Translator: Alejandro Comas Reviewer: Nerea García Garmendia
In this planet we live in,
there is a living being that stands out and dominates the others.
There are thousands of millions of individuals
whose activity greatly affects, without a doubt,
the lives of all the animals
and all the living beings that inhabit this planet.
I'm speaking about bacteria, of course.
They are all over the Earth:
in the Antarctic, in the depths of the sea,
they are found in forests, in this very theatre,
they are in your skin,
in your intestines, in everybody's intestines,
even in the intestines of astronauts.
There are hundreds and hundreds of different species of bacteria,
and all of them live in perfect harmony
with the environment they colonise.
Sometimes, eventually,
bacteria embark on the colonisation of a new medium,
a new habitat,
and humanity makes a benefit out of it.
Sometimes.
Because some other times they cause a tremendous damage to it.
I'm speaking about infections.
Infections take place when a bacterium colonises our body.
Tuberculosis, for instance.
Tuberculosis is caused by the 'Mycobacterium tuberculosis' bacterium
when it colonises our lungs.
The bacterium grows, and gets the food it needs to grow
from our cells, destroying our lungs.
See? If you pay attention, the bacterium isn't an evil being,
the only thing it wants is to grow, to survive.
The conflict, the problem lies in the fact that we are its food.
Bacteria have caused death
to millions and millions of people throughout the history of humankind,
and there's no need to look back to the Black Death or leprosy,
those pandemics which did wreak havoc in the Middle Ages in Europe.
You only need to think that in the 1920s or 1930s,
catching a tuberculosis infection virtually implied a death sentence,
and the only possibility to alleviate that infection
was isolating those infected in sanatoriums in the mountains,
where, on the one hand, people in the city who weren't infected were safe,
and, at the same time, those infected had sunlight, fresh air and could get rest,
so they could stay strong and fight the infection.
I was born in a village in Murcia called Alhama,
a small village at the bottom of Sierra Espuña.
That sanatorium for tuberculosis patients is in that mountain range.
Luckily, the sanatorium is abandoned and on the verge of collapse,
but there was a time when it was a very busy spot
to seclude tuberculosis patients and try to get them recover,
with a very low success rate, very few could get over the infection.
Today we can open a window and look back in time,
we can be there for a moment,
because someone took this picture when the sanatorium was still open.
Look what a crowd
and so many young people basking in the sun out in the terrace
hoping to get better from tuberculosis,
oblivious, or maybe resigned, to a more than likely fatal ending,
because, as I have previously said,
contracting tuberculosis at the time
was pretty much a death sentence.
These sanatoriums, like many others,
they closed down in the 1950s due to lack of use.
Antibiotics wiped them off the map
in what became one of the most important discoveries
in the history of humankind.
Antibiotics are molecules produced by bacteria
to kill other bacteria that also try to colonise that same niche.
Human beings, thanks to our intelligence,
managed to extract and purify them,
to use them in our own profit,
to cure infections.
Antibiotics meant the revolution of the modern medicine
of the 20th century,
because, thanks to them,
we've managed to carry out extremely complex surgery procedures
without risking getting infections during surgery or in postoperative period.
Apart from that, they have truly helped to eradicate pandemics of the world:
typhus, cholera, leprosy, tuberculosis, gonorrhoea ...
However, nowadays,
we can say antibiotics have been victims of their own success,
for we have been using them incorrectly, inadequately,
we have been overusing them.
We've included them in every aspect of our lives.
We've used them not only to cure infections,
but to prevent the possibility of catching them.
We've produced toothpaste with antibiotics,
acne lotion with antibiotics,
cough tablets with antibiotics,
antibiotics in the food, antibiotics in the water,
antibiotics in the rivers, in the farms, in the animals,
antibiotics everywhere to protect ourselves,
because they worked so well.
But life always finds a way,
and bacteria adapt
because they want to survive as any other living being,
and they evolve, they become resistant to antibiotics.
The so-called antibiotic-resistant or superbug can grow
in environments we intentionally poison with antibiotics.
And they are the reason why in the last decades
there has been a significant increase in the number of infections.
I'm going to give a close example:
in Spain, 30 times as many people die from superbug infections
than from car accidents.
And if the problem escalates in the fashion it does now,
the World Health Organization predicts that, by 2050,
infections caused by superbugs
will be the number one cause of death in the world,
over many others such as cancer,
or cardiovascular illnesses.
"But, where are these dangerous superbugs?
I've never heard of them", you may be wondering.
The niches we're most worried about
are those in which human beings are vulnerable,
such as hospitals.
Hospitals use many antibiotics, of course,
and the defences of patients there are low,
obviously, because they are ill,
and that makes them prone to be infected by resistant bacteria.
Hospital infections are causing
that relatively simple surgeries
now turn to be really complex and difficult to carry out
because of the high risk of contracting an infection
which hinders patient's recovery,
or may develop into a chronic illness, or even cause death.
Let me introduce you today to the main character of the story:
this bacterium I'm showing you is the 'Staphylococcus aureus',
a penicillin-resistant bacterium.
