US20190359947A1 - Therapeutic bacteriophage compositions - Google Patents

Therapeutic bacteriophage compositions Download PDF

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US20190359947A1
US20190359947A1 US16/485,408 US201716485408A US2019359947A1 US 20190359947 A1 US20190359947 A1 US 20190359947A1 US 201716485408 A US201716485408 A US 201716485408A US 2019359947 A1 US2019359947 A1 US 2019359947A1
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bacteriophage
orf
bacteriophage composition
composition according
composition
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Karen Joy Shaw
Sandra P. MORALES
Gillian MEARNS
Deborah A. RANKIN
Frenk SMREKAR
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Biocontrol Ltd
Armata Pharmaceuticals Inc
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Biocontrol Ltd
Armata Pharmaceuticals Inc
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Assigned to ARMATA PHARMACEUTICALS, INC. reassignment ARMATA PHARMACEUTICALS, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: MORALES, Sandra P., MEARNS, Gillian, RANKIN, Deborah A., SMREKAR, Frenk, SHAW, KAREN JOY
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    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N7/00—Viruses; Bacteriophages; Compositions thereof; Preparation or purification thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/66—Microorganisms or materials therefrom
    • A61K35/76—Viruses; Subviral particles; Bacteriophages
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2795/00—Bacteriophages
    • C12N2795/00011—Details
    • C12N2795/00032—Use of virus as therapeutic agent, other than vaccine, e.g. as cytolytic agent

Definitions

  • the present invention relates to compositions of bacteriophages, and use of the same for medical and non-medical applications.
  • MRSA Methicillin-resistant Staphylococcus aureus
  • Bacteriophages are targeted therapeutics capable of infecting specific bacterial species or strains. Bacteriophage-target binding is facilitated by way of viral structural elements, such as tail fibres. Viral nucleic acid, usually encased within the bacteriophage head, is then injected (typically via the tail) into the bacterial target cell. In the case of obligate lytic bacteriophages, the injected viral nucleic acid directs the production of bacteriophage progeny using the intracellular mechanisms of the bacterium. The host cell is killed by lysis at the end of the cell cycle with a concomitant release of viral progeny.
  • viral structural elements such as tail fibres.
  • Viral nucleic acid usually encased within the bacteriophage head, is then injected (typically via the tail) into the bacterial target cell. In the case of obligate lytic bacteriophages, the injected viral nucleic acid directs the production of bacteriophage progeny using the intracellular mechanisms of the bacter
  • the present invention provides a bacteriophage composition comprising one or more bacteriophage(s) selected from Sa87, J-Sa36, Sa83, or mutants thereof.
  • Said bacteriophage composition is an alternative to conventional antibacterial agents/therapeutics, and overcomes one or more problems associated therewith.
  • the bacteriophage composition of the present invention is particularly advantageous for use in medicine, and shows clinical efficacy in the treatment of Staphylococcus aureus infections.
  • said bacteriophage composition is particularly suited to treatment of Staphylococcus aureus pulmonary infections.
  • the bacteriophage composition of the invention is efficacious against a broad spectrum of Staphylococcus aureus strains.
  • a bacteriophage composition comprising (or consisting essentially of) Sa87, J-Sa36, and Sa83 (optionally further including one or more mutants thereof) surprisingly exhibits reduced bacteriophage antagonism and/or reduces development of resistance in Staphylococcus aureus target bacteria, for example when compared to a composition comprising (or consisting essentially of) Sa87, J-Sa36, Sa83, and J-Sa37 (optionally further including one or more mutants thereof).
  • the bacteriophages Sa87, J-Sa36, and Sa83 were deposited at the European Collection of Cell Cultures (ECACC), Culture Collections, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, United Kingdom, on 9 Feb. 2017 under ECACC accession numbers 17020901 (Sa87), 17020903 (J-Sa36), and 17020902 (Sa83). All of the deposits were made under the provisions of the Budapest Treaty on the International Recognition of the Deposit of Microorganisms for the Purposes of Patent Procedure.
  • ECACC European Collection of Cell Cultures
  • a bacteriophage composition comprises at least two bacteriophages selected from Sa87, J-Sa36, Sa83, or mutants thereof.
  • a bacteriophage composition comprising at least two bacteriophages may be referred to herein as a “panel” of bacteriophages.
