Cotter doesn’t know how the metabolites would be administered yet. A lollipop or throat spray for strep? Delivered topically for staph? His testing is still thoroughly ongoing. Should he receive the NIH grant he's applying for––a grant backed by a $1.2 billion White House Initiative to stop resistant diseases––answers could arrive rapidly. Analytical labs would go up, animal testing would begin, streptococcus lollipopus before we know it.
But Cotter’s dramatic departure from traditional pharmaceuticals sits uneasy with some scientists I spoke to about his idea. For starters, it strikes many as dangerous. In medicine, science painstakingly searches for and isolates helpful metabolites, because metabolites can be toxic, too. Cotter’s process would have to find a way to identify metabolites that are harmful to people and somehow remove or neutralize them first. “Maybe you found a fungus that produces a metabolite that kills strep. Well fungi don’t just make one metabolite,” says Nancy Keller, a University of Wisconsin microbiologist. “The fungus is likely making many other metabolites, and although one might be useful, other metabolites might be injurious.” At worst, the magic Cotter’s hoping for may just be pseudoscience.
Not everyone was so dismissive, though. Aaron Hawkins, a microbiologist and chemical engineer at the Danish biotechnology company Novozymes, described Cotter's process as a unique, "almost holistic" idea, comparing it to the difference between herbal and allopathic medicine, in that herbal medicine relies on both active and supporting compounds to heal people. It's the difference between taking vitamin C versus eating an orange; the vitamin C is only part of what makes it healthy.
Still, Hawkins concedes that “in the way that modern medicine looks at things,” Cotter’s process “is really messy.”
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Science isolates. Science synthesizes. But in the case of rapidly adapting bacteria, science also seems to be falling behind. Significant time, money, and effort are required to get traditional antibiotics to market (if and when we discover them), and once there, with no adaptivity, these drugs often become sitting ducks for disease resistance. Penicillin had its first resistant bacterium within two years. Methicillin rapidly begot MRSA. Ditto: VRE, Salmonella, C. difficile—the list goes on. Our current drugs may be doing a better job of arming dangerous bacteria than defeating them.
Cotter's concept, early in the process though it may be, aspires to give medicine a leg up with an inherently less-susceptible approach. It's adaptive, and allows the fungus to decide—as fungi have since they first had to defend themselves against bacteria—what it would take to best defeat each bacteria in the moment.
Currently, Cotter is still testing the toxicity of these secondary metabolites while "playing matchmaker" to locate the best fungus or fungi for any given bacterium. He is also working with agricultural pathogens—botrytis (known for attacking wine grapes) and sclerotinia (known for causing white mold), for instance––which is an area where his technique first may be applied. Part of this process has been licensed out to Clemson University, where they are better equipped to manage drug-resistant bacteria. And though advisors there couldn't yet comment on specific results of the trials—due to a patent Cotter has on his technique and his collaborative agreement with the university—Clemson microbiologist Tamara McNealy did confirm the superbug MRSA is actively being tested.