Infections caused by MRSA bacteria (pictured) can lead to serious health complications. Lysins kill the microbes by destroying the bacterium’s cell wall (green).
Humans are in a constant arms race with infectious bacteria. To kill these disease microbes, we develop powerful antibiotics; and in turn, the bacteria develop resistance against these drugs. So we enhance our antibiotics, and the bacteria enhance themselves accordingly—resulting in so-called superbugs. Increasingly, medications fail to eliminate these highly adapted bacteria, leaving our bodies dangerously defenseless.

In light of this crisis, for almost 20 years Rockefeller’s Vincent A. Fischetti has been developing a novel form of antimicrobial ammunition known as lysins. Now, these bacteria-killing enzymes have been studied in a phase II human clinical trial, becoming the first antibiotic alternatives to achieve successful outcomes in this stage of clinical development.

Natural born killer

Some viruses are very good at killing bacteria. Known as bacteriophages, or simply phages, these viruses infect a microbe, replicate inside of it, and then produce lysin enzymes, which cleave the bacterium’s cell wall. As a result, progeny phages are released from within the bacterium, and the bacterium itself perishes.

In nature, this kind of assault is commonplace: bacteriophages inhabit everything from oceans and soil to human bodies, helpfully regulating microbe populations wherever they go. In fact, every 48 hours half the bacteria on earth are killed by phages, making lysins the most widespread bacteria-killing agents on Earth.

In the lab, lysins can be used as a tool to break down and study the cell walls of bacteria—which is exactly what Fischetti was doing at Rockefeller about two decades ago. Simultaneously, his lab was also working on a vaccine for streptococcus infections, and the broader research community was becoming increasingly worried about antibiotic-resistant infections. This confluence of events led Fischetti to a breakthrough.

“Since I was working with lysins, I knew they killed bacteria instantly. My lab happened to have animals that were orally colonized with streptococci for my vaccine studies,” he recalls. “So, I thought, let me just give these colonized mice some lysin and see what happens to the streptococci.”

The effect was dramatic: an hour after getting the drug, the animals were decolonized of their streptococci. The subsequent publication of this finding was the first to report the therapeutic use of phage lysins.

Compelled by this result, Fischetti and later other scientists began developing lysins against several types of drug-resistant bacteria, many of which successfully cured infections in a wide range of animal models. Until recently, however, no one had tested whether this type of therapy was safe and effective in humans.