title: Beyond killing: Can we find new ways to manage infection?
abstract: The antibiotic pipeline is running dry and infectious disease remains a major threat to public health. An efficient strategy to stay ahead of rapidly adapting pathogens should include approaches that replace, complement or enhance the effect of both current and novel antimicrobial compounds. In recent years, a number of innovative approaches to manage disease without the aid of traditional antibiotics and without eliminating the pathogens directly have emerged. These include disabling pathogen virulence-factors, increasing host tissue damage control or altering the microbiota to provide colonization resistance, immune resistance or disease tolerance against pathogens. We discuss the therapeutic potential of these approaches and examine their possible consequences for pathogen evolution. To guarantee a longer half-life of these alternatives to directly killing pathogens, and to gain a full understanding of their population-level consequences, we encourage future work to incorporate evolutionary perspectives into the development of these treatments.
authors.affiliation: Centre for Immunity, Infection and Evolution Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, UK pedro.vale@ed.ac.uk.
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Vale
authors.affiliation: Centre for Immunity, Infection and Evolution Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, UK.
authors.forename: Luke
authors.initials: L
authors.lastname: McNally
authors.affiliation: The Roslin Institute and R(D)SVS, University of Edinburgh, Easter Bush EH25 9JT, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Doeschl-Wilson
authors.affiliation: Department of Zoology, University of Oxford, Oxford OX1 3PS, UK.
authors.forename: Kayla C
authors.initials: KC
authors.lastname: King
authors.affiliation: Centre for Immunity, Infection and Evolution Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, UK.
authors.forename: Roman
authors.initials: R
authors.lastname: Popat
authors.affiliation: Institute for Genetics and Development of Rennes - CNRS UMR 6290, 2, Avenue Du Pr. Léon Bernard, Rennes 35043, France.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Domingo-Sananes
authors.affiliation: Centre for Immunity, Infection and Evolution Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, UK.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Allen
authors.affiliation: Instituto Gulbenkian De Ciência, Rua Da Quinta Grande, 6, Oeiras 2780-156, Portugal.
authors.forename: Miguel P
authors.initials: MP
authors.lastname: Soares
authors.affiliation: Department of Plant and Microbial Biology, University of Zürich, Switzerland.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kümmerli
keywords: anti-virulence drugs; damage limitation; disease tolerance; evolution; infection; microbiota