Dr. Eleftherios Mylonakis is chief of infectious diseases at Lifespan Corp. affiliate Rhode Island Hospital. He is also the Charles C.J. Carpenter professor of infectious disease at the Warren Alpert Medical School of Brown University. He trained at Lifespan in the mid-1990s, moved to Harvard for 14 years and then returned to Lifespan six years ago. He has edited seven books on infectious diseases and been involved in research reported in more than 300 articles in peer-reviewed literature.
Mylonakis’ mother died from infectious complications and hospital infection by resistant bacteria. These infections have become more frequent, severe and difficult to treat. His mother developed sepsis even though she was on multiple antibiotics.
Beyond Cash Donations: How New Forms of Giving Are Transforming Not-for-Profit Accounting
Evolving Funding Landscape for Not-for-Profits Not-for-profit organizations are being asked to do more with less,…
Learn More
“However, she was into her 70s and lived a full life. Even though I love her as we all love our mothers, as a physician I am far more motivated from the heartbreaking stories of young people that I see that come down with resistant infections and feel that I cannot help them,” he said.
In March, he co-authored a study in the journal Nature about the discovery of a new class of antibiotics, synthetic retinoids that may help combat drug-resistant “superbugs.”
PBN: Please explain the problem of drug-resistant bacteria and the public health implications.
MYLONAKIS: A significant challenge in the treatment of bacterial infections has been the appearance of antibiotic-resistant strains. A well-known example of this is methicillin-resistant Staphylococcus aureus (MRSA), which was first identified in the 1960s as a hospital-acquired infection but in recent years has become prevalent in the general population (community-associated MRSA).
Staphylococci possess a wide spectrum of virulence factors and have developed many strategies to bypass host defense mechanisms. MRSA infections are a growing concern, which have been deemed a “serious threat” by the Centers for Disease Control [and Prevention]. Overall, the CDC estimates that in 2011, MRSA was responsible for more than 70,000 life-threatening infections in the U.S. alone, surpassing the number of yearly deaths due to AIDS.
PBN: Your research has uncovered synthetic retinoids with the ability to kill MRSA, which is resistant to several antibiotics. Could MRSA eventually become resistant to them too?
MYLONAKIS: Because they can be used with different antibiotics and because after 100 days of trying to induce resistance we were only able to elicit modes of retinoid-resistance, we are optimistic that resistance development can be delayed.
PBN: You’ve referenced your recent research as a means of filling the gap in work being done to produce effective antibiotics to replace the ones bacteria are becoming immune to. What is your estimate of how much more work should be done in this area?
MYLONAKIS: In addition to significant scientific research that is needed, the whole business concept of paying for antibiotics should change and that also requires significant work. Antibiotics should not be compensated by their use because this incentivizes overuse. Instead, the compensation should be based on availability and the ongoing need to keep up with the evolving needs to address microbial resistance.
It can take many years and dollars for large pharmaceutical companies to develop new antibiotics, but there is less return on investment on these drugs compared with medications that must be taken daily instead of rarely. Even with widespread agreement on the importance of identifying new classes of antibacterial agents, the rate of progress is unlikely to meet the expected need for the foreseeable future.
The exodus of many large pharmaceutical companies from the antimicrobial research arena have limited antibiotic drug discovery. Moreover, traditional methods of drug discovery have usually involved in vitro screening for antimicrobial activity followed by further in vitro/in vivo testing for toxicity and finally structure activity relationships analysis. This time-consuming, multistage screening effort also lacks information on persister cell activity.”
PBN: What is the next step for your research?
MYLONAKIS: Evaluate toxicities and understand the dosing before we move into finding the significant support that is necessary to bring this discovery to clinical practice.
PBN: What is the most effective thing the general public can do to help?
MYLONAKIS: Follow common sense infection control policies, such as hand-washing. Do not pressure physicians to prescribe antibiotics when you do not need them. Support policies that limit the use of antibiotics, for example in agriculture. And fund research for new antibiotics that we desperately need!
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
