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     <h3>Practices</h3>
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    .navbar-default .navbar-brand,
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</div>
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            <div class="section" id="introduction">
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                    <h2>Introduction</h2>
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    .main-container .section a {
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                    <p>
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                        Our project relies on a three way conversation between the team, the public and experts. It touches every aspect of the project, from our choice of application to the details of our delivery system. We promoted Synthetic Biology and iGEM through outreach programs to inspire the next generation.
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    }
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                    </p>
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                    <p>
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                        Urinary tract infections are a huge problem globally with millions of cases reported each year. We’re producing a guide for everything you need to know about urinary tract infections, as well as a treatment to beat antibiotics, which are rapidly becoming ineffective.
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                    </p>
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                    <p>
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                        We want to make our website as accessible as possible to all readers, regardless of their level of expertise. Words with a <a class="definition" title="Dotted Blue Underline" data-content="Yep, just like this one.">dotted blue underline</a> will show a definition when you hover over them.
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             <div class="section-spacer"></div>
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            <div class="section" id="project-choice">
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                <div class="slim">
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                    <h2>Project Choice</h2>
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                    <div id="project-choice-approaching-the-public">
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                             <h3>Approaching the Public</h3>
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    <div class="container-fluid page-heading" style="background-image: url(https://static.igem.org/mediawiki/2015/c/c2/Ox_questionnaire.png)">
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        <h3>Questionnaire Results</h3>
 +
    </div>
 +
    <div class="container-fluid">
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        <div class="row">
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             <div class="col-md-9">
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                <div class="section" id="first_questionnaire">
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                    <div class="slim">
 +
                        <h2>First Questionnaire</h2>
 +
                        <div id="q1_aim">
 +
                             <h4>Aim:</h4>
 
                             <p>
 
                             <p>
−
                                 To decide on our project idea, we sent out an initial questionnaire to the public to hear about what they thought about synthetic biology. We asked what big problems they wanted solving. We took the questionnaire to schools, to the streets and to our friends.
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                                 To find out what the public want synthetic biology to do for them.
 
                             </p>
 
                             </p>
 +
                        </div>
 +
                        <div id="q1_introduction">
 +
                            <h4>Introduction</h4>
 
                             <p>
 
                             <p>
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                                 Examples of their suggestions for the applications of synthetic biology include bacteria which:
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                                 We conducted this survey in the Christmas vacation, with the idea that the results from this survey could inform our choice of project. The responses we got back were very varied, with some very interesting and detailed possibilities, and other, less thought-through options, such as "stop racism".
 
                             </p>
 
                             </p>
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                            <ul>
 
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                                <li>Remove carbon dioxide from the atmosphere</li>
 
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                                <li>Target and kill cancerous cells</li>
 
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                                <li>Help treat Alzheimer's disease</li>
 
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                                <li>Produce energy</li>
 
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                                <li>Sew up holes in clothes</li>
 
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                                <li>Produce teeth glue</li>
 
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                                <li>Indicate how long someone has been dead for</li>
 
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                                <li>Combat antibiotic resistance</li>
 
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                            </ul>
 
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                            <p>
 
−
                                Of our responses, around 40 were related to Medicine and Health [<a href="#PRef1">1</a>]. This led us to choose that track for our project. However, it was our team member George Driscoll’s work at the UTI clinic in London which helped us to select UTIs as a specific cause. Due to the un-aesthetic nature of the infection, it often receives less attention with regard to research.
 
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                            </p>
 
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                            <p>
 
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                                A large proportion of our responses expressed concern for how Synthetic Biology would be used in society, with several references to the issues of contamination and exploitation for profit. With this in mind, we constructed a second questionnaire about our project, to test whether the public would get behind it.
 
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                            </p>
 
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                    </div>
 
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                        <div id="project-choice-approaching-the-public-initial-feedback">
 
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                              <h4>Initial Feedback</h4>
 
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                              <p>
 
−
                                  We sent a second questionnaire to find out more about whether the public would use a Solution from synthetic biology to treat Urinary tract infections. We asked more about whether they had heard of genetic engineering or synthetic biology, and how much they trust a recommended treatment by a doctor. In collaboration with UCL, we also filmed some of these responses on the street. The results were overwhelmingly positive.
 