  • a bacteriophage composition comprises Sa87, J-Sa36, Sa83 or mutants thereof.
  • a bacteriophage composition may comprise Sa87, J-Sa36, and Sa83.
  • a bacteriophage composition consists essentially of Sa87, J-Sa36, and Sa83 or mutants thereof.
  • a bacteriophage composition consists essentially of Sa87, J-Sa36, and Sa83.
  • consists essentially of means that only the bacteriophage(s) explicitly indicated are present in the bacteriophage composition, but that said composition may also contain a further non-bacteriophage constituent, such as an appropriate carrier, diluent, etc.
  • mutant refers to a bacteriophage differing genetically from Sa87, J-Sa36, or Sa83 by one or more nucleotide(s) but still retaining the ability to infect and lyse a Staphylococcus aureus target bacteria.
  • a “mutant” bacteriophage is capable of lysing the same target bacterial strains as Sa87, J-Sa36, and/or Sa83, and further capable of lysing one or more additional bacterial strains.
  • a mutant may have at least 75%, 80%, 85%, 90%, 95% or 99% sequence identity across its entire genome when compared to Sa87, J-Sa36, or Sa83.
  • a “mutant” may be a bacteriophage progeny.
  • a bacteriophage progeny may be a bacteriophage obtainable after lysing a Staphylococcus aureus target bacteria using a bacteriophage of the invention (i.e. the “parent bacteriophage”).
  • the bacteriophage progeny may be a second (or further) generation bacteriophage.
  • a bacteriophage progeny is obtainable by: contacting one or more bacteriophage(s) Sa87, J-Sa36 and/or Sa83 with a Staphylococcus aureus target bacteria such that the one or more bacteriophage(s) infects and lyses said target bacteria; and obtaining a bacteriophage released following lysis of said target bacteria.
  • Said bacteriophage progeny will typically comprise one or more nucleotide(s) mutation(s) when compared to the relevant parent bacteriophage.
  • sequence alignment methods can be used to determine percent identity, including, without limitation, global methods, local methods and hybrid methods, such as segment approach methods. Protocols to determine percent identity are routine procedures within the scope of one skilled in the art. Global methods align sequences from the beginning to the end of the molecule and determine the best alignment by adding up scores of individual nucleotide pairs and by imposing gap penalties. Non-limiting methods include, e.g., CLUSTAL W, see, e.g., Julie D.
  • Non-limiting methods include, e.g., BLAST, Match-box, see, e.g., Align-M, see, e.g., Ivo Van Walle et al., Align-M—A New Algorithm for Multiple Alignment of Highly Divergent Sequences, 20(9) Bioinformatics:1428-1435 (2004).
  • the bacteriophage composition of the invention targets one or more Staphylococcus aureus strain(s).
  • a Staphylococcus aureus strain targeted is a methicillin-resistant Staphylococcus aureus (MRSA).
  • MRSA methicillin-resistant Staphylococcus aureus
  • VRSA vancomycin-resistant Staphylococcus aureus
  • the bacteriophages of a composition of the invention may be provided in the form of a single therapeutic composition (preferred) or as a number of separate compositions each comprising one or more members of the composition. In embodiments where the bacteriophages are provided in a number of separate compositions, said bacteriophages may be administered to a subject sequentially or simultaneously (suitably simultaneously).
  • a bacteriophage for inclusion in a composition of the invention may be propagated by any suitable method known in the art.
  • one or more bacteriophage(s) may be grown separately in host bacterial strains capable of supporting growth of the bacteriophage.
  • the bacteriophage will be grown in said host bacterial strain to high concentrations, titrated and combined to form a composition of the invention.
  • each bacteriophage employed e.g. in a bacteriophage composition, method or use of the invention
  • the amount of each bacteriophage employed will depend upon its virulence against the target bacterial species.
  • Count bacterial strains may be used in the development of a composition, i.e. bacterial strains which are indicators for individual prospective members of the composition (e.g. panel).
  • a count strain may permit at least 1000 times more plaque formation by one prospective member of the bacteriophage composition than any other. In this way, a composition (e.g. panel) that is consistently effective against a wide range of bacterial isolates may be achieved.
  • said one or more bacteriophage(s) may be combined to form a composition comprising at least about 1 ⁇ 10 7 , 1 ⁇ 10 8 , 1 ⁇ 10 9 or 1 ⁇ 10 10 , or 1 ⁇ 10 11 plaque forming units (PFU) of each phage per ml of composition.
