Biofilm & Our Future

Marilyn Bruno, CEO of Aequor, Inc.

We have all heard of dental plaque because it is in our mouth and, every day, we brush and swish with an antiseptic. But we also know that brushing and swishing does not work. Plaque builds, hardens, and has to be scraped away by a dental professional every six months. If not, the bacteria living under the plaque dig into our gums, travel through our blood steam, and end up in our hearts, where the same plaque is called endocarditis.

But what is this plaque and why is it so dangerous? The microbiologist’s name for plaque is “Biofilm.” It is formed by most bacteria and fungi to attach themselves to surfaces and then envelop themselves in an impenetrable shield. It is dangerous because it is not just on your teeth where it can be scraped away, but everywhere that bacteria and fungi are found: on all surfaces, in water, in plants and animals, in food, in wounds on our skin, and infections inside our body. Biofilm is in fact the first resistance response of most bacteria and fungi to protect themselves when they sense stress of any kind – from the human immune response, antiseptics and other antimicrobial biocides, antibiotics, heat and all sterilization methods, sonication, etc. Today, the bacteria’s resistance triggers are so well-developed that biofilm forms thicker and faster than ever when the microorganism is stressed. Biofilm on industrial surfaces causes corrosion, slime, scale, and contamination. On medical surfaces, biofilm causes infection and disease.

There are few methods to remove biofilm once it is formed. Not all surfaces can be sterilized or scraped. Our immune system, antimicrobials and antibiotics are designed to kill free-floating bacteria. Nothing known can remove the biofilm shield at non-toxic doses. That is right. All the disinfectants flying off the shelves can only work at toxic doses. And their use and the overuse of antibiotics is spawning new antimicrobial-resistant (AMR) Superbugs. It is no coincidence that every pandemic threat and AMR pathogen listed by the World Health Organization and U.S. Centers for Disease Control (CDC) is a biofilm-former for which there is no cure.

Over 2.7 million people died from biofilm-related antimicrobial-resistant AMR Superbug infections in 2019 (32,000 in the U.S.). In April 2020, the CDC reported that 20% of COVID-19 deaths (over 50,000 to date) were due to secondary infections, including Superbug infections from indwelling medical devices (respirators, catheters, implants, stents, etc.) and contaminated surfaces (Legionella in hospital plumbing and air conditioning, Candida auris on curtains separating hospital beds). In addition to patient suffering and death, biofilm contamination and infection cost the global healthcare system over $300 billion annually and rising. We can see the socioeconomic impacts of the COVID pandemic – a virus that is comparatively easier to contain.

There is high global demand for remedies for infection that cure the patient in 7-10 days but “anti-infective” products are considered to have a relatively low return on investment compared with “blockbuster” therapeutics (that you have to take every day for the rest of your life – like remedies for heart disease, diabetes, blood pressure, etc.)

Pharma companies and investors have walked away from funding research and development of antiinfectives because the regulatory approval process is long and costly and revenues from sales of antiinfectives are too low to offset the costs of production. Few new antibiotics have been approved since Penicillin because they cannot work in the presence of biofilm.

Additionally, according to the U.S. Food and Drug Administration (FDA), biofilm is not a medical condition against which antibiotics work. Therefore, there is no “Reimbursement Code” for antibiofilm remedies in the U.S. Since a doctor or hospital cannot bill for their use, they can’t be bought! They do not exist in the eyes of health insurance companies, Pharma companies, grantors, investors, etc.

In 2016, the United Nations General Assembly High Level Meetings called Antimicrobial Resistance the greatest threat to mankind. The next pandemic, projected to be from Superbugs, is estimated to claim 10 million lives. Antibiofilm remedies can control the pandemic spread by following the UN “One Health” approach – eradicating the biofilm-forming pathogens in their three vectors of transmission: from human contact, from animals to humans, and from the environment to humans.

November 3rd is International One Health Day. We can all can celebrate awareness of the public health threats and ways to prepare to eradicate them by supporting the development of antibiofilm remedies in industry, the environment and healthcare.

Company leaders can assess their cleaning products and protocols, require building and facilities management to eliminate bacterial and fungal threats, train their teams to adopt best practices early to minimize the spread of contamination, and keep informed of the scientific breakthroughs that will enable their businesses and employees to survive and prosper.