It is very common in hospitals,
and causes most of the infections there.
In the picture it does not look so dangerous, it's like a bunch of grapes.
The name Staphylococcus comes from Greek, and it means exactly that:
bunch of grapes.
It is found naturally in our skin
and in our nostrils, and we all have it,
and there, in that environment, it is not pathogenic,
it even helps us to prevent getting yeast infections.
The problem starts when our skin, which is a barrier,
breaks due to surgery or a scalpel, a catheter or just an injection
that could let the Staphylococcus aureus in our body
and produce an infection.
If it infects our bones, it will produce an osteomyelitis;
if that occurs in our lungs that will produce a pneumonia;
if it invades our whole body, it will be a generalised sepsis.
And all those infections will be so hard to treat
if the strain that infected us is antibiotic-resistant.
What can be done to fight this superbug?
What resources do we have?
There are many laboratories in the world whose sole aim
is to understand how bacteria develop their resistance to antibiotics
and how can a new strategy be developed to fight and beat them.
I manage one of those laboratories here in Madrid,
and we work with penicillin-resistant Staphylococcus aureus.
So far we knew the Staphylococcus aureus
produces that resistance to antibiotics
by means of a protein complex which is like the engine of a car.
It has several components
that need to be assembled so that the engine can work
and protect it, like an armour
against a hammer, which are the antibiotics.
We've found out that the assembling of the protein complex,
the assembling of that engine takes place in very specific areas
of the bacterium's surface.
We've found out that the surface of the bacterium is not regular,
it's heterogeneous, with several areas of different composition,
just as if it was the skin of a cow, with black and white stains,
and the protein complex needs to be located
in one of those specific areas in the black stains, let's say,
in order to be assembled correctly and be functional.
Then, using molecular biology,
we've able to manipulate the bacterium's DNA
we've created a mutant
whose surface is far more homogeneous and regular than the bacterium's,
and we've seen that, in the mutant,
the protein complex doesn't find its place and is not assembling correctly
so the superbug is no longer that
and turns into a conventional bacterium
which we can be normally eliminated by using common antibiotics.
From then on, molecular biology shows us the way,
and decides the strategy to be followed.
Our combat strategy is to generate a bacterium
which is homogeneous in its surface so the complex can't assemble.
We've used compounds that, when added to the cultures,
they stop the production of a grease in the bacterium's surface
which distorts its surface and makes it more homogeneous.
In other words:
these compounds, when presented to the bacterium,
make the cow's skin not to be spotted in black and white,
but they make the cow totally white.
In that moment, in the presence of the compounds
that engine, the protein complex,
can't be assembled correctly and loses its functionality.
Interestingly,
many of those compounds are statins,
the molecules that are used to lower cholesterol
in patients who suffer from hypercholesterolemia, high cholesterol.
I'm sure many people in the audience are taking statins,
you may also wonder for how long you haven't caught an infection.
A combination of statins and antibiotics,
it's able to kill strains resistant to antibiotics
which usually we had no clue on how to do it.
Another important aspect of this work
is that we hope to recycle antibiotics which were no longer used,
that were totally forgotten,
because bacteria's resistance to antibiotics
had made them useless.
We can increase our resources
as statins dismantle the antibiotics' resistance complexes,
and once they're dismantled,
we can kill the bacteria with common antibiotics.
We've tested our experiments on mice,
producing amazing results,
and we hope that, in the future, they can become a therapy
which helps the human being to protect himself
from superbugs in hospitals.
But it is only a battle that we've won
in this never-ending war,
because, as I've previously said, life always finds its way,
and the bacterium will adapt because it needs to survive
and it will undoubtedly find a way to avoid that treatment.
We need to evolve with it,
and produce more complex procedures
that enable us to go on fighting against superbugs.
All together:
hospitals, doctors, research centres
and us, from our homes, with small gestures,
we can make a huge contribution to stop superbugs.
Small gestures such as these:
Using antibiotics only under prescription of a doctor,
because it may be that our infection is not of a bacterial origin,
in this case antibiotics are completely useless.
When prescribed by a doctor, we must finish the treatment,
even if we feel well on the first day, we must go on until the end,
as an early ending of the treatment makes it weaker
and increases the chances of producing superbugs.
Once we've finished the treatment
we can't throw antibiotics to the bin nor the toilet
as they will end up in the rivers and into the soil,
and the bacteria there will develop super-resistance, too.
We must be careful and become aware
that undergoing surgery implies a certain risk,
we only must do it if necessary.
And last, wash your hands very well
and cook your food well to protect yourselves.
By doing all of this,
and with the help of hospitals and research laboratories,
these are the only tools we have
to remain in this race against bacteria
and win this battle.
Because, every time bacteria have taken advantage in this race
we've been vulnerable to them,
and, in the last decades
it was us who were leading the race, and had an advantage,
and they've been the healthiest decades in the history of humanity.
We must protect that advantage, we must manage well our resources,
resources that so much work and effort we invested in.
Thank you.
(Applause)