In a cramped lab in rural Pennsylvania, surrounded by technicians in obligatory white lab coats and fume hoods leaking an occasional acrid smell, Neil Pearson holds up a plastic model of a chemical compound that resembles a spidery piece of Lego.
Pearson, a 54-year-old chemist and senior fellow at British pharmaceutical giant GlaxoSmithkline , explains how he spent more than a decade tinkering with chemical compounds before engineering a molecule that may yield the industry's first truly new antibiotic in 30 years to fight the rise of superbugs that risk killing an extra 10 million people every year by 2050.
Adverse reactions, including possible eye and heart problems discovered in animals, forced Pearson to start over multiple times, with each re-jigging of the compound's atomic structure requiring a fresh round of tests to prove it was safe and effective. Pearson, wearing clear lab glasses, likens it to a game of snakes and ladders.
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Pearson's slicked back salt-and-pepper hair is just one sign of his years in the lab doing what few pharmaceutical companies are doing these days: trying to come up with novel ways to kill bacteria that have become increasingly resistant to existing antibiotics. In 2007, he uprooted his family from England to work in Glaxo's research hub, set amid rolling farmland an hour outside Philadelphia.
Glaxo is now testing Pearson's drug, gepotidacin, on gonorrhea patients in the US after trialling it on patients with severe skin infections. With lab studies suggesting it could fight plague, a potential bio-terrorism agent, it's among only eight genuinely new classes of antibiotics in clinical development anywhere in the world.
Not since Eli Lilly discovered daptomycin in 1984 has the pharmaceutical industry come up with a completely novel antibiotic, according to the Pew Charitable Trusts. During that time, all but a few big pharma companies have shuttered their bacterial research units, shrinking the universe of expertise.
Just this month, AstraZeneca became the latest big pharmaceutical company to pull out of antibacterial drug development when it sold its antibiotics business to Pfizer. GlaxoSmithKline is one of the few big players that's kept at it, sinking about $1 billion of its own money over the past decade into antibacterial research.
Alarming reports keep coming about bacteria that can evade modern medicine's trusted arsenal of anti-biotics. This month, researchers at the University of Cambridge found that a quarter of all supermarket chicken sold in Britain harbours drug-resistant E. coli, which can cause kidney failure and, in severe cases, death. Also this month, the Centres for Disease Control and Prevention reported a fourth US case of a superbug carrying the so-called mcr-1 gene that makes bacteria resistant to the last-resort antibiotic colistin.
Fears of superbugs spreading have prompted the United Nations to convene a high-level meeting with heads of state in New York. Wednesday to devise ways to combat antimicrobial resistance.
The meeting comes two years after the World Health Organization warned that, without action, the planet was headed for a post-antibiotic era, in which common infections and minor injuries that have been treatable for decades could once again kill.
"High-tech medicine faces a very substantial threat," potentially jeopardizing everything from intensive care units to major surgery, says David Livermore, a professor of medical microbiology at the University of East Anglia, north of London. "We face major resistance problems with gonorrhea and tuberculosis."
Despite the rise of superbugs, big pharma has largely exited antibiotic research because the payoff is so low. Even if Glaxo brings a new medication to the market, by definition it can't be a blockbuster drug. Overuse of antibiotics has encouraged resistance, which means new treatments must be used sparingly.