Modified Bacteriophage

The present invention relates to modified bacteriophage and a process for the production of modified bacteriophage.

Background to the Invention

Staphylococcus aureus is the most common cause of infections contracted whilst in hospital (nosocomial infections) (Noskύi et ah, 2005). It frequently causes infections in the lungs, wounds, skin and the blood and, because of the number of toxins the bacterium can produce, these infections may be life threatening.

Almost all strains of S. aureus are now resistant to penicillin owing to their ability to produce an enzyme (penicillinase) which breaks down the drug; and 45 years after the introduction of methicillin in 1959, a penicillinase-resistant penicillin, methicillin resistant S. aureus (MRSA) strains are endemic in many hospitals. More recently MRSA strains have also become a problem in the community. Many MRSA strains are now resistant to multiple antibiotics.

MRSA levels have risen dramatically in hospitals in both the US and the UK and, in addition, new Community Acquired MRSA (CA-MRSA) strains have spread rapidly across the globe since they were first reported in the late 1990's. These CA-MRSA strains have proven to be highly transmissible and often carry a set of genes encoding Panton Valentine Leukocidin which is a toxin that can make these strains highly virulent. There are concerns that these CA-MRSA strains may further add to the difficulties of controlling MRSA infections in hospitals (Donegan, 2006).

In fact, MRSA is now such a serious (and lethal) problem in hospitals that significant effort is being put into implementing infection control measures as a way of minimising the spread of MRSA in hospitals and thus reducing the number of infections. In relation to MRSA in particular, infection control measures include, variously, the use of hand sanitisers by healthcare workers; screening, isolation and barrier nursing of infected and carrier patients; and decontamination of patients and healthcare workers who carry MRSA. The carriage of bacteria is defined as the

presence of bacteria, usually at a low level, without any associated pathology such as inflammation. However, MRSA carriers do constitute a significant risk for the spread of MRSA to the wider hospital community, and the elimination of MRSA from carriers, particularly on or prior to admission, is a very important part of the infection control process.

Carriage of S. aureus (and therefore MRSA) occurs in and around the nose, armpits, groin, and perineum as well as in superficial skin lesions. A number of studies report that S. aureus is carried in the nose by 25 to 30% of the general population with MRSA being carried by around 1%. Amongst hospital patients the carriage rate is significantly higher. In the US it has been estimated that 89 million people carry S. aureus in their nose, and 2.3 million of those carry MRSA (Mainous et ah, 2006). The intra-nasal elimination of MRSA is therefore fundamental to controlling the spread of this potentially lethal organism in hospitals.

As an alternative to conventional antibiotics, one family of proteins which demonstrate broad spectrum antibacterial activity inside bacteria comprises the α/β- type small acid-soluble spore proteins (known henceforth as SASP). Inside bacteria, SASP bind to the bacterial DNA: visualisation of this process, using cryoelectron microscopy, has shown that SspC, the most studied SASP, coats the DNA and forms protruding domains and modifies the DNA structure (Francesconi et ah, 1988; Frenkiel-Krispin et ah, 2004) from B-like (pitch 3.4 run) towards A-like (3.18 nm; A- like DNA has a pitch of 2.8 nm). The protruding SspC motifs interact with adjacent DNA-SspC filaments packing the filaments into a tight assembly of nucleo-protein helices. In this way DNA replication is halted and, where bound, SASP prevent DNA transcription. SASP bind to DNA in a non-sequence specific manner (Nicholson et al, 1990) so that mutations in the bacterial DNA do not affect the binding of S ASP.

WO02/40678 describes the use as an antimicrobial agent of bacteriophage modified to incorporate a SASP gene. In order to provide effective production of the modified bacteriophage in a bacterial host, WO02/40678 aims to avoid expression of the SASP gene during proliferation of the production host. To this end, the SASP gene was

preferably inserted into the lysis genes of the bacteriophage so as to put the SASP gene under the control of a lysis gene promoter which is active only at the end of the bacteriophage life cycle. It was thought that proliferation of the bacterial production host would otherwise be prevented owing to the presence of the SASP gene product, particularly if the SASP gene was under the control of a constitutive promoter. In a less preferred arrangement, the SASP gene could be located elsewhere on the bacteriophage chromosome and placed under the control of a bacteriophage or bacterial promoter whereby the lytic cycle could be left to run its course. In this arrangement, the bacterial promoter would be non-constitutive and could be up- regulated by environmental cues.

