Key Insights from the Liverpool Phage Therapy Workshop

The recent Nature Microbiology publication titled "Realizing phage therapy in the UK," details a landmark workshop held on November 25, 2025, at the University of Liverpool. Organized under the BBSRC Engineering Biology ‘SafePhage’ Mission Award by researchers from the Universities of Manchester, Liverpool, and Exeter, the event united international experts to bridge the gap between phage research and clinical application in the UK. This gathering highlighted the UK's robust phage biology research ecosystem while underscoring the need for structured implementation amid rising antimicrobial resistance (AMR).

Understanding Phage Therapy: Bacteriophages as Precision Weapons Against Bacteria

Phage therapy, or bacteriophage therapy, involves using viruses that specifically infect and destroy bacteria—known as bacteriophages or phages— to treat infections. Discovered over a century ago, phages offer a targeted alternative to broad-spectrum antibiotics, which often disrupt the human microbiome and fuel resistance. In phage therapy, lytic phages (those that burst bacterial cells) are selected or engineered to attack specific pathogenic strains, replicating within the host bacterium until it lyses, releasing more phages to continue the cycle.

Unlike antibiotics, phages evolve alongside bacteria, self-amplifying at infection sites and sparing beneficial microbes. This precision makes them ideal for multidrug-resistant (MDR) infections, such as those caused by Klebsiella pneumoniae, Acinetobacter baumannii, and Mycobacterium abscessus, prevalent in hospitals and chronic conditions like cystic fibrosis.

UK Universities Leading Phage Research Innovation

UK higher education institutions are at the forefront. At the University of Liverpool, Joanne L. Fothergill co-organized the workshop and researches Pseudomonas aeruginosa phages for lung infections. University College London’s Joanne Santini uses genomic surveillance to design broad-spectrum phage cocktails against K. pneumoniae neonatal sepsis. The University of Warwick’s Antonia Sagona engineers jumbo phages for Burkholderia cenocepacia in cystic fibrosis patients. Meanwhile, the University of Manchester’s Michael A. Brockhurst and Edze R. Westra, alongside Exeter’s Stineke van Houte, drive the SafePhage project, focusing on safe, engineered phages.

These efforts position UK universities as global leaders, fostering collaborations that could create exciting opportunities in research jobs and higher education research positions.

International Lessons: Belgium's Magistral Model

Jean-Paul Pirnay from Queen Astrid Military Hospital in Belgium shared a retrospective of 100 phage therapy cases, revealing 77% clinical improvement and 61% pathogen eradication across 14 pathogens when combined with antibiotics. Belgium's 'magistral' approach—personalized phage preparation by hospital pharmacists—has treated over 230 patients in 20 years, inspiring Portugal and the Netherlands.

Regulatory Progress: MHRA Guidance and Pathways

The Medicines and Healthcare products Regulatory Agency (MHRA) published 'Regulatory considerations for therapeutic use of bacteriophages in the UK' on June 4, 2025, clarifying pathways for licensed, unlicensed ('specials'), and clinical trial use. Phages are biological medicines requiring Good Manufacturing Practice (GMP), but compassionate imports from Belgium have treated 10 UK patients with diabetic foot ulcers. A clinician survey identified over 500 suitable MDR cases annually.

Challenges include case-by-case approvals burdening NHS trusts. For researchers, early MHRA Innovation Office engagement is key for trials and genetically modified phages classified as Advanced Therapy Medicinal Products (ATMPs).

Photo by Michael Dziedzic on Unsplash

Clinical Evidence and UK Case Studies

UK successes include Great Ormond Street Hospital's engineered three-phage cocktail for a cystic fibrosis patient's systemic M. abscessus infection, with over 50 follow-on cases via the US SEA-PHAGES project. Liverpool researchers demonstrate phages resensitizing P. aeruginosa to antibiotics in biofilms.

• High safety profile: Minimal side effects in hundreds of cases.
• Efficacy boost: 77% improvement in combined phage-antibiotic therapy.
• Targeted pathogens: MDR A. baumannii, K. pneumoniae, mycobacteria.

Technological Breakthroughs from UK and Global Experts

Speakers showcased innovations: UCL's surveillance-driven cocktails, Warwick's homing-peptide jumbo phages, Manchester/Exeter's anti-defence mechanisms (e.g., tRNAs countering bacterial CRISPR-like systems). US experts like Graham Hatfull (Pittsburgh) detailed obligately lytic temperate phages, while Vivek Mutalik (Berkeley) used machine learning on 3,000+ screens (1.7M interactions) to predict phage receptors.

These advances, rooted in UK university labs, promise broader host ranges and resistance evasion.

The Upcoming UKHSA Centralized Phage Service

Launching early 2026, the UK Health Security Agency (UKHSA) service will stock pre-characterized phages, streamline imports, and support named-patient treatments—addressing clinician frustrations. Mark Sutton's survey underscores demand, positioning UKHSA as a hub akin to Belgium's.

Challenges and Solutions for UK Implementation

Key hurdles:

• No domestic GMP: CPI is validating protocols; public investment needed.
• Phage-host matching: Surveillance and ML accelerate this.
• Resistance: Cocktails and engineering mitigate.
• Regulation: MHRA Sandbox for synthetic phages.

Solutions emphasize flexible 'magistral' models and IP-protectable engineered phages to attract industry.

Future Outlook: Engineered Phages and Research Opportunities

The workshop envisions engineered phages dominating, with synthetic genomes expanding ranges. Upcoming Phages 2026 in Oxford and Bacteriophage Therapy Summit signal momentum. For UK universities, this means expanded funding, trials, and careers in AMR research. Explore academic career advice or lecturer jobs in microbiology.

Photo by Wyxina Tresse on Unsplash

Implications for Higher Education and Academia

This publication spotlights UK universities' pivotal role, from SafePhage to clinical translations. It calls for interdisciplinary training, attracting talent to higher ed jobs in phage engineering. As GMP facilities emerge, expect postdoc and faculty positions in postdoc opportunities and beyond, bolstering the UK's AMR leadership.

Stakeholders urge follow-up meetings; contribute via SafePhage channels.