Small Steps and Giant Leaps in the battle against MRSA

Although they have been around since the '60s, MRSA, and in general Hospital Acquired Infections have taken on a new urgency in the medical research spectrum (if you want more basic information, I am linking my older posts below). This should not be very surprising, since you would want to leave the Hospital healthy, not trading in one bug for another to be re-gifted to anyone who comes in contact with you.

Getting to the roots

For the longest time, it was assumed that MRSA was a cause for worry to folks that visited Hospitals and the effects on the larger society were not known. However, Hospital/Healthcare Acquired Infections have found their way into communities" and are now called "Community MRSA" and other names. It has been noted that these drug-resistant strains are adding, and not taking away from the hospital strains. All this has resulted in a general sense of urgency to try and understand the disease much better.

With modern biological tools such as very high-throughput gene sequencing, getting to the pathological history of microorganisms has become more detailed, if not easy or expensive. This is exactly what a team of international scientists at Britain's Wellcome Trust Sanger Institute are purported to have done. They took 63 strains of MRSA from across the world, ranging a timespan of twenty years from 1983 to 2003 and used DNA to try and understand the spread and maturation of the bacteria.

The results can only be termed ground-breaking at the least. The study was able to make it's unique findings because earlier genetic study techniques, were unable to pick through the minute changes and differences in strains. Without identifying these minute changes, such research and conclusions were previously not feasible.

1. The disease, as predicted, started in Europe and spread through South America and Asia. Where North America fits in is not clear yet (I haven't read the Science paper yet), but the very origin of the disease appears to be in Europe, not so unusually, coinciding with the time when antibiotics first saw heavy use, in the 1960s.

2. The rate of mutation in the bacteria appears to be about six weeks.

3. MRSA appears to have been created out of patients or their visitors bringing non-resistant bacteria to the hospitals rather than via transfer from patient to patient. This is a key finding, and it still may need verification, yet, it represents a large opportunity spectrum to fend off the origin and spread of the disease. We will revisit this later.

Opportunities

There are unique opportunities here, from a biotechnology perspective:

1. This study, with 62 samples was merely proof of concept, a starting point for very high-throughput genetic sequencing. There is a lot more work to be done to identify the origin, spread and other aspects of MRSA. A smart company could develop set of protocols and develop niche leadership, in quickly identifying and laying out the modes by which MRSA and other Hospital Acquired Infections spread. Such data would be invaluable for government and private healthcare organizations in the fight to fend off the HAI from affecting large portions of the public.

2. There appear to be lots of opportunities for bioengineering solutions, or medical device solutions that can help at prevention. Device solutions could either be consumer based, providing solutions for public places where MRSA can be found, or they can be based in the hospital setting where they can provide much needed protection against increasing rates of infection.

More on the MRSA coming soon...

Previous Posts:

1. http://chaaraka.blogspot.com/2009/11/looking-for-lucrative-socially.html

2. http://chaaraka.blogspot.com/2009/12/more-on-mrsa-business-opportunities-and.html

3. http://chaaraka.blogspot.com/2009/12/quick-update-one-more-on-mrsa-this-time.html

References:

1. http://abcnews.go.com/Technology/wirestory?id=9625552&page=1

2. http://www.businessweek.com/lifestyle/content/healthday/635225.html

3. http://globalhealth.kff.org/Daily-Reports/2010/January/22/GH-012210-MRSA.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+kff%2Fkdghpr+%28Kaiser+Daily+Global+Health+Policy+Report%29

More on the MRSA Business - Opportunities and Updates

It is interesting how you barely notice something, and then you pay attention and you suddenly see it everywhere. Two weeks ago, I blogged here about haiwatchnews.com and MRSA in general and suddenly, here we are with more MRSA stuff.

I am reporting on two pieces of news in this post, the first of which represents another, smaller window of opportunity:

1. Community MRSA Vs. HAI-MRSA:

Community MRSA is the kind of bacteria that you pick up from "community" places - gyms, hotels, public restrooms, etc. Apparently community based MRSA is yet another arena of trouble just waiting to plunge itself upon us.

Analyzing data from 1999 to 2006, a certain Dr. Laxminarayanan and his colleagues looked at over 300 labs and concluded that community MRSA brought in by outpatients is complementing and not supplementing HAI-MRSA (the kind you get in the hospital setting).

This means that you are looking at an increased danger and cross-over of infections. While the percentage of HA-MRSA has remained steady, CA-MRSA has increased. You can read more of the details in the article linked at the end of the blog.

The Opportunity

In the last post, I talked about in-hospital devices and systems that might be designed to combat MRSA. In this particular blog, I would like to highlight the opportunity spectrum that exists in community situations, ranging from gymnasiums to hotels, to public restrooms and more.

In this opportunity space, however, it is not likely to design a disposable, clinical type of device. You would be thinking more in terms of either a disposable device, or better, a bioengineered solution where you could provide a mechanism that keeps equipment, their surfaces and so on, clean and free of community based MRSA and other strains. Given the threat from community MRSA, there is a wide market available in this space and the pitch should be easier to make, provided your solution is effective, elegant and cost effective.

2. Potentional breakthrough especially useful to fight resistant bacterial strains

A couple of days ago, I came across an article on BBC about a nifty discovery - a molecule that binds an enzyme in a bacterium in two sites, as opposed to one. This is supposedly a breakthrough that could help ensure that bacteria are unable to develop resistance to drugs at the same pace as they are doing now.

The whole principle was demonstrated through a natural molecule called "simocyclinone", supposedly made by soil bacteria. This molecule itself is not a drug, but it exhibits the above said phenomenon. More details are available in the B.B.C article.

In effect, I agree and believe this concept can be further extended in synthetic molecules.

How about molecules that bind on multiple sites on the AIDS virus and completely neutralize the virus, alongside slowing down it's ability to quickly evolve and develop resistance to the molecule (which is what the virus does now).

Such innovations will completely change medicine of the future and create new battlefields in the war on disease.

Excessive Regulation?

This clearly indicates that there is true promise. If you read the B.B.C. article, there is also talk about excessive regulation driving down research. I believe this is slightly misleading. I believe that the lack of an ample pipeline points to the fact that pharma companies and the VCs and stakeholders that prod them have been carried away by the promise of "blockbusters" for so long, they have left behind well meaning opportunities. Given all the shake up that has happened in 2009, there is a wide open playing field for anyone ready to buck the trends. Regulation comes into play only after Phase 0 has been completed really, so who are they blaming for the lack of a good number of molecules on the pipeline?

Conclusion

In effect, MRSA, whether acquired in healthcare settings or in community settings present a great threat in general. There is a wide open landscape for both device and drug players to break open into the field in many ways.

References:

1. The MedPage article on Community MRSA:

http://www.medpagetoday.com/HospitalBasedMedicine/Hospitalists/17162

2. The B.B.C. Article on double-binding molecules:

http://usproxy.bbc.com/2/hi/health/8393781.stm