Summary of the Invention

It has now surprisingly been found that effective production of bacteriophage may be achieved where the bacteriophage has been modified to carry a gene encoding a SASP under the control of a promoter which is controlled independently of the bacteriophage, and which is constitutive with no exogenous or in trans regulation necessary or provided, When present in multiple copies, for example following infection of target cells, the promoter.drives toxic levels of SASP expression.

Accordingly, in a first aspect, the present invention provides a modified bacteriophage capable of infecting a target bacterium, which bacteriophage includes an α/ ^β small acid-soluble spore protein (SASP) gene encoding a SASP which is toxic to the target bacterium, wherein the SASP gene is under the control of a constitutive promoter which is foreign to the bacteriophage and the SASP gene.

In a second aspect, there is provided a process for the production of a modified bacteriophage capable of infecting a target bacterium, which process comprises growing a bacterial host comprising genetic material encoding the bacteriophage in a growth medium; causing the bacteriophage to replicate in the bacterial host; and harvesting the bacteriophage.

Use of a modified bacteriophage in which the SASP gene is under the control of a constitutive promoter has a number of advantages. Control of expression of the SASP gene is removed from the bacteriophage whereby production of SASP becomes independent of phage gene expression. This enables the SASP to be produced even when the bacteriophage cannot carry out its full life cycle; which may happen in the case of super-infection (where the bacteriophage infects a bacterial host already carrying a prophage) and host restriction of the bacteriophage DNA. As described below this strategy thus allows one phage type to inhibit many different strains of one bacterial species.

Whilst bacteriophage generally tend to have narrow host ranges, putting a SASP gene under the control of a constitutive promoter can broaden the host range of the modified bacteriophage. This is because one of the key ways in which bacteria limit their host range is by degrading bacteriophage DNA on entry into a bacterial cell. Use of bacteriophage to deliver aSASP gene, whose production is independent of the bacteriophage, means that the fate of the bacteriophage DNA may not impact on the efficacy of the SASP. In this way, the bacteriophage acts as a delivery vector by delivering the gene encoding the SASP to a target bacterial cell.

Production of a modified bacteriophage according to the invention requires a bacterial host which can be lysogenised by the bacteriophage. This Iy so gen should allow proliferation of the bacteriophage upon induction, so that an adequate bacteriophage titre may be obtained for harvesting. According to the invention, the SASP do not prevent the production of adequate phage titres within the timescale required by a manufacturing process, i.e. prior to host cell death.

A preferred approach according to the present invention is to use a constitutive promoter to control the SASP gene, such that the promoter does not promote the expression of sufficient SASP to kill the host production strain from which the modified bacteriophage is to be harvested. The promoter may be a bacterial promoter, such as from S. aureus. Preferred promoters include the S. aureus promoters pdhA for pyruvate dehydrogenase El component alpha subunit, rpsB for the 3OS ribosomal protein S2, pgi for glucose-6-phosphate isomerase. Sequences having >90% identity

to these sequences may also be used on promoters according to the invention. A particularly preferred promoter is the promoter for the fructose bisphosphate aldolase gene, fiaA, from S. aureus N315 (accession no. BAB43211), or a sequence showing >90% homology to this sequence. An advantage of using the flaA promoter to express the SASP gene is that this promoter expresses constitutively in bacterial cells and does not appear to be regulated by any mechanism within S. aureus cells. In addition, a single copy of ihefl>aA::SASP-C element does not produce enough SASP- C to be lethal to a host cell, enabling maintenance and production of the PTSA 1.2/A bacteriophage, as described in further detail below. Upon infection of target bacteria, however, multiple copies of the fbaA promoter (from multiple infection events or phage replication within the target cell) drives sufficient expression of SASP-C so as to cause loss of viability of the target.

