Our First Adventure With Phage Therapy: Alfred’s Story

By Betty Kutter

I first met Alfred Gertler standing on the broad steps outside the Thirteenth Evergreen International Phage Biology Meeting at McGill University. Standing on crutches, he was regaling Rezo Adamia and the other smokers in the group with stories of his catastrophic climbing accident 4 years earlier while working as a musician on a cruise ship. His pulverized ankle had become badly infected, leading to osteomyelitis that was not cleared up by multiple surgeries, an IV pump of an antibiotic for a full year and other available treatments. The bacteria had built a reservoir in his ankle that was so deeply entrenched and well isolated from the circulating antibiotic that no resistance had even developed. The same antibiotic still served to keep the bacteria under control in the rest of his body so long as he spent most of his time in bed, but that constraint was devastating to both his career as a string bass player and to his family life with a pair of preschoolers, and things were getting worse rather than better.

The only option he was now given by his physicians was unthinkable – amputation! And then he had seen an article a few months earlier in the New York Times Magazine about the Republic of Georgia and the use of bacteriophages as antibiotics. The article had mentioned the upcoming International Phage Biology meeting in Montreal, where his parents lived, and he arranged to participate in the meeting, studying all he could in advance and undaunted by being the only nonscientist in attendance. His sincerity and dedication impressed everyone there and he soon made many friends.

Rezo Adamia took a sample of his bacteria back to Tbilisi, where scientists soon confirmed that it was highly sensitive to the Pyophage mixture standardly used in hospitals there as well as to their special single phage against Staphylococcus. For 6 months, he tried to find a physician near his home in Toronto willing to administer the phage, but still was unsuccessful when I called in January, 2001 shortly before I was to leave to give a talk in Bangalore and then visit Tbilisi. We agreed that with such a complex problem, it made much more sense to be treated in Tbilisi, where people had so many years of experience – and our Tbilisi colleagues managed to arrange with Dr. Guram Gvasalia, the best surgeon there, to treat him.

Alfred met me in London, stayed with me at the home of my long-time friend Liana Gachechiladze for a week of evaluation by a phalanx of physicians, and then entered the hospital for 10 days of treatment. There were still open wounds in both sides of his ankle and the phage solution could be pumped through from one side to the other over 24 hours. Phage bioderm was then inserted to gradually release phage over a couple of days, along with enzymes to help break down the scar tissue and let the phage better access the bacteria. Electrical stimulation was used to further enhance the process. Within a few days, the fluid draining from his ankle was free of bacteria!! He headed home 2 weeks later armed with phage and other supplies, with an admonition to have surgery to fuse the ankle and reduce the irritation within about half a year or expect some further trouble.

Alfred soon was back playing his bass in bands, playing with his kids, and generally again picking up the pieces of his life – feeling that a miracle had happened. (He finally had the surgery!) Hopefully there will be more routine mechanisms in place before long for others to follow in his footsteps – and eventually phage therapy will be available around the world for all who need it so desperately.

While in Toronto for the 2007 ASM meeting, I had the wonderful opportunity to see Alfred again and watch him playing a gig — foot still intact. A 2009 conversation showed that his gratitude for the healing power of phages is still very strong.