RESEARCHERS have found that removing antibodies from patients’ bloodstreams could reduce the effects of chronic infections, as well as shortening hospital stays and the need for antibiotics.
In a study, published in the American Journal of Respiratory and Critical Care Medicine, they outline a new treatment pathway for antibiotic resistant bacteria and infectious diseases which could benefit thousands of patients in future.
The researchers, from the University of Birmingham and Newcastle University, identified two patients with bronchiectasis who suffered with chronic Pseudomonas aeruginosa infections that were resistant to many antibiotics; a 64-year-old male, diagnosed with bronchiectasis aged fifteen, and a 69-year-old female who had bronchiectasis from childhood.
Bronchiectasis is a disease that leads to permanent enlargement of the airways in the lung and affects over 300,000 patients in the UK. Symptoms can be debilitating for patients, and can include a chronic cough, shortness of breath, coughing up blood, and chest pain. The disease often affects patients beyond the age at which lung transplantation is possible.
Chronic Pseudomonas aeruginosa lung infections commonly occur in patients suffering from bronchiectasis. Pseudomonas aeruginosa is a common bacterium that can cause disease and is known as a multidrug resistant pathogen, which means it has strong resistance to antibiotics and an association with serious illnesses.
The technique is believed to be the first successful use of antibody-dependent enhancement of bacterial disease. The researchers say it could be widely applicable to other bacterial infections and offers hope for the treatment of some antibiotic resistant infections. Antibiotic resistance is now a major problem in treating many diseases as older antibiotics are no longer effective in many cases, and there is often little commercial incentive for drug companies to develop new ones.
The patients in the study were volunteers in an explorative treatment which built on previous findings from the research group in 2014. Professor Ian Henderson, Director of the Institute of Microbiology and Infection, at the University of Birmingham, said: “These patients had an excess of a particular antibody in the bloodstream. In contrast to the protective effect normally associated with antibody, in these patients the antibody stopped the immune system killing the Pseudomonas aeruginosa bacterium and this worsened the patients’ lung disease. Perhaps counter-intuitively, we decided to remove this antibody from the bloodstream and the outcomes were wholly positive.”
Dr Tony de Soyza, bronchiectasis service lead at Newcastle Upon Tyne Hospitals Trust and a senior lecturer at Newcastle University, said: “We needed a brand new way of tackling this problem.Working with kidney and immunology experts, we used a process known as plasmapheresis, which is akin to kidney dialysis. The plasmapheresis involved the removal, treatment, and return of blood plasma from circulation, and was done five times in a week in order to remove antibody from the patients. We then replaced antibodies with those from blood donations. This treatment restored the ability for the patients’ blood to kill their infecting Pseudomonas.”
Both patients reported a rapid improvement in health and wellbeing, greater independence and improved mobility compared to any point in the previous two years.
Professor Henderson added: “This shows that we can improve patient wellbeing significantly, by reducing the need for treatment and the numbers of days spent in hospital, which will also help to reduce reliance on antibiotics. The next step is to do longer term studies to investigate whether an earlier intervention, with slightly less aggressive therapies, could help prevent disease progression in patients.”