Thus promoters which are suitable to be used upstream of SASP in bacteriophage constructs, such as the flaA promoter, have two defining properties; they are not strong enough to kill the bacteriophage's host during growth of the host bacterium; they do not prevent the production of adequate phage titres within the timescale required by a manufacturing process, i.e. prior to host cell death. However, they are sufficiently strong so as to drive the production of toxic levels of SASP when present in multiple copies, i.e. following delivery of multiple copies of the SASP gene to a targeted cell or due to phage replication in a targeted cell. Selection of promoters with such activities may be made by analysing bacteriophage constructs for these characteristics.

The promoter controlling transcription and therefore expression of the SASP gene is foreign to both the bacteriophage and the SASP gene in the sense that it does not originate from the bacteriophage and is not the native promoter of the SASP gene. In this way, control of expression of the SASP gene is divested from the phage.

The bacterial host can be any host suitable for a given bacteriophage. The host must support the bacteriophage through the proliferation of mature bacteriophage particles within the host, when induced to do so. WO02/40678 sets out in appendix 4 a list of

common pathogens and some of their phages. This appendix is reproduced in the present application as appendix 1. Staphylococcus and Clostridium hosts, preferably Staphylococcus aureus and Clostridium difficile, are particularly useful hosts. Bacteriophage øl l is capable of infecting Staphylococcus aureus and is described in further detail below. This bacteriophage may be modified in accordance with the present invention.

Sequences of α/β-type SASP may be found in appendix 1 of WO 02/40678, including SASP-C from Bacillus megaterium which is the preferred α/β-type SASP.

Bacteriophage vectors modified to contain a SASP gene have generally been named SASPject vectors. SASPject vector PTSAl.2/A is described in further detail below for delivery of the SASP gene to S. aureus, including MRSA. Once the SASP gene has been delivered to a target bacterium, SASP is produced inside those bacteria where it binds to bacterial DNA and changes the conformation of the DNA from B- like towards A-like. Production of sufficient SASP inside target bacterial cells causes a drop in viability of affected cells; thus toxicity caused by SASP is dose dependent, which in turn is dependent upon promoter activity and number of promoter:: SASP copies present.

In general, the SASP gene and its promoter may be placed anywhere within the bacteriophage genome. However, it is preferred for targeting pathogenic bacteria that the modified bacteriophage is non-lytic and this may be achieved by the removal or inactivation of one or more genes required by the phage for lysing infected bacteria, most preferably by inactivating at least one of the lysis genes. In a preferred embodiment, the SASP gene is inserted into one of the lysis genes or the lysis gene is replaced with the toxin gene. The genes for lysing infected bacteria include the bacteriophage holin gene and/or an amidase gene. One or more of these genes may be interrupted or replaced by the SASP gene. Preventing the modified bacteriophage from lysing its target bacterial host allows continued expression and accumulation of the SASP, possibly beyond the time at which the bacteriophage would normally cause the bacterial host to lyse.

In a further aspect, the present invention provides a composition for inhibiting or preventing bacterial cell growth, which comprises a modified bacteriophage as defined herein and a carrier therefor. Such a composition may have a wide range of uses and is therefore to be formulated according to the intended use. The composition may be formulated as a medicament, especially for human treatment and may treat various conditions, including bacterial infections. Among those infections treatable according to the present invention are topical infections, dental carries, respiratory infections, eye infections and localised tissue and organ infections. The carrier may be a pharmaceutically-acceptable recipient or diluent. The exact nature and quantities of the components of such compositions may be determined empirically and will depend in part upon the routes of administration of the composition.

Routes of administration to recipients include oral, buccal, sublingual, intranasal, by inhalation, topical (including ophthalmic), intravenous, intra-arterial, intra-muscular, subcutaneous and intra-articular. For convenience of use, dosages according to the invention will depend on the site and type of infection to be treated or prevented. Respiratory infections may be treated by inhalation administration and eye infections may be treated using eye drops. Oral hygiene products containing the modified bacteriophage are also provided; a mouthwash or toothpaste may be used which contains modified bacteriophage according to the invention formulated to eliminate bacteria associated with dental plaque formation.