  • said one or more bacteriophage(s) may be combined to form a composition comprising at least about 1 ⁇ 10 8 or 1 ⁇ 10 9 PFU of each phage per ml of composition.
  • WO 2013/164640 A1 When selecting bacteriophages for inclusion in a composition of the invention, the methods taught in WO 2013/164640 A1 (incorporated herein by reference) may be used. In one embodiment said method comprises:
  • an improved bacteriophage composition (comprising bacteriophages Sa87, J-Sa36 and Sa83 (and optionally mutants thereof)) is obtained.
  • said bacteriophage composition exhibits improved therapeutic efficacy against Staphylococcus aureus when compared to conventional bacteriophage compositions and/or a composition comprising bacteriophages Sa87, J-Sa36, Sa83, and J-Sa37 (and optionally mutants thereof).
  • a preferred bacteriophage composition comprises or consists essentially of Sa87, J-Sa36 and Sa83.
  • a bacteriophage composition of the present invention may further comprise one or more additional bacteriophages.
  • Said one or more additional bacteriophages may target a Staphylococcus aureus species or strain, or a different bacterial target, for example selected from one or more of the following genera Staphylococcus, Helicobacter, Klebsiella, Listeria, Mycobacterium, Escherichia, Meningococcus, Campylobacter, Streptococcus, Enterococcus, Shigella, Pseudomonas (e.g. Pseudomonas aeruginosa ), Burkholderia, Clostridium, Legionella, Acetinobacter, Salmonella , or combinations thereof.
  • Staphylococcus aureus species or strain or a different bacterial target, for example selected from one or more of the following genera Staphylococcus, Helicobacter, Klebsiella, Listeria, Mycobacterium, Escherichi
  • the one or more additional bacteriophage(s) may be one taught in WO 2009/044163 (incorporated herein by reference), a bacteriophage K and/or bacteriophage P68 described therein.
  • the one or more additional bacteriophage(S) may be one or more taught in WO 2005/009451 A1, which is incorporated herein by reference.
  • said one or more additional bacteriophage(s) may target Pseudomonas bacteria, such as Pseudomonas aeruginosa bacteria.
  • a composition of the invention comprises one or more bacteriophage(s) taught in WO 2013/068743 A9 (incorporated herein by reference).
  • a composition of the invention comprises a Staphylococcus bacteriophage K mutant, which comprises one or more mutations within one or more of the following regions, corresponding to the nucleotide sequence of wild-type Staphylococcus bacteriophage K (SEQ ID No. 1), selected from:
  • the Staphylococcus bacteriophage K mutant comprises (or consists of) mutations in all of the regions referred to above.
  • ORF designations referred to above may be identified using GeneMark software (http://exon.biology.gatech.edu/). The individual reading frames may then be compared against the NCBI GenBank using BLAST and the highest scoring matches then attributed to the respective ORF.
  • the ORFs referred to above may be the bacteriophage K ORFs described by O'Flaherty S. et al. (J. Bacteriol. (2004), 186(9) 2862-2871), the teaching of which is incorporated herein by reference.
  • SEQ ID No. 1 comprises 118 ORFs.
  • the ORFs may be annotated as follows (nucleotide numbering indicated is that of SEQ ID No. 1 and is orientated from start codon to stop codon): ORF 1: 2934-2449; ORF 2: 3358 2927; ORF 3: 3914-3372; ORF 4: 4414-3926; ORF 5: 4825-4427; ORF 6: 5529-4822; ORF 7: 6183-5629; ORF 8: 8050-7502; ORF 9: 9194-8457; ORF 10: 10003-9614; ORF 11: 10798-10316; ORF 12: 11390-10848; ORF 13: 11923-11390; ORF 14: 13213-12368; ORF 15: 13809-13225; ORF 16: 15233-14817; ORF 17: 15669-15367; ORF 18: 18110-16062; ORF 19: 19226-18648;
  • ORFs are believed to be transcribed in the reverse direction with respect to SEQ ID No. 1 as reflected by the nucleotide numbering above (e.g. ORFs 1-33).
  • said mutation occurs within ORF 96 of the corresponding nucleotide sequence of wild-type Staphylococcus bacteriophage K (SEQ ID No. 1).