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                              </p>
 
 
                         </div>
 
                         </div>
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                    <div id="project-choice-our-inspiration">
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                        <div id="q1_results">
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                             <h3>Our Inspiration</h3>
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                             <h1>Results</h1>
 
                             <p>
 
                             <p>
 +
                                We decided to display the responses from this questionnaire as a word cloud. The size of each word in the word cloud is proportional to the frequency of its occurrence in the questionnaire responses, so that it is clear what the public consensus of useful project ideas is.
 
                             </p>
 
                             </p>
 +
                            <div class="image image-full">
 +
                                <img src="https://static.igem.org/mediawiki/2015/0/04/Ox_Wordcloud-white-background.png">
 +
                            </div>
 +
                        </div>
 
                     </div>
 
                     </div>
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                         <div id="project-choice-our-inspiration-jorge-talk">
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                </div>
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                             <h4>Jorge Talk</h4>
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                <div class="section" id="second_questionnaire">
 +
                    <div class="slim">
 +
                        <h2>Second Questionnaire</h2>
 +
                         <div id="q2_aim">
 +
                             <h4>Aim:</h4>
 
                             <p>
 
                             <p>
 +
                                To find out the public's thoughts on genetic modification, and see whether they would consider a treatment involving modified bacteria if they were suffering with a <a class="definition" title="UTI" data-content="An infection in the bladder or kidney, symptoms include inflammation, needing to urinate more frequently, and occasionally blood in the urine. Treatments currently rely on antibiotics, and typically follow a two week course. 50% of women acquire one in their lifetime.">UTI</a>
 +
, as well as gauging their opinion as to whether antibiotic resistance is a problem.
 
                             </p>
 
                             </p>
 
                         </div>
 
                         </div>
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                         <div id="project-choice-our-inspiration-churchill">
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                         <div id="q2_introduction">
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                             <h4>Churchill Hospital, Oxford</h4>
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                             <h4>Introduction</h4>
 
                             <p>
 
                             <p>
−
                                 Our first visit to the hospital was to the outpatient clinic during which we spoke with Jan, one of the nurses on the ward. Jan told us about a case of a person getting septicaemia as a result of a urinary infection. The patient had received antibiotics for seven days and had come back for a check up. Their urine sample was clear and all seemed fine but then the patient had started to shake. The bacteria were now in their blood as it had travelled back up the ureter to the kidney. Even though this was a rare case, it was shocking to hear about such a serious case and made our project feel very relevant.
+
                                 Throughout our project, we have been determined to engage with the public so that we can develop a project which will be as useful to as many people as possible. These questionnaires, along with interviews with medical professionals and posts on social media, comprise a dialogue that we have maintained with the public for the duration of our project.
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                            </p>
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−
                            <p>
+
−
                                Jan also made the following points:
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                            </p>
+
−
                            <ul>
+
−
                                <li>People with infections have a catheter because they need a way to empty the bladder; else the urine travels up the ureter and back into the bladder</li>
+
−
                                <li>If a patient becomes septic the catheter has to be removed or can be fatal</li>
+
−
                                <li>UTIs are not just contracted by the catheter and it is important to also consider community based UTIs</li>
+
−
                                <li>“UTIs are very common and can be quite painful”</li>
+
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                                <li>No separate ward for UTIs – they are treated in every ward</li>
+
−
                                <li>The protocol for treatment is to take a urine sample, see if there is an infection, and prescribe antibiotics that the bacteria are most sensitive to</li>
+
−
                                <li>Elderly hospital wards are likely to have many cases of UTIs</li>
+
−
                            </ul>
+
−
                            <p>
+
−
                                We took a lot from this initial conversation. We went onto investigating the pros and cons of the current methods of treating urinary infections and compared these to what Solution could offer. We realized that we needed to consider the catheter more from a hospital/medical perspective as up to this point we had confused its function, thinking it was more to do with administering medication rather than emptying the bladder. Following this meeting, the design of the catheter became an integral part of the project.
+
 