A modified bacteriophage according to the invention may be used as a bacterial decontaminant, for example in the treatment of surface bacterial contamination as well as land remediation or water treatment. The bacteriophage may be used in the treatment of medical personnel and/or patients as a decontaminating agent, for example in a handwash. Treatment of work surfaces and equipment is also provided, especially that used in hospital procedures or in food preparation. One particular embodiment comprises a composition formulated for topical use for preventing, eliminating or reducing carriage of bacteria and contamination from one individual to another. This is important to limit the transmission of microbial infections, particularly in a hospital environment where bacteria resistant to conventional antibiotics are prevalent. For such a use the modified bacteriophage may be contained in Tris buffered saline containing CaCl ₂ (10 mM) and MgCl ₂ (1 mM) or may be

formulated within a gel or cream. For multiple use a preservative may be added. Alternatively the product may be lyophilised and excipients, for example a sugar such as sucrose may be added.

Detailed Description of the Invention

The present invention will now be described in further detail, by way of example only, with reference to the accompanying drawings and the following example.

Brief description of the drawings:

Figure 1. Region of S. aureus phage φl 1, showing the holin and amidase genes, and the priming sites for amplification of the genes and flanking DNA

Figure 2. Diagram of pSAl, showing the cloned region and the location of the priming sites for inverse PCR of pSAl.

Figure 3. Diagram of pSA4, showing the cloned promoter- saspC region with the cadmium resistance (Cd ^R ) gene and the flanking φl 1 DNA, together with the location of relevant priming sites.

Figure 4. Arrangement of DNA within the genome of PTL1003, showing the replacement of the holin gene with foreign genes. The arrangement of genes in the wild-type φl 1 genome is shown for comparison.

Figure 5. An example of a kill curve showing efficacy of PTSAl .2/A against an S. aureus strain.

Figure 6. A kill curve comparing the killing ability of PTSAl.2/A with the same phage minus the SASP gene.

Figure 7. A kill curve of PTSAl .2/A infecting an S. aureus strain.

Summary of construction of a genetically altered bacteriophage carrying SASP-C under control of a fructose bisphosphate aldolase homologue (fbaA) promoter

Genes can be removed and added to the phage genome using homologous recombination. There are several ways in which phages carrying foreign genes and promoters can be constructed and the following is an example of such methods.

For the construction of a φl 1 derivative it is shown how, using an E. coli I S. aureus shuttle vector, as an example only, the phage holin gene has been replaced with the gene for SASP-C, under the control of a S. aureus fructose bisphosphate promoter homologue {fbaA is used from this point on to denote the fructose bisphosphate aldolase promoter). Genes for resistance to the heavy metal Cadmium (referred to henceforth as Cd ^R ) are used as a non- antibiotic resistance marker.

The fbaA- SASP-C and Cd ^R regions were cloned between two regions of φl 1 DNA which flank the φl 1 holin gene. Subsequently, this plasmid was introduced into cells and double recombinants were selected for, where the holin was replaced with the fboA-S ASP-C and Cd ^R region.

Experimental procedures

All PCR reactions were performed using Expand High Fidelity PCR system and stringent conditions, depending upon the melting temperatures (T _m ) of the primers, according to the manufacturers instructions. Unless otherwise stated, general molecular biology techniques, such as restriction enzyme digestion, agarose gel electrophoresis, T4 DNA ligase-dependent ligations, competent cell preparation and transformation were based upon methods described in Sambrook et al. (1989). DNA was purified from enzyme reactions and prepared from cells using Qiagen DNA purification kits. S. aureus cells were transformed with plasmid DNA by electroporation, using methods such as those described by Schenck and Ladagga (1992).

Primers were obtained from Sigma Genosys. Where primers include recognition sequences for restriction enzymes, an extra 2-6 nucleotides was added at the 5' end to ensure digestion of amplified PCR DNA.

