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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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In the Pipeline: Don't miss Derek Lowe's excellent commentary on drug discovery and the pharma industry in general at In the Pipeline

In the Pipeline

« Looking Backwards | Main | What We Don't Know About Enzymes »

October 29, 2007

Bacterial Infection: Better Or Worse Than Cancer?

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Posted by Derek

There’s been a steady stream of reports in the news about methacillin-resistant Staph. aureus. It’s not a new problem, but (like other nasty infections) it does get a lot of press when the media start paying attention. Works in reverse, too – on the viral front, have you noticed the much reduced number of bird-flu-will-kill-us-all stories this year as we head toward winter? This despite the likelihood of bird flu killing us all being as high (or low) as ever, as far as I can tell.

But the resistant bacteria problem is certainly no joke, and there doesn’t seem to be any reason why it won’t gradually get worse over time. It struck me the other day that antiinfectives, as a drug research field, might be moving toward a similar spot to oncology. In both cases, you have a problem with rapidly multiplying cells, giving you a serious medical outcome - often in cancer, and increasingly with infections. The average tumor is a lot more worrisome than the average infection, of course, but that’s something we can only say with confidence in the industrialized world, and we've only been able to say it for the last sixty or seventy years. As cancer gradually becomes more manageable and infections gradually become less so, the two might eventually meet – or even switch places, which would be bad news indeed. (In some genetically bottlenecked species, in fact, the two problems can overlap, which is fortunately extremely unlikely in humans).

There are, of course, a lot of differences between the two fields, not least of which is that you’re fighting human cells in one case and prokaryotes (or worse, viruses) in the other. But many of those differences actually come out making infectious diseases look worse. The transmissibility of bacteria and viruses make them serious contenders for causing havoc, as they have innumerable times in human history, and they can grow more quickly in vivo than any cancer. It’s only the fact that public health measures allow then to be contained, and the fact that we’ve had useful therapies for many of them, that makes people downrate the infectious agents. If either (or both) of those change, we’re going to be rethinking our priorities pretty quickly.

What this means for drug development is that some researchers will have to rethink their attitudes towards antiinfective drugs. For serious infections, we're going to have to think about these projects the way we've traditionally thought of oncology agents - last-ditch therapies for deadly conditions. Anticancer therapies have long had more latitude in their side effects, therapeutic ratios, and dosing regimes, and antibiotics for resistant infections are in the same position. For some years now, there's been a problem that new drugs in this field would perforce have small markets, since they'd be used only when existing agents fail. That market may not be as small as it used to be. . .

Comments (13) + TrackBacks (0) | Category: Cancer | Drug Development | Infectious Diseases


COMMENTS

1. John Spevacek on October 29, 2007 8:36 AM writes...

"For some years now, there's been a problem that new drugs in this field would perforce have small markets, since they'd be used only when existing agents fail."

The smallness of the market is also due to the duration of the treatment. A 10-day antibiotic course is much shorter than any chemotherapy routine. And there is no comparison to a chronic condition.

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2. Wavefunction on October 29, 2007 11:02 AM writes...

I hear somewhere that deaths from MRSA this year have been more than deaths from AIDS. If true that is stupendous news.

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3. Dave H on October 29, 2007 1:30 PM writes...

The need for antiinfectives has prompted the following resurrection:

http://biz.yahoo.com/bizj/071003/1529759.html?.v=1

I'm sure your happy to know that it finally paid dividends to Magainin shareholders

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4. Morten on October 29, 2007 2:06 PM writes...

Doesn't "stupendous" usually carry a positive modality? As in colossally good news? I'm not a native English speaker btw.

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5. Chrispy on October 29, 2007 2:58 PM writes...


On the plus side, assays for antibacterials are super-simple. Death is an easy thing to assess! Cancer is not so easy to model...

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6. Wavefunction on October 29, 2007 3:45 PM writes...

You are right; the dictionary meaning says "very impressive" which in this case might also be applied albeit in a negative way. But the correct word may have been abysymally depressing or something like that.

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7. DLIB on October 29, 2007 4:22 PM writes...

For a while post-SARS, TB, Anthrax scare... Congress was considering legislation to incentivize Pharma to get back into anti-infectives ( gauranteed government purchases ...). Don't if anything ever came of it.

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8. bitter pill on October 29, 2007 5:50 PM writes...

Chrispy,

You are right the assays are easy to run. That's why nearly every issue of Egytian Journal of Heterocyclic Chemistry has new heterocyles that exhibit some "moderate" antibacterial activity. :)

As someone who has worked in antibacterial development, I can tell you that large and medium companies do not see this as a viable business. Of course they told us that there was no need for drugs that treated community aquired resistant bacteria either. The argument always seems to come down to the thought that the "drug of last resort" will not make money.

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9. Polymer Bound on October 30, 2007 3:33 PM writes...

re: duration of treatment -- does that really need to impact the price of the drug? It seems like you could just increase the price of the regimen (as unpopular as that would be) giving company X a fat juicy profit margin. This type of thing already happens with rare diseases.

In the face of death or dismemberment, I'd pay a lot of money to cure myself of a multidrug-resistant infection.

I don't get why companies aren't all over this... the clinical trials should be relatively cheap and easy to populate.

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10. markm on November 1, 2007 12:47 PM writes...

Polymer: The "drug of last resort" should be very high priced. That provides another reason for not overusing it.

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11. James Stein on November 2, 2007 11:55 AM writes...

As for 'last resorts' and the overlap of antiinfectives and oncology:

One of the (fairly recent) advances in oncology is using radioimmunotherapy to target virus-associated cancerous cells. The same (or similar) technique can be used, I believe, to target bacteria or viruses.

It would be expensive and the side-effects unpleasant, but it seems to be something that is worthy of consideration as a 'last ditch' treatment for fatal infections.

As an aside, it's worth noting that cancer and virii also feed off of one another in a sense - cancer is correlated with a compromised immune system (the causative relationship is as yet unknown); reducing the prevalence of cancer will reduce the population's vulnerability to infection.

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12. Per Gynt on November 4, 2007 9:48 AM writes...

SARS in China and Canada and elsewhere was enough of an alert for me - a wee wanton coronavirus spreading not only death but also fear of contagion. How quickly we progress from quarantine to visions of a science fiction scenario as future documentary (millennia later, archaeologists finding bodies where they lay when they died).

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13. Joanne on April 26, 2009 11:40 AM writes...

If the diagnosis is a bacterial infection, does that then eliminate a cancer?

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