                             </p>
 
                             </p>
 
                         </div>
 
                         </div>
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                         <div id="project-choice-our-inspiration-jr">
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                         <div id="q2_questions">
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                             <h4>John Radcliffe Hospital, Oxford</h4>
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                            <h1>Questions</h1>
 +
                            <div id="q2_age">
 +
                                <h3>Ages of participants</h3>
 +
                                <div class="image image-right">
 +
                                    <img src="https://static.igem.org/mediawiki/2015/3/38/Ox_Colour_scheme_age_pie_chart.png">
 +
                                </div>
 +
                                <p>
 +
                                    We included age brackets as part of the survey so that we could check that our data is roughly representative, and so that we could see to what extent people of different ages are informed about genetic modification and antibiotic resistance. We found that most older people (31+) have heard of genetic modification but not synthetic biology, and are less likely to allow genetically modified bacteria to be used as a treatment. Younger people (up to 30) tend to be more open to the new treatment ideas, and more of them have heard of synthetic biology. However, our results may be biased, due to the high proportion of our participants aged under 30. Different generations are likely to have had different educations; synthetic biology is a very new field, so it is likely not to have been taught in schools yet. Similarly, older people may be more aware, and sceptical, due to the previous GM food scare.
 +
                                </p>
 +
                            </div>
 +
                            <div id="q2_awareness">
 +
                                <h5>Awareness</h5>
 +
                                <div id="q2_antibiotic_resistance">
 +
                                    <h3>To what extent do you feel that antibiotic resistance is a problem that needs addressing in society today?</h3>
 +
                                    <p>
 +
                                        Our survey clearly shows that the public think that antibiotic resistance is an important problem that needs solving, therefore we feel that it is an appropriate and useful area to direct our project towards. One of our team members, George, worked in a UTI clinic last summer, so he knows first-hand that UTIs are a big problem for a lot of people, with current methods of treatment still being inadequate in severe cases. When he brought this to our attention while we were trying to decide on a project, we thought it was worthwile trying to find a solution to this problem.
 +
                                    </p>
 +
                                    <div class="image image-full">
 +
                                        <img src="https://static.igem.org/mediawiki/2015/0/02/Ox_THISONE.png">
 +
                                    </div>
 +
                                </div>
 +
                                <div id="q2_hospital_infection">
 +
                                    <h3>Which of these do you think is the most common infection acquired in hospitals?</h3>
 +
                                    <p>
 +
                                        Most of the public (45.5%) thought that MRSA is the most commonly acquired infection in hospitals, showing that they think that antibiotic resistance is a problem. However, with UTIs coming in quite far behind this (19.5%), it seems that the public are not aware of the risk of getting UTIs in hospital due to urinary <a class="definition" title="catheter" data-content="A small, flexible tube inserted into the body to remove fluid. Urinary tract infections are a common side effect of using these.">catheter</a>isation. This could be due to the fact that UTIs are advertised less than MRSA, but since this is an important issue, we looked into educating the public through sessions with summer schools and school students, as well as getting in touch with local media, such as BBC Radio Oxford, ad promoting our project across social media. We believe that this has helped raise awareness of problems associated with catheter-based infections, not only in the urinary tract, but also due to other catheterised parts of the body.
 +
                                    </p>
 +
                                    <div class="image image-full">
 +
                                        <img src="https://static.igem.org/mediawiki/2015/0/05/Ox_q2_hospital_infection2.png">
 +
                                    </div>
 +
                                </div>
 +
                                <div id="q2_genetic_engineering">
 +
                                    <h3>Have you heard of genetic engineering?</h3>
 +
                                    <p>
 +
                                        96.5% of the people we surveyed had heard of genetic engineering. However, we did not collect data for whether people thought it was a good thing or not. This would be something to pursue in further surveys.
 +
                                    </p>
 +
                                    <div class="image image-full">
 +
                                        <img src="https://static.igem.org/mediawiki/2015/2/28/Ox_q2_genetic_engineering2.png">
 +
                                    </div>
 +
                                </div>
 +
                                <div id="q2_synthetic_biology">
 +
                                    <h3>Have you heard of synthetic biology, before this questionnaire?</h3>
 +
                                    <p>
 +
                                        Compared to the question about genetic modification, the results for this question were much more evenly spread between yes and no, with 58% saying they had heard of synthetic biology. Again, it would be interesting to see whether those who have heard of synthetic biology have a good opinion of it or not, and this would be an avenue for future surveys.
 +
                                    </p>
 +
                                    <div class="image image-full">
 +
                                        <img src="https://static.igem.org/mediawiki/2015/3/3d/Ox_q2_synthetic_biology2.png">
 +
                                    </div>
 +
                                </div>
 +
                             </div>
 +
                            <div id="q2_treatment">
 +
                                <h5>Treatment</h5>
 +
                                <div id="q2_options">
 +
                                    <h3>If you had the option of using two treatments for an infection, where one was antibiotics and one was bacteria that were designed to cure the infection, which would you choose?</h3>
 +
                                    <p>
 +
                                        The majority (70%) of the people we surveyed said that they would take the advice of their doctor on this. This means that it is important that we talk to and get advice from doctors as to how we can improve out treatment, since if we can't convince doctors that this is a better treatment than any current treatment, the patients won't take it either. However, encouragingly, of those who wouldn't take the advice of their doctor, our treatment was favourite with just under half saying they would prefer the designed bacteria (48%), compared to 40% who would prefer antibiotics.
 +
                                    </p>
 +
                                    <div class="image image-full">
 +
                                        <img src="https://static.igem.org/mediawiki/2015/a/a0/Ox_q2_options2.png">
 +
                                    </div>
 +
                                </div>
 +
                                <div class="section" id="q2_doctor_recommendation">
 +
                                    <h3>If your doctor recommended a treatment for an infection, which involved the use of bacteria that had been engineered to treat the infection, would you use it?</h3>
 +
                                    <p>
 +
                                        Our survey showed that if a doctor recommended our treatment, only 6% would not consider it. This is very encouraging data for our project, but again highlights the importance of gaining support from doctors, because without their backing, this project is likely never to become as common a treatment as antibiotics.
 +
                                    </p>
 +
                                    <div class="image image-full">
 +
                                        <img src="https://static.igem.org/mediawiki/2015/c/cc/Ox_q2_doctor_recommendation2.png">
 +
                                    </div>
 +
                                </div>
 +
                            </div>
 +
                            <div class="section-spacer"></div>
 +
                        </div>
 +
                    </div>
 +
                </div>
 +
                <div class="section" id="third_questionnaire">
 +
                    <div class="slim">
 +
                        <h2>Third Questionnaire</h2>
 +
                        <div id="q3_aim">
 +
                            <h4>Aim:</h4>
 