All clonings, unless otherwise stated, are achieved by ligating DNAs overnight with T4 DNA ligase and then transforming them into E. coli cloning strains, such as DH5α or XLl -Blue, with isolation on selective medium, as described elsewhere (Sambrook ef α/., 1989)

An E. colilS. aureus shuttle vector, designated p SMl 98 was used to transfer to genes between E. coli and S. aureus. Plasmid pSM198 was previously produced by combining E. coli cloning vector pUC18 and the tetracycline resistance and replication regions of S. aureus plasmid pT181. The plasmid carries resistance markers that can be selected for in E. coli and S. aureus. This plasmid retains the pUC18 multiple cloning site (MCS), although not all the sites remain as unique sites. The remaining unique sites in the MCS of pSM198 are: Pstl, Sail, BamHI, Sad and EcoRL

Construction of a plasmid for targeted replacement of the φl 1 holin gene with fbaA- SASP-C/Cd ^R

1. Plasmid pSAl, comprising pBluescript SK+ containing a 1.8 kb fragment of φl 1 spanning the lytic genes, was constructed as follows. Figure 1 shows the priming sites for the oligonucleotides described below for amplification of regions from the φl 1 genome.

PCR amplification of φl 1 DNA using primers BlOOl and B 1002, was carried out and yielded a 1.8 kb fragment which was cleaned and digested with Xbal and Pstl. After digestion, the DNA was cleaned and cloned into Xbal and Pstl digested pBluescript SK+, yielding pSAl.

Primer BlOOl (SEQ ID NO: 1) comprises a 5' Pstl site (underlined) followed by sequence of φl l (Genbank: AF424781) from base 39779 to base 39798, (see Figure 1). Primer B 1002 (SEQ ID NO: 2) comprises an Xbal site (underlined) followed by the reverse and complement of sequence of φll from base 41537 to base 41556 (see Figure 1).

BlOOl (SEQ ID NO:1)

5' - AACTGCAGGTGTATTGCAACAGATTGGCTC - 3'

B1002 (SEQ ID NO:2)

5' - GCTCTAGACTTTGCTCCCTGCGTCGTTG - 3'

2. Inverse PCR was carried out on pSAl as the template, using primers Bl 003 (SEQ ID NO: 3) and B 1004 (SEQ ID NO: 4) (see Figure 2).

Primer B 1003 comprises a 5' BamHI site (underlined) followed by the reverse and complement sequence of φl 1 from base 40454 to base 40469 (see Figure 1). Primer B 1004 comprises a 5' Spel site (underlined), followed by sequence of φl l from base 40891 to base 40911 (see Figure 2).

B1003 (SEQ ID NO. 3)

5' - CGGGATCCGACTAAAAATTAGTCG - 3'

B1004 (SEQ ID NO. 4)

5' - GGACTAGTGAATGAGTATCATCATGGAGG - 3'

This PCR reaction yielded an -4.2 kb fragment which constituted: φl 1 left arm, the entire pBluescript SK+ plasmid, and the φl l right arm. This fragment was digested with BamHI and Spel, cleaned, and subsequently used as a vector to clone in the following fragment.

3. The cadmium resistance region from pI258 was amplified by PCR using primers B 1005 and B1006, yielding an -2.8 kb fragment. The PCR product was cleaned and digested with BamHI and Xbal. The digested PCR product was cleaned and cloned into pSAl (PCR amplified and digested, above), making pSA2.

Primer Bl 005 (SEQ ID NO: 5) is complementary to DNA 308 bp upstream from the ATG for the putative cadmium-responsive regulatory protein gene cadC from pI258 (Genbank: J04551), the 3' end being nearest the ATG (see Figure 3). The 5' end of the primer carries a non-complementary tail with a BamHI site (underlined) to aid cloning.

Primer Bl 006 (SEQ ID NO: 6) is complementary to DNA at the 3' end of the cadA gene for the cadmium resistance protein from plasmid pI258, such that the last 3 complementary nucleotides are complementary to the stop codon TAG of the cadA gene (see Figure 3). The 5' end carries a non-complementary Xbal site (underlined) to aid cloning.

