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We will be treating the patients’ eyes rather than the microbes themselves: Prof Pete Monk

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A team of scientists and clinicians from the University of Sheffield are working with colleagues at the LV Prasad Eye Institute in Hyderabad, India, to develop a new treatment for eye infections that does not rely on conventional antibiotics – to which many microbes are becoming rapidly resistant

Professor Pete Monk from the University of Sheffield’s Department of Infection, Immunity and Cardiovascular Disease, is leading the research and in an exclusive interview with Tanuvi Joe discusses about how the treatment can be applied safely without needing time-consuming identification of the bacterial pathogen, allowing it to be used as early as possible in remote rural locations.

Why has the University of Sheffield partnered with the LV Prasad Eye Institute for its upcoming eye treatment?
LV Prasad has an international reputation for clinical excellence but it is also internationally renowned for the quality of the scientific research that it performs. This makes it a unique institution in India and one that many overseas partners would like to work with. The University of Sheffield has a long-standing connection with LV Prasad that has already resulted in a new, effective therapy for loss of vision that is being adopted throughout India. Building on these established links, the University of Sheffield and LV Prasad have jointly developed a new project, to help prevent eye infections in India. If successful, we would expect to see the new treatment adopted in similar countries throughout the world.

Which are the various factors that contribute to eye infections in India?
Infections to the eye often follow accidental injury to the transparent layer at the surface of the eye, the cornea. The cornea normally resists infection by preventing bacteria and fungi in the environment attaching to the eye, so that they are routinely swept away every time that we blink. Damage to the cornea provides a site to which microbes can stick strongly, resisting the action of blinking and tears. These microbes grow and cause further damage, penetrating into lower layers and eventually into the body of the eye. At this stage, removal of the infected eye is required to save the patients’ lives.

With a high number of agricultural workers, India naturally has many people whose eyes can be damaged during the harvest. Unsafe working conditions in small industries or at home can also lead to corneal damage. Another factor in India is the frighteningly rapid rise of resistance to antibiotics: up to 50 per cent of eye infections can be caused by resistant bacteria which cannot be treated with conventional antibiotics. Finally, due to the climate in India, fungal infections are far more common than in the USA or UK and these infections are often difficult to treat.

What could be the reasons for incorrectly detecting eye infections in India?
After damage, the eye will become red and sore whether it has become infected or not. A patient with ‘red eye’ may have minor damage that will quickly heal or a potentially catastrophic infection and this can only be diagnosed by access to a clinical laboratory that can detect the presence of infectious microbes. Such laboratories are often only available in larger towns, with cost and distance a major barrier that prevents patients seeking help until it is too late. This is why we are aiming to develop a treatment to prevent microbes from sticking to damaged eyes, that is sufficiently cheap and safe to apply to any ‘red eye’ without diagnosis of an infection. Importantly, our proposed treatment will not lead to increased resistance to antibiotics.

While developing this treatment, what principles have been kept in mind?
It is important to note that LV Prasad has established a ‘pyramid’ of eye health care, with the Institute in Hyderabad as the apex that broadens out in secondary and primary centres, down to a base of individual trained healthcare workers in the villages of states in Andhra Pradesh, Telangana, Odisha and Karnataka. By providing a treatment that can be applied at the base of the pyramid of care, we hope to prove the principle that both the treatment and an efficient means of distribution are necessary. After doing this, we will create a global network of developing countries that uses the LV Prasad pyramid model to provide effective eye protection to all citizens.

How is this treatment unique compared to the existing ones?
Our treatment is unique, in that we will actually be treating the patients’ eyes rather than the microbes themselves. We use a small fragment of protein found in the cornea which acts on the cells of the eye to disperse the ‘landing sites’ that bacteria and fungi use to stick to areas of eye damage. Treating the eye rather than the microbes means that resistance does not get produced in the bacteria and fungi. We have also shown that our treatment works well in combination with old antibiotics to which some bacteria have become resistant, allowing the re-use of these existing drugs.

How will this treatment be made accessible to the rural households?
We will use the LV Prasad pyramid to get the treatment to rural households. We envisage that stocks of the treatment will be held by village healthcare workers and used in cases of damage to the cornea even without diagnosis of infection. A partner pharmaceutical company in India will be required to make this possible.

We will be working with scientists at LV Prasad to develop the best possible treatment. We already know that our treatment works well in the laboratory but it is important that we test the treatment on samples of the microbes that are encountered frequently in clinics at LV Prasad. By working with clinicians, we will also be able to ensure that the treatment causes no harm to the human eye.

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