  • a mutation may be one or more mutation selected from C105975T, C18554T, G40894A, G78197A, G99388C, G102111A, T103720C, C105975T and/or A109329G of the corresponding nucleotide sequence of wild-type Staphylococcus bacteriophage K (SEQ ID No. 1).
  • a bacteriophage K mutant may comprise (or further comprise) an insertion at position 116111 of the corresponding nucleotide sequence of wild-type Staphylococcus bacteriophage K (SEQ ID No. 1).
  • an insertion may be an insertion of at least 9000 base pairs in length (e.g. 9547 base pairs in length).
  • a composition of the invention comprises a Staphylococcus bacteriophage K (mutant) comprising a nucleotide sequence having at least 70% or at least 80% sequence identity to SEQ ID No. 1.
  • a composition of the invention comprises a Staphylococcus bacteriophage K (mutant) comprising a nucleotide sequence having at least 80% or at least 90% sequence identity to SEQ ID No. 1.
  • a composition of the invention may comprise a Staphylococcus bacteriophage K (mutant) comprising a nucleotide sequence having at least 95% or at least 100% sequence identity to SEQ ID No. 1.
  • a bacteriophage composition comprises one or more (preferably at least two) bacteriophages selected from Sa87, J-Sa36, and Sa83, or mutants thereof, and a pharmaceutically acceptable carrier, diluent, excipient or combinations thereof.
  • Suitable carriers, diluents and/or excipients may include isotonic saline solutions, such as phosphate-buffered saline.
  • a bacteriophage composition of the invention may be formulated as a disinfectant composition.
  • the disinfectant composition may be in the form of a spray or liquid wash for a surface.
  • the composition may be a hand wash.
  • the composition may take the form of a lotion, cream, ointment, paste, gel, foam, or any other physical form as a carrier generally known for topical administration.
  • Such thickened topical formulations are particularly advantageous because the formulations adhere to the area of the skin on which the material is placed, thus allowing a localised high concentration of bacteriophages to be introduced to the particular area to be disinfected.
  • paraffin- and lanolin-based creams which are particularly useful for the application of product to the nasal cavity, are generally known in the art.
  • other thickeners such as polymer thickeners, may be used.
  • the formulations may also comprise one or more of the following: water, preservatives, active surfactants, emulsifiers, anti-oxidants, or solvents.
  • a bacteriophage composition of the invention may be formulated for nasal, oral, parenteral, intramuscular, intravenous, subcutaneous, transdermal, ocular or aural administration.
  • a bacteriophage preparation may be used directly, stored frozen in aqueous or other solution with an appropriate cryoprotectant (e.g. 10% sucrose), freeze dried and rehydrated prior to use, or rendered stable in some other formulation including (but not limited to) tablet, emulsion, ointment, or impregnated wound dressing or other item.
  • the bacteriophage composition may be formulated for pulmonary delivery via nasal or oral administration (e.g. by aerosolisation of the bacteriophage composition).
  • the bacteriophage composition may be comprised in a pulmonary delivery means, such as an inhaler or a respirator.
  • a pulmonary delivery means (such as an inhaler or a respirator) comprising a bacteriophage composition of the invention.
  • the present invention further relates to the use of a bacteriophage composition herein as a medicament (e.g. for treating a Staphylococcus aureus infection).
  • a bacteriophage composition of the invention for use as a medicament.
  • Corresponding methods of treating a disease comprising administration of the bacteriophage composition to a subject are also provided.
  • a bacteriophage composition of the invention for use in treating a bacterial infection.
  • the bacteriophage composition finds particular use in treating a Staphylococcus aureus bacterial infection.
  • the bacterial infection is a pulmonary bacterial infection.
  • the pulmonary bacterial infection may comprise (or consist of) Staphylococcus aureus.
  • the invention provides use of a bacteriophage composition of the invention in the manufacture of a medicament for use in treating a pulmonary bacterial infection in a subject, wherein the bacteriophage composition is administered to the subject, and wherein the bacterial infection comprises Staphylococcus aureus .
  • a method of treating a pulmonary bacterial infection in a subject comprising administering the bacteriophage composition of the invention to the subject, wherein the bacterial infection comprises Staphylococcus aureus.