B1005 (SEQ ID NO: 5)

5' - CGATGGATCCTCTCATTTATAAGGTTAAATAATTC - 3'

B1006 (SEQ ID NO: 6)

5' - GCAGACCGCGGCTATTTATCCTTCACTCTCATC - 3'

4. The DNA containing the φ 11 left and right arms and Cd ^R were cut out of pS A2 using Pstl and Sad, and gel purified away from the vector. This fragment was cloned

into shuttle vector pSM198 which was also cut Pstl and Sad. Clones were screened for the restriction fragment and candidates were sent for sequencing. A correct plasmid construct was identified and named pSA3. This plasmid was used to clone in the following fragments.

5. PCR amplification of the fiaA promoter using B 1007 and B 1008 yielded an approximately 300 bp fragment which was cleaned and subsequently digested with Ncol, then re-cleaned.

The fiaA PCR fragment was ligated to the SASP-C coding sequence from B. megaterhtm. The amplification and preparation of the SASP-C gene is described below.

Primer B 1007 (SEQ ID NO: 7) comprises a 5' sequence tail which includes a BamHI site, followed by the reverse complement of bases 2189404 to 2189427 from the S. aureusNCTC 8325 genome (Genbank: CP000253) (see Figure 3).

Oligonucleotide Bl 008 (SEQ ID NO: 8) comprises a sequence tail which includes an Ncol site, then the sequence of bases 2189214 to 2189232 from the S. aureus NCTC 8325 genome (see Figure 3). When a PCR product is made using this primer, the Ncol site incorporated into the primer at the ATG of the gene results in the change of the base 2 nucleotides upstream of the ATG from T>C.

B1007 (SEQ ID NO: 7)

5' - CTACGGATCCTTTATCCTCCAATCTACTTATAAA - 3'

B1008 (SEQ ID NO: 8)

5' - CATGCCATGGAAGTTCCTCCTTGAGTGCT - S'

6. The SASP-C gene from B. megaterium strain KM (ATCC 13632) was amplified by PCR with primers B 1009 and BlOlO and yielded an -300 bp fragment. The PCR product was cleaned and digested with Ncol. The digested PCR product was cleaned and used in a ligation with the fboA PCR fragment, as described below.

Oligonucleotide B1009 (SEQ ID NO: 9) comprises a 5' tail containing an Ncol site and is complementary to the first 20 nucleotides of SASP-C (accession no. KOl 833), starting at the ATG, from B. megaterium strain KM (see Figure 3). The Ncol site at the beginning of the oligonucleotide incorporates the ATG of the SASP-C gene.

B1009 (SEQ ID NO: 9)

5' - CGATCCATGGCAAATTATCAAAACGC - 3'

Oligonucleotide BlOlO (SEQ ID NO: 10) comprises a BgIII site (underlined), and an EcoRI site (double underlined), followed by the reverse complement of DNA starting 59 bases downstream of the stop codon to 74 bases downstream of the stop codon of the SASP-C gene (see Figure 3).

B1010 (SEQ ID NO: 10)

5 ' - AGTGAGATCTGAATTCGCTGATTAAAAGAAAC - 3 '

7. The fbaA and the SASP-C PCR fragments (both cut Ncol) were ligated together using T4 DNA ligase. The ligated DNAs were used as a template for PCR, to amplify the joined flaA and SASP-C DNAs. PCR was performed using primers B 1007 and BlOlO. The main PCR product of -500 bp was gel purified. The PCR product was digested with BamHI and BgIII and cleaned. This fragment was cloned into pSA3 which was prepared as follows. The plasmid was cut with BamHI, and the ends were dephosphorylated using calf intestinal alkaline phosphatase (CIAP). The DNA was cleaned again.

Plasmids were screened so that the end of the SASP-C gene was adjacent to the "left arm" region of φl l, and so the start of the fbaA promoter was adjacent to the cadmium chloride resistance region. The resulting plasmid, carrying ftaA-SASP-C, was named pSA4.

Replacment of the holin gene from S. aureus phage φl l with fbaA-SASV-C and the Cd ^R marker

1. pSA4 was transformed into S. aureus strain PTL47. PTL47 is a monolysogen of φl l in RN4220.

