Thursday, 26 June 2014

Fighting Back Against Evolution

Antibiotic resistance focus of UK’s Longitude Prize : Nature News Blog

Great news that, by popular vote, the £10 million ($17 million) Longitude Prize will be awarded to the group which comes up with "a cost-effective, accurate, rapid, and easy-to-use test for bacterial infections" within the next five years. The intention is to help target antibiotic use so reducing the rate at which bacteria are evolving resistance.

This comes close behind a stark WHO report which stated:

Antimicrobial resistance (AMR) within a wide range of infectious agents is a growing public health threat of broad concern to countries and multiple sectors. Increasingly, governments around the world are beginning to pay attention to a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.

The report went on to say:
Key findings and public health implications of ABR [Antibacterial Resistance] are:
  • Very high rates of resistance have been observed in bacteria that cause common health-care associated and community-acquired infections(e.g. urinary tract
    infection, pneumonia) in all WHO regions.
  • There are significant gaps in surveillance, and a lack of standards for methodology, data sharing and coordination.

Key findings from AMR surveillance in disease-specific programmes are as follows:
  • Although multidrug-resistant TB is a growing concern, it is largely under-reported, compromising control efforts.
  • Foci of artemisinin resistance in mataria have been identified in a few countries. Further spread, or emergence in other regions, of artemisinin-resistant strains could jeopardize important recent gains in malaria control.
  • Increasing levels of transmitted anti-HIV drug resistance have been detected among patients starting antiretroviral treatment.

WHO op cit

The reason this fight is so important is because, quite frankly, we are losing the fight against evolution as bacteria are evolving resistance. We have created an arms-race in which to avoid reverting to the time before the discovery of penicillin transformed medicine and surgery as well as the treatment of former large-scale killer diseases, we have to keep inventing new antibiotics while all bacteria need to do is replicate their genes with occasional mistakes, just as they have been doing for billions of years, and doing so at such a rate and in such vast numbers that a billion to one chance comes up regularly.

The resistant strain then wins the struggle for resources in competition with the non-resistant forms and a new, resistant strain is produced. No effort and no planning required and the entire process is actually facilitated by irresponsible and ignorant use of antibiotics throughout the world and even in meat production so we and our bacteria live in an environment with a low-level background of antibiotics as well as those produced naturally by fungi in their struggle with bacteria.

I reported on this arms-race in July 2013 with Bacteria Are Winning With Evolution and on how the phage viruses in our gut help bacteria evolve resistance and even act as stores for resistance previously evolved in response to natural antibiotics produced by fungi in their battle for resources with bacteria in our intestines.

Malaria, which at one point looked as though it could be eradicated, is now becoming resistant to artemisinin:

Parasite resistance to artemisinin has so far been detected in five South-East Asian countries: in Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam (all in the Greater Mekong subregion). Artemisinin resistance is also suspected is some parts of South America but confirmatory studies are still ongoing. Resistance is occurring as a consequence of several factors, including poor treatment practices, inadequate patient adherence to prescribed antimalarial regimens, and the widespread availability of oral artemisinin-based monotherapies and substandard forms of the drug.

Other organisms which are gaining the upper hand, according the WHO are:

  • Escherichia coli: resistance to third-generation cephalosporins, including resistance conferred by extended spectrum beta-lactamases (ESBLs), and to fluoroquinolones;
  • Klebsiella pneumoniae: resistance to third-generation cephalosporins, including resistance conferred by ESBLs, and to carbapenems;
  • Staphylococcus aureus: resistance to beta-lactam antibacterial drugs (methicillin, methicillin-resistant S. aureus [MRSA]);
  • Streptococcus pneumoniae: resistance of non-susceptibility to penicillin (or both);
  • Nontyphoidal Salmonella (NTS): resistance to fluoroquinolones;
  • Shigella species: resistance to fluoroquinolones;
  • Neisseria gonorrhoeae: decreased susceptibility to third-generation cephalosporins.

Hopefully, and for the sake of future generations, the Longitude Prize will help us create a rational approach to antibiotic development and control systems for monitoring their use and ensuring they are used responsibly. We are already down to an antibiotic of last resort for the potential killer Staphylococcus aureus, carbapenems. Some reports say that 95% of adults in India and Pakistan carry bacteria which are resistant to even this group of antibiotics.

One thing is certain: our battle with microorganisms and our approach to antibiotic development and control can only come from an understanding of evolution, how it works and how the changes we make to the organisms' environments are going to create the conditions for them to evolve resistance.

It is the height of hypocrisy for those science-deniers who live by spreading lies and misinformation about science in general and evolution in particular to go running to their doctor for the latest antibiotics for themselves and their families, only made necessary because of evolution and only available because those who create them know and understand how evolution works.

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