  • a bacteriophage composition comprising or consisting essentially of Sa87, J-Sa36, Sa83, or mutants thereof is particularly advantageous when treating a Staphylococcus aureus infection (e.g. pulmonary infection).
  • treat or “treating” as used herein encompasses prophylactic treatment (e.g. to prevent onset of a disease) as well as corrective treatment (treatment of a subject already suffering from a disease).
  • corrective treatment treatment of a subject already suffering from a disease.
  • treat or “treating” as used herein means corrective treatment.
  • a use or method of the invention typically comprises administering a bacteriophage composition described herein to a subject.
  • a “subject” is a mammal, such as a human or other animal.
  • the term “subject” refers to a human subject.
  • the subject is a human subject with a Staphylococcus aureus infection (e.g. a Staphylococcus aureus pulmonary infection).
  • a bacteriophage composition of the invention may be administered to a subject in a therapeutically effective amount or a prophylactically effective amount.
  • a “therapeutically effective amount” is any amount of the composition, which when administered alone or in combination to a subject for treating a bacterial infection (or a symptom thereof) is sufficient to effect such treatment of the infection, or symptom thereof.
  • a “prophylactically effective amount” is any amount of the composition that, when administered alone or in combination to a subject inhibits or delays the onset or reoccurrence of a bacterial infection (or a symptom thereof). In some embodiments, the prophylactically effective amount prevents the onset or reoccurrence of a bacterial infection entirely. “Inhibiting” the onset means either lessening the likelihood of a bacterial infection's onset (or symptom thereof), or preventing the onset entirely.
  • An appropriate dosage range is one that produces the desired therapeutic effect (e.g. wherein the composition is dosed in a therapeutically or prophylactically effective amount).
  • a bacteriophage composition is administered to a subject at a dosage of at least about 1 ⁇ 10 7 PFU of each phage or at least about 5 ⁇ 10 7 PFU of each phage.
  • the bacteriophage composition may be administered at a dosage of at least about 1 ⁇ 10 8 PFU of each phage or at least about 1 ⁇ 10 9 PFU of each phage.
  • a suitable dosage range may be between about 1 ⁇ 10 7 PFU of each of phage to about 1 ⁇ 10 11 PFU of each of phage, preferably between about 5 ⁇ 10 7 PFU of each of phage to about 5 ⁇ 10 9 PFU of each of phage.
  • the bacteriophage composition is administered at least once, twice, three times, or four times daily.
  • the bacteriophage composition may be administered twice daily.
  • a dosage of at least about 5 ⁇ 10 7 PFU of each phage is administered at least once, twice, three times, or four times daily.
  • at least about 1 ⁇ 10 8 PFU of each phage is administered at least once, twice, three times, or four times daily.
  • at least about 1 ⁇ 10 9 PFU of each phage is administered at least once, twice, three times, or four times daily.
  • a dosage range between about 1 ⁇ 10 7 PFU of each phage to about 1 ⁇ 10 11 PFU of each phage may be administered at least once, twice, three times, or four times daily.
  • a dosage range between about 5 ⁇ 10 7 PFU of each phage to about 5 ⁇ 10 9 PFU of each phage may be administered at least once, twice, three times, or four times daily.
  • a bacteriophage composition for use as a medicament may be administered by any route selected on the basis of the condition to be treated.
  • the route of administration is nasal, oral, pulmonary, parenteral, intramuscular, intravenous, subcutaneous, transdermal, ocular, aural or combinations thereof.
  • the bacteriophage composition may be administered nasally or orally, for example via aerosolisation using an appropriate pulmonary delivery means, such as an inhaler or respirator.
  • an antibiotic (suitably a chemical antibiotic) may be administered in combination with the bacteriophage composition of the invention.
  • Combinatorial administration of antibiotics and bacteriophages is taught in WO 2008/110840 and WO 2005/009451, which teaching is incorporated herein by reference.
  • the antibiotic may be administered simultaneously or sequentially with the bacteriophage composition.
  • the one or more antibiotics may be administered after the composition such that bacteriophage replication has become established before antibiotic treatment begins.
  • antibiotic treatment may be delayed for one or more hours or days from application of the one or more bacteriophages.
  • the antibiotic treatment may be delayed for at least 12 or 24 hours, suitably at least 48 hours.