2. Cells which had undergone a double crossover, where the DNA contained between the φl 1 left and right arms of pSA4 have replaced the DNA between the φl 1 left and right arms in the phage genome (ie the holin gene) gave rise to colonies with the following phenotype: CdCl ₂ (0.1 mM) resistant, tetracycline (5 μg/ml) sensitive. Tetracycline resistance is carried by the shuttle vector pSM198. Loss of tetracycline resistance is indicative of loss of pSM198. Colonies which had the phentoype: CdCl ₂ ^R , tetracycline ⁵ were screened further by colony PCR.

3. PCR reactions were performed to check that the holin gene was no longer present, and that the/Sα^-SASP-C and the CdCl ₂ ^R gene were present and correctly placed in the φl l prophage genome. PCR fragments were sequenced to ensure that the isolate carried the expected sequence, especially in regions:/?)^ and SASP-C.

Verified prophage constructs were thus identified and a representative was picked and named PTLlOOl.

4. Phage was induced from a culture of strain PTLlOOl by heat shock, and the cells were lysed with lysostaphin (0.25 μg/ml), and then filtered through a 0.2 μm filter, yielding a crude cell-free phage Iy sate.

5. This lysate was used to infect S. aureus strain 8325-4. The infection mixture was plated onto φVPB (vegetable peptone brothcontaining 10 g/1 sodium chloride) + CdCl ₂ (0.1 mM) agar plates to select for lysogens after overnight growth at 37 ⁰ C.

6. Lysogens were checked by colony PCR as described above. A verified lysogen was identified and named PTL 1002.

7. PTL1002 was passaged 5 times on φVPB agar, picking a single colony and re- streaking to single colonies at each passage.

8. A single colony was picked and analysed again by PCR and sequencing. The verified isolate was named PTL 1003. The phage carried by this lysogen strain is called PTSAl.2/A (see Figure 4).

SASPject vector PTSAl.2/A has been tested against a panel of S. aureus strains and clinical isolates, including methicillin sensitive S. aureus (MSSA) and MRSA strains belonging to each of the 5 recognised scc-mec types. An example of a kill curve showing efficacy of PTS Al.2/A against an 5. aureus strain is given in Figure 5.

A kill curve comparing the killing ability of PTSAl.2/A versus the same phage minus the SASP gene (phage SAO/ A) is given in Figure 6, and confirms that the kill rate is due to presence of the SASP.

A kill curve of PTSAl .2/A infecting an S. aureus strain which is a monolysogen of PTSAl.2/A is given in Figure 7, and shows that superinfection immunity to the phage does not prevent SASP from inhibiting infected cells.

REFERENCES

Donegan, N. 2006. Annual Meeting of the Soc. for Healthcare Epidemiology of America.

Francesconi, S.C., MacAlister, T.J., Setlow, B., and Setlow, P. 1988. Immunoelectron microscopic localization of small, acid-soluble spore proteins in sporulating cells of Bacillus subtilis. J. Bacteriol. 170: 5963-5967.

Frenkiel-Krispin, D., Sack R., Englander, J., E. Shimoni, Eisenstein, M., Bullitt, Horowitz-Scherer, E. R., Hayes, C. S., Setlow, P., Minsky, A., and Wolf, S.G. 2004. Structure of the DNA-SspC Complex: Implications for DNA Packaging, Protection, and Repair in Bacterial Spores. J. Bacteriol. 186: 3525 - 3530. Mainous, A.G. Ill, Hueston, W.J., Everett, C.J., and Diaz V.A.. 2006. Nasal Carriage of Staphylococcus aureus and Methicillin Resistant S. aureus in the US 2001-2002. Annals of Family Medicine 4:132-137.

Nicholson, W. L., Setlow, B., and Setlow, P. 1990. Binding of DNA in vitro by a small, acid-soluble spore protein from Bacillus subtilis and the effect of this binding on DNA topology. J. Bacteriol. 172: 6900-6906.