                             <p>
 
                             <p>
−
                                 We still wanted to learn more about urinary infections as well as to get some feedback from nurses abourtour idea. We organized a trip to the Adams Ward (Geratology) to learn more about how urinary infections affect elderly people.
+
                                 To return to the public with a variety of delivery methods for our bacteria, so that they can provide feedback on what they like and don’t like about the options, and to see which they would like to see in use.
−
                            </p>
+
−
                            <h4>First interview with Laura Evans, Adams Ward</h4>
+
−
                            <p>
+
−
                                What is the procedure for treating UTIs?
+
−
                            </p>
+
−
                            <ol class="interview-response">
+
−
                                <li><em>Dip urine</em></li>
+
−
                                <li><em>If the test comes back as positive, treat with a wide spectrum antibiotic</em></li>
+
−
                                <li><em>Whether or not the catheter is inserted with prophylactic antibiotic treatment is the doctor’s decision</em></li>
+
−
                            </ol>
+
−
                            <p>
+
−
                                What happens when a patient tests positive for a urinary infection?
+
−
                            </p>
+
−
                            <p class="interview-response">
+
−
                                <em>Whether or not the catheter is removed if a patient tests positive for a urinary infection depends largely on the reason that the catheter has been fitted. On the whole, the catheter remains fitted and the patient is treated with a large dose of antibiotics.</em>
+
−
                            </p>
+
−
                            <p>
+
−
                                Is antibiotic resistance a problem?
+
−
                            </p>
+
−
                            <p class="interview-response">
+
−
                                <em>Yes, particularly on this ward. As we treat elderly patients with recurring infections, their UTIs are frequently resistant to antibiotic treatment. We try different combinations of antibiotics but recurring infections are a significant problem.</em>
+
−
                            </p>
+
−
                            <p>
+
−
                                Our project involves designing a catheter that prevents the formation of a biofilm on its surface. What do you think of this idea?
+
−
                            </p>
+
−
                            <p class="interview-response">
+
−
                                <em>A catheter like that would be useful, but it depends on how long your catheter would work for. Patients can have catheters fitted for 3 months or longer. Catheters are also removed for other reasons, for example if they become blocked. Blockage is particularly an issue when the patient is suffering from a urinary infection.</em>
+
−
                            </p>
+
−
                            <p>
+
−
                                Laura’s response regarding how long a catheter remains in place spurred us into researching how we could keep our Solution bacteria alive. This is what we found.
+
 
