the book is on the treatment of disease (biotherapeutics) ... photographs varies throughout the book. ... There is an almost unlimited diversity of potential bio-.
JAC
Journal of Antimicrobial Chemotherapy (1999) 44, 422
Book reviews Biotherapeutic Agents and Infectious Diseases G. W. Elmer, L. V. McFarland & C. M. Surawicz Humana Press Inc., Totowa, NJ, USA, 1999. ISBN 0-89603-647-2, $125.00. The editors have brought together review articles from twenty authors with experience in the use of live microbial interventions in animal and human health. The emphasis of the book is on the treatment of disease (biotherapeutics) rather than prevention of disease or the long-term health consequences associated with food supplementation with probiotics. The book provides a useful overview of biotherapeutic interventions and their potential benefits. Live microbial supplements are widely available over the counter, but their distribution and quality control have been poorly regulated, so it is appropriate that the first chapter addresses some of these issues. Thereafter, there are chapters covering mechanisms of action, pharmacokinetics, the microbiological and immunological consequences of biotherapeutic interventions, potential risks and the experimental evidence that biological agents have a therapeutic role in certain disease states. The final chapter outlines an agenda for future research. The chapters are generally well written and the references are up to date. The standard of tables, figures and photographs varies throughout the book. Although generally acceptable, some photographs are unfocused and there are figures such as ‘Scheme of the role of S. boulardii in C. difficile infections’ (Figure 5, Chapter 7) which are almost illegible. One of the major problems with this area of research is the complexity of interactions associated with administration of live microorganisms. There has been little work on defining the ability of laboratory or animal models to predict the consequences of administration of biotherapeutic agents to ill patients, so that the strains selected for study tend to be from low virulence species (such as lactobacilli) which can colonize animal or human subjects and which are not known to be associated with disease. A criticism of the book is that there is little critical analysis of disease models.
There is an almost unlimited diversity of potential biotherapeutic agents and methods of screening strains for further study are urgently needed. The chapter on risks is very brief. The main emphasis is on the risks of infectious complications in the recipients of biotherapeutic agents. Human studies have shown that cross-colonization can occur with probiotics but there is little discussion of the ethical issues and potential medicolegal consequences of detrimental effects resulting from cross-colonization or infection. The potential consequences of long term colonization or cross-colonization with a biotherapeutic agent are important issues, but given little emphasis. Immune modulation by biotherapeutic agents could have profound long term consequences for an individual. A biotherapeutic agent could be of benefit in one patient group but of detriment in another. The gastrointestinal tract contains a large proportion of an individual’s total lymphoid tissue. The gut microflora is thought to be important in mucosal development and contributes to systemic and mucosal immunity. It may also be important in determining the predisposition of an individual to allergic diseases. Some of these aspects are covered in the chapter on immunological effects, but this aspect of biotherapeutic interventions is barely mentioned as a potential risk. In conclusion, this book is of interest to those wanting an introduction to the field of biotherapeutics. If subsequent editions are planned, the editors might consider increasing the coverage of potential risks and including more on the medicolegal, ethical and public health consequences resulting from administration of biotherapeutic agents. Michael Millar Microbiology Department, Camelia Botnar Laboratories, Great Ormond Street Hospital, 30 Guildford Street, London WC1N 3JH, UK
422 © 1999 The British Society for Antimicrobial Chemotherapy
