fewer patients from other countries, but before that, up to 35-40 foreign patients per month were coming for treatment at the Phage Therapy Center.

(In addition to foreign patients, many local patients are also treated here).

Besides of this Eliava Phage Therapy Center provides a kind of remote treatment: Patients send clinical specimens from abroad; the Eliava Diagnostic Center recommends appropriate phage preparations, and then appropriate phage preparations with an information about phage treatment procedures accompanied by all necessary documentation are sent to the patients.

However, according to the doctor, it is still better for patients to undergo a course of treatment under the constant supervision of the center’s doctors. According to the doctor, the phage therapy conducted at the center gives “very good results”.

Let’s talk about the treatment process specifically.
Patients receive bacteriophage drugs in a variety of ways, depending on the site of infection, including drugs taken by orally. Phages enter bloodstream rapidly through the intestinal mucosa.
After 2, 3 hours, the first signs of exposure are noted. The duration of treatment depends on the individual patient, their symptoms and the types of infection. But usually the treatment lasts on average about 10-14 days. Then, if necessary, the course is repeated.

There are many symptoms of infection that can be treated with phage therapy. According to Mzia Kutateladze, a positive effect can be obtained for the treatment of infections of the digestive organs, urogenital organs, gynecological and other vital human systems.
Recently, scientists around the world often say that the state of the intestinal flora can be associated with various mental disorders.
Kutateladze answered the question posed by our correspondent that “it is possible to use phage therapy in such cases, but more research is needed to confirm the effect of phages.”

According to the scientist, the areas in which the Eliava Institute pays special attention of phage therapy are: “bacterial infections in various systems of the human body, in particular the digestive system, skin and soft tissues, organs of the urinary tract system, gynecological diseases, chronic lung diseases.”

The Institute is implementing a joint EU-funded program to study the function of bacteriophages in maintaining the balance of microflora in children with asthma. The institute also works on several other research programs and projects.

Besides of this, the Institute conducts various studies on the use of bacteriophages in various fields of agriculture.

Lastly, when it comes to the study of bacteriophages, some emphasize the study of artificial modification of bacteriophages.
However, according to M. Kutateladze, “In general, the genetic engineering of bacteriophages is an interesting approach, but it has some limitations.” According to her, the institute mainly works on natural bacteriophages.

Globally, the spread of the coronavirus has become a major problem. Is it possible to use phage therapy in the fight against coronaviruses? “Bacteriophages are used only for bacterial infections,” she said. “Bacteriophages only work against bacteria, not viruses. “However, in her opinion, “phages can be used against secondary bacterial infections in viral infections.”