"When I first started, I was treating anything and everything in terms of ‘this is highly drug resistant and it's failed’. But I think I have a clearer idea now, at least clinically, where I think phage would be beneficial, rather than all comers.”

What does it take to achieve an 85% success rate with phage therapy? We talk to Dr. Saima Aslam, MD, MS, a Professor of Medicine at UC San Diego and the clinical lead of IPATH (Center for Innovative Phage Applications and Therapeutics), about her strategies for successful phage treatment. 

Since 2017, Dr. Aslam has treated many patients with phages, and learned crucial lessons about patient selection, trial design, and the importance of collaboration between clinicians and phage researchers. We explore how her approach has evolved from "treating anything and everything" to targeted strategies, why early clinical trials struggled, and her exciting NIH-funded placebo-controlled trial for recurrent UTIs in kidney transplant patients. 

The conversation covers practical implementation challenges and lessons for phage therapy practitioners, and discusses her vision for a centralized US phage repository and manufacturing center to reduce the current 6-12 month delays in accessing treatment.

Here's a taste of what we covered:

1. 🧫 Why patient selection is crucial: not all infections benefit equally from phage therapy

2. 🏥 Why phage scientists and clinicians must work together from day one

3. 🧪 Learning from early studies to create pragmatic, enrollable protocols

4. ⌛ The challenge of long-established biofilms in chronic infections like LVAD bacteremia

5. 💉 Why recurrent UTIs in transplant patients represent the "lowest hanging fruit"

6. 🔬 How Dr. Aslam designed her NIH-funded clinical trial for recurrent UTIs in kidney transplant patients

7. 🌐 The urgent need for centralized phage production in the US to reduce treatment delays

Chapters:

00:00 Introduction to Phage Therapy and Dr. Saima Aslam

02:11 Early Experiences and Lessons in Phage Therapy

05:27 Criteria for Patient Selection in Phage Therapy

09:14 Challenges in Phage Therapy: Availability and Effectiveness

12:31 Collaboration and Research in Phage Therapy

24:08 Bottlenecks in Phage Therapy Development

36:07 Future Directions and Hopes for Phage Therapy

Learn more:

Saima’s team is now enrolling for their kidney transplant phage clinical trial! (https://clinicaltrials.gov/study/NCT06409819)

A recent paper by Saima and her team:

Phage Therapy in Lung Transplantation: Current Status and Future Possibilities (https://pubmed.ncbi.nlm.nih.gov/37932113/)