Noskin, G.A., Rubin, R. J., Schentag, J. J., Kluytmans, J., Hedblom, E. C, Smulders, M., Lapetina, E., and Gemmen, E. 2005. The Burden of Staphylococcus aureus Infections on Hospitals in the United States: An Analysis of the 2000 and 2001 Nationwide Inpatient Sample Database. Arch Intern Med 165: 1756-1761

Sambrook, J., Fritsch, E. F. and Maniatis, T. in Molecular Cloning, A Laboratory Manual 2nd edn (Cold Spring Harbor Press, New York, 1989).

Schenk, S., and R. A. Laddaga. 1992. Improved method for electroporation of Staphylococcus aureus. FEMS Microbiol. Lett. 73:133-138.

APPENDIX 1

A list of common pathogens and some of their phages (This list is representative but not exhaustive) .

Coliphages :

Bacteriophage lambda

Bacteriophage 933W {Escherichia coli 0157 :H7)

Bacteriophage VT2-Sa (E. coii 0157 :H7)

Coliphage 186

Coliphage Pl

Coliphage P2

Coliphage N15

Bacteriophage T3

Bacteriophage T4

Bacteriophage T7

Bacteriophage KUl

Bacteriophages of Salmonella spp

Bacteriophage Felix

Bacteriophage P22

Bacteriophage L

Bacteriophage 102

Bacteriophage 31

Bacteriophage FO

Bacteriophage 14

Bacteriophage 163

Bacteriophage 175

Bacteriophage Vir

Bacteriophage ViVI

Bacteriophage 8

Bacteriophage 23

Bacteriophage 25

Bacteriophage 46

Bacteriophage E15

Bacteriophage E34

Bacteriophage 9B

Bacteriophages of Shigella dysenteriae

Bacteriophage φ80 Bacteriophage P2 Bacteriophage 2 Bacteriophage 37

Bacteriophages of Vibrio choleras

Bacteriophage fs-2 Bacteriophage 138

Bacteriophage 145 Bacteriophage 149 Bacteriophage 163

Bacteriophages of Mycoplasma arthr±t±dls

Bacteriophage MAVl Bacteriophages of Streptococci

Bacteriophage CP-I

Bacteriophage φXz40

Bacteriophage IA

Bacteriophage IB

Bacteriophage 12/12

Bacteriophage 113

Bacteriophage 120

Bacteriophage 124

Bacteriophages of Pseudomonas aeruginosa.

Bacteriophage D3 Bacteriophage φCTX Bacteriophage PP7

Bacteriophages of Haemophilus influenzae

Bacteriophage S2 Bacteriophage HPl Bacteriophage flu Bacteriophage Mu

Bacteriophages of Staphylococcus aureus

Bacteriophage Twort Bacteriophage tIII-29ξ Bacteriophage φPVL Bacteriophage φPV83 Bacteriophage φll Bacteriophage φl2 Bacteriophage φl3 Bacteriophage φ42 Bacteriophage φ812 Bacteriophage K Bacteriophage P3 Bacteriophage P14 Bacteriophage UC18 Bacteriophage 15 Bacteriophage 17

Bacteriophage 29 Bacteriophage 42d Bacteriophage 47 Bacteriophage 52 Bacteriophage 53 Bacteriophage 79 Bacteriophage 80 Bacteriophage 81 Bacteriophage 83 Bacteriophage 85 Bacteriophage 93 Bacteriophage 95 Bacteriophage 187

Bacteriophages of Chlamydia

Bacteriophage φCPAR39 Mycobacter±ophage

Bacteriophage L5 Bacteriophage LG Bacteriophage D29 Bacteriophage RvI Bacteriophage Rv2 Bacteriophage DSGA

Bacteriophages of Listeria monocytogenes

Bacteriophage A118 Bacteriophage 243 Bacteriophage A500 Bacteriophage A511 Bacteriophage 10 Bacteriophage 2685 Bacteriophage 12029 Bacteriophage 52 Bacteriophage 3274

Bacteriophages of Klebsiella pneumoniae

Bacteriophage 60 Bacteriophage 92

Bacteriophages of Yersinia pestis

Bacteriophage R Bacteriophage Y Bacteriophage Pl