  • the antibiotic treatment may be delayed for at least 3 or 4 days, suitably at least 5 days. In another embodiment, the antibiotic treatment may be delayed for at least one week, for example at least 8, 9 or 10 days. Where a bacteriophage composition in which each phage of the composition exhibits different strain specificity is administered to a subject, it will suffice that at least one or more bacteriophage(s) is capable of targeting the bacterial infection.
  • a bacteriophage composition comprises one or more antibiotics, such as one or more chemical antibiotics.
  • a combination of a bacteriophage composition and an antibiotic may provide an enhanced (e.g. synergistic) therapeutic showing unexpectedly improved efficacy when treating a Staphylococcus aureus infection, particularly when used in treating a pulmonary Staphylococcus aureus infection.
  • An antibiotic may be selected based on sensitivity of a Staphylococcus aureus species or strain to said antibiotic.
  • the Staphylococcus aureus species or strain may be the same species or strain present in a subject to be treated.
  • a Staphylococcus aureus species or strain is taken from a subject to be treated and tested for antibiotic sensitivity.
  • Sensitivity may be determined by in vitro sensitivity assays known in the art.
  • an antibiotic may be selected because it is known to be active against a bacteria known to be (or thought likely to be) present together with a Staphylococcus aureus infection to be treated (e.g. as part of a bacterial biofilm).
  • an antibiotic comprises (or consists of) a penicillin, a penicillinase-resistant penicillin, a cephalosporin, a beta-lactamase inhibitor, a tetracycline or combinations thereof, or pharmaceutically acceptable salts thereof.
  • an antibiotic comprises one or more of: vancomycin, nafcillin, oxacillin, teicoplanin, penicillin, methicillin, flucloxacillin, dicloxacillin, cefazolin, cephalothin, cephalexin, cefuroxime, clindamycin, cefazolin, amoxicillin/clavulanate, ampicillin/sulbactam, lincomycin, erythromycin, trimethoprim, sulfamethoxazole, daptomycin, linezolid, rifampin, ciprofloxacin, gentamycin, tetracycline, doxycycline, minocylcine, tigecycline or combinations thereof or pharmaceutically acceptable salts thereof.
  • the antibiotic may be vancomycin and/or teicoplanin, or pharmaceutically acceptable salts thereof.
  • the antibiotic e.g. chemical antibiotic
  • the time period may be at least 12 or 24 hours, suitably at least 48 hours.
  • the bacteriophage composition and the antibiotic may be administered at intervals of one day to two months apart, preferably at intervals of one to four weeks apart, suitably at intervals of two weeks apart.
  • an antibiotic is administered at a dose of at least about 50 or about 100 mg/kg (suitably at least about 150 mg/kg) once or twice daily.
  • an antibiotic may be administered at a dose of about 100 mg/kg once or twice daily.
  • a bacteriophage composition may be used in a method of killing bacteria (e.g. Staphylococcus aureus ) on a surface, said method comprising applying a bacteriophage composition of the invention (e.g. formulated as a disinfectant composition) to the surface.
  • a bacteriophage composition of the invention e.g. formulated as a disinfectant composition
  • the surface is a site of contamination or prospective site of contamination.
  • the surface is the skin of a mammal (e.g. a human), for example a nasal cavity.
  • a mammal e.g. a human
  • the surface may be equipment (suitably medical equipment), bedding, furniture, walls or floors (e.g. in a clinical environment).
  • a bacteriophage composition may be applied to a surface at a ratio of at least 4:1, 5:1, 6:1, 7:1, 8:1, 9:1, 10:1, at least 20: 1, 40: 1, 50: 1, at least 100: 1 PFU of (suitably each) bacteriophage to colony forming units (CFU) of bacteria.
  • the present invention also provides a kit comprising: a bacteriophage composition according to the invention; and instructions for use of same (e.g. in medicine).
  • the kit may further comprise an antibiotic (e.g. a chemical antibiotic) and instructions for use of same in combination with the bacteriophage composition.
  • the kit may also comprise means for testing antibiotic resistance, e.g. as described in the foregoing embodiments.
  • the instructions provide details for dosing a bacteriophage composition of the invention as described herein.
  • the instructions included in a kit of the invention are for use of same in treating a Staphylococcus aureus infection, e.g. a pulmonary infection.
  • the invention provides in one aspect use of a bacteriophage composition or kit of the invention for a non-medical application.
  • a bacteriophage composition or kit may be used in food hygiene, agriculture or crop protection, and/or in environmental hygiene applications.
