title: Inhaled phage therapy: a promising and challenging approach to treat bacterial respiratory infections.
abstract: Bacterial respiratory tract infections (RTIs) are increasingly difficult to treat due to evolving antibiotic resistance. In this context, bacteriophages (or phages) are part of the foreseen alternatives or combination therapies. Delivering phages through the airways seems more relevant to accumulate these natural antibacterial viruses in proximity to their bacterial host, within the infectious site. Areas covered: This review addresses the potential of phage therapy to treat RTIs and discusses preclinical and clinical results of phages administration in this context. Recent phage formulation and aerosolization attempts are also reviewed, raising technical challenges to achieve efficient pulmonary deposition via inhalation. Expert opinion: Overall, the inhalation of phages as antibacterial treatment seems both clinically relevant and technically feasible. Several crucial points still need to be investigated, such as phage product pharmacokinetics and immunogenicity. Furthermore, given phage-specific features, appropriate regulatory and manufacturing guidelines will need to be defined. Finally, randomized controlled clinical trials should be carried out to establish phage therapy's clinical positioning in the antimicrobial arsenal against RTIs.
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.|c CHRU de Tours, Service de Pharmacie , Tours , France.
authors: Elsa
authors: E
authors: Bodier-Montagutelli
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.
authors: Eric
authors: E
authors: Morello
authors: d Pherecydes Pharma , Romainville , France.
authors: Guillaume
authors: G
authors: L'Hostis
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.|e CHRU de Tours, Service de Réanimation Polyvalente , Tours , France.
authors: Antoine
authors: 0000-0002-4884-8620
authors: A
authors: Guillon
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.
authors: Emilie
authors: E
authors: Dalloneau
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.|c CHRU de Tours, Service de Pharmacie , Tours , France.
authors: Renaud
authors: R
authors: Respaud
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.
authors: Nikita
authors: N
authors: Pallaoro
authors: c CHRU de Tours, Service de Pharmacie , Tours , France.
authors: Hélène
authors: H
authors: Blois
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.|f DTF-Aerodrug , St Etienne , France.
authors: Laurent
authors: L
authors: Vecellio
authors: c CHRU de Tours, Service de Pharmacie , Tours , France.
authors: Jérôme
authors: J
authors: Gabard
authors: a Université François Rabelais, UMR 1100 , Tours , France.|b INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100 , Tours , France.
authors: Nathalie
authors: N
authors: Heuzé-Vourc'h
mesh_terms: D000280:Administration, Inhalation; D000818:Animals; D001424:Bacterial Infections / Q000628:therapy*; D001435:Bacteriophages; D006801:Humans; D000071059:Phage Therapy; D012141:Respiratory Tract Infections / Q000628:therapy*
keywords: Respiratory tract infection; aerosol delivery; antibiotic resistance; bacteriophage; biotherapeutics; formulation; phage therapy