Host and pathogen response to bacteriophage engineered against Mycobacterium abscessus lung infection

Two mycobacteriophages were administered intravenously to a male with treatment-refractory Mycobacterium abscessus pulmonary infection and severe cystic fibrosis lung disease. The phages were engineered to enhance their capacity to lyse M. abscessus and were selected specifically as the most effective against the subject’s bacterial isolate. In the setting of compassionate use, the evidence of phage-induced lysis was observed using molecular and metabolic assays combined with clinical assessments. M. abscessus isolates pre and post-phage treatment demonstrated genetic stability, with a general decline in diversity and no increased resistance to phage or antibiotics. The anti-phage neutralizing antibody titers to one phage increased with time but did not prevent clinical improvement throughout the course of treatment. The subject received lung transplantation on day 379, and systematic culturing of the explanted lung did not detect M. abscessus. This study describes the course and associated markers of a successful phage treatment of M. abscessus in advanced lung disease. [Display omitted] •Treatment-refractory M. abscessus pulmonary infection was eradicated in a person with CF•Specific mycobacteriophages lysed the bacteria over the course of a year•M. abscessus did not acquire resistance to the phages•M. abscessus eradication occurred despite a partial anti-phage antibody response Phage treatment of an individual with cystic fibrosis, advanced lung disease, and M. abscessus infection enabled a subsequent successful lung transplant.