  • the kit comprises instructions for use of a bacteriophage composition in a non-medical application.
  • a bandage or wound dressing comprising a bacteriophage composition of the invention.
  • the wound dressing may be a pad or sticking plaster-type dressing.
  • the bacteriophages may be applied to the wound dressing or bandage as a disinfectant formulation or topical cream, prior to applying to the wound dressing or bandage.
  • the wound dressing or bandage may be soaked in a carrier containing the bacteriophages and dried to impregnate said bacteriophages within the dressing or bandage.
  • Bacteriophages may also be adsorbed onto the surface of the bandage or wound dressing using techniques generally known in the art. The advantage of this approach is that the bandage or wound dressing allows the bacteriophages to be brought into contact with a wound which may contain the bacteria.
  • the present invention also provides methods of inhibiting the growth of and/or treating and/or killing bacteria by applying a bandage or wound dressing to a subject.
  • the invention provides a method of treating a pulmonary bacterial infection in a subject comprising administering a panel of four bacteriophages to the subject, wherein the panel comprises bacteriophages Sa 87, J-Sa36, J-Sa37, and Sa83, and wherein the bacterial infection comprises Staphylococcus aureus.
  • bacteriophage composition includes a plurality of such candidate agents and reference to “the bacteriophage” includes reference to one or more bacteriophages and equivalents thereof known to those skilled in the art, and so forth.
  • FIG. 1 shows efficacy of a phage panel vs. vancomycin in a S. aureus pneumonia model: statistical analysis of dosage groups. Statistical analysis was performed using Tukey's multiple comparisons test (Graphpad Prism 6, La Jolla, Calif.). Only groups demonstrating a significant difference in the pairwise comparisons are shown (p ⁇ 0.05). Where two groups are compared to a third, the p value presented is the higher of the two pairwise comparisons. **p ⁇ 0.001, *p ⁇ 0.05.
  • phage lysates were prepared using manufacturing hosts SPS1216 and SPS1226, which do not release endogenous prophage during the production cycle. Cultures were grown in bioreactors to an OD 600 0.2 prior to phage addition. Incubation at 37° C. was continued and absorbance read at least every 60 minutes.
  • Frozen stocks of Staphylococcus aureus UNT109-3 and UNT144-3 were inoculated into TrypticaseTM Soy Broth (BBLTM Laboratories)+5% defibrinated sheep blood (TSBb) and incubated for 18 hrs at 37° C. (shaking). After 18 hrs the culture was diluted 1:10 into fresh TSBb and incubated for a further 5 hrs before being diluted in fresh TSB for inoculation into the mice.
  • mice Female Hsd:ICR(CD-1) mice (Harlan Laboratories, Houston, Tex.) were administered 150 and 100 mg/kg cyclophosphamide on day ⁇ 4 and day ⁇ 1 prior to infection to render them neutropenic. Groups of 5 mice were then anaesthetized by intraperitoneal (IP) injection of 0.15 mL of a mixture of ketamine HCl (100 mg/kg body weight) plus xylazine (10 mg/kg body weight). Once anaesthetized, mice were infected intranasally by placing drops on the external nares and allowing inhalation of the 50 ⁇ l inoculum.
  • IP intraperitoneal
  • mice Twenty-four hours after infection, mice were euthanized by CO 2 inhalation and lungs processed for bacterial titers. Bacterial counts were enumerated on Brain Heart Infusion agar (DifcoTM Laboratories)+0.5% activated charcoal (Sigma-Aldrich) plates for ease of recovering and detecting S. aureus (Barr, J. G., et al., J. Clin. Pathol . (1987) 40:372-376). Mice that had received 7.13 log 10 CFU of strain UNT109-3 all succumbed to the infection prior to the 24-hour harvest, indicating unsuitable virulence.
  • Brain Heart Infusion agar DifcoTM Laboratories
  • activated charcoal Sigma-Aldrich
  • mice infected with 6.95 log 10 CFU of strain UNT144-3 survived until sampling, and exhibited mean log 10 CFU/lung pair titers of 6.78 ⁇ 0.34 and 8.17 ⁇ 0.91 and 2 and 24 hours post-infection, respectively.
  • UNT144-3 was selected for use in the efficacy studies.
  • mice Six groups of 5 mice were rendered neutropenic as described above. Once anaesthetized, an inoculum of 6.98 log 10 CFU in 50 ⁇ L of strain UNT144-3 was delivered intranasally, resulting in mean bacterial lung titers of 7.24 log 10 CFU/lung pair at 2 hrs, which increased to 9.18 log 10 CFU/lung pair at 24 hours in the untreated control group ( FIG. 1 ). 100 mg/kg Vancomycin was administered as a subcutaneous injection 2 hr and 6 hr post-infection; PBS-Mg diluent was delivered intranasally at 2 hr and 6 hr post-infection to the untreated control group.
  • Three phage panel treatment groups were evaluated for efficacy: 2 ⁇ 10 10 PFU/mL per phage, 2 ⁇ 10 9 PFU/mL per phage, and 2 ⁇ 10 8 PFU/mL per phage.
  • 50 ⁇ L doses of phage were administered at both 2 hr and 6 hr post-infection, such that each mouse received 1 ⁇ 10 9 PFU of each phage, 1 ⁇ 10 8 PFU of each phage, or 1 ⁇ 10 7 PFU of each phage at each time point, according to its dosage group.
  • the colony counts in the lung were 7.24 log 10 CFU/lung pair.
  • the multiplicity of infection was ⁇ 60, ⁇ 6 and ⁇ 0.6 for the 3 dosage groups at the 2 hr time point when the first phage dose was administered.
  • FIG. 1 shows a comparison of the different treatment groups that demonstrated statistical significance as determined by ANOVA analysis (Tukey's multiple comparisons test).
  • the 1 ⁇ 10 9 PFU/phage, 1 ⁇ 10 8 PFU/phage, treatment groups demonstrated a significant reduction in lung CFU vs the 24 hr non-treated control (P ⁇ 0.0001 for both).
  • Vancomycin administration 100 mg/kg SC at 2 and 6 hrs
  • a number of bacteriophages (including Sa87, J-Sa36, Sa83, and J-Sa37) targeting Staphylococcus aureus are grown on permissive host strains and then tested against a range of S. aureus strains by: spot testing on bacterial lawns, enumerative plaque assay and broth culture using a plate reader assay system.
  • the plate reader monitors the optical density of a broth culture containing bacteriophages with a suitable host in a multi-well plate format. This latter method allows detailed kinetics of the infection process to be evaluated. Bacteriophages showing good plaque formation are selected.
  • Candidate bacteriophages are propagated in liquid (broth) culture and lysates prepared. Clarified lysates are purified by centrifugation through a sucrose cushion (27 ml of each lysate is carefully over-layered onto 5 ml of a sterile 10% w/v sucrose ‘cushion’, in 36 ml polypropylene tubes prior to centrifugation).
  • the individual bacteriophages (including Sa87, J-Sa36, Sa83, and J-Sa37) are then retested both individually at higher MOI (multiplicity of infection [ratio of infecting bacteriophage to bacterial host cells]) and as a mixture.
  • MOI multiplicity of infection [ratio of infecting bacteriophage to bacterial host cells]
  • bacteriophage J-Sa37 appears to be antagonistic to the effects of bacteriophages Sa87, J-Sa36 and/or Sa83 in reducing the development of bacterial resistance (as is measured by optical density at OD600) illustrating the antagonistic effect of J-Sa37.
  • An improved bacteriophage composition is provided having bacteriophages Sa87, J-Sa36 and Sa83 which demonstrates enhanced therapeutic efficacy when tested using the pneumonia model (see Examples 3-5).
  • Bacteriophages Sa87, J-Sa36, and Sa83 are iteratively passaged with S. aureus strains using conventional techniques (see for example Kelly et al, (2011), Bioengineered Bugs, 2:1, 31-37, which is incorporated herein by reference). Escape phages capable of lysing S. aureus strains previously resistant are selected. Genetic mutation of said escape phages compared to bacteriophages Sa87, J-Sa36, and/or Sa83 is confirmed by genetic sequencing. The escape phages are selected for inclusion in a bacteriophage composition comprising Sa87, J-Sa36, and/or Sa83 based on the methodology of Example 6. The bacteriophage composition demonstrates similarly enhanced therapeutic efficacy to the composition having bacteriophages Sa87, J-Sa36, and Sa83 when tested using the pneumonia model (see Examples 3-5).

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