                             </p>
 
                             </p>
 
                         </div>
 
                         </div>
−
                    <div id="project-choice-the-problem">
+
                        <div id="q3_intro">
−
                             <h3>The Problem</h3>
+
                             <h4>Introduction:</h4>
 
                             <p>
 
                             <p>
 +
                                Having last surveyed the public on how receptive they would be to treatments involving engineered bacteria, and received very positive results, we decided to work on a selection of delivery options. Having designed several containment options with physical and molecular barriers to unwanted colonisation, we returned to the public to see which they would prefer.
 
                             </p>
 
                             </p>
−
                    </div>
 
−
                        <div id="project-choice-the-problem-experts">
 
−
                            <h4>Feedback from Oxford Experts</h4>
 
−
                            <p>
 
−
                              To gain a further insight into the feasibility of Solution, we gave two talks during the summer, one at the termly Corpus Christi College Biochemistry talks and another to a group of alumni from the Oxford Biochemistry department. Two important questions arose from these talks:
 
−
                            </p>
 
−
                            <ul>
 
−
                              <li>Have you considered whether the proteins you planning on secreting are immunogenic?</li>
 
−
                              <li>If you are to kill all of the pathogenic bacteria in the urinary tract, will that make fungal infections more likely?</li>
 
−
                            </ul>
 
 
                         </div>
 
                         </div>
−
                    <div id="project-choice-our-solution">
+
                         <div id="q3_results">
−
                          <h3>Our Solution</h3>
+
                             <h1>Results</h1>
−
                          <p>
+
                             <div id="q3_results_sealed">
−
                          </p>
+
                                <h3>Sealed within a section of catheter</h3>
−
                    </div>
+
−
                </div>
+
−
            </div>
+
−
            <div class="section-spacer"></div>
+
−
            <div class="section" id="project-viability">
+
−
                <div class="slim">
+
−
                    <h2>Project Viability</h2>
+
−
                    <p>
+
−
                    </p>
+
−
                    <div id="project-viability-will-our-idea-work">
+
−
                         <h3>Will Our Idea Work?</h3>
+
−
                        <p>
+
−
                        </p>
+
−
                    </div>
+
−
                    <div id="project-viability-ethics">
+
−
                        <h3>Ethics</h3>
+
−
                        <p>
+
−
                             To find out the public opinion on our project, we sent out a questionnaire to over 150 people, asking: <em>'If your doctor recommended a treatment for an infection, which involved the use of bacteria that had been engineered to treat the infection, would you use it?'</em>. We also asked this question to a number of medical professionals during our visits to hospitals and clinics.
+
−
                        </p>
+
−
                        <p>
+
−
                             Whilst the majority of feedback was very positive, we did encounter some valuable criticism, as shown in the graph below. Most medical professionals we spoke to had positive responses, though one nurse did have certain reservations about our idea.
+
−
                        </p>
+
−
                        <div class="image image-full">
+
−
                            <img src="https://static.igem.org/mediawiki/2015/1/15/Ox_Q2_doctor_recommendation.png">
+
−
                        </div>
+
−
                        <p>
+
−
                            This proportion of negative feedback, although small, highlighted to us that our dialogue with the public needed to be improved. We believe that, through improving people's understanding of our project, we can convince pessimists that genetic engineering is now a force for good. This also led us onto holding talks to student groups, which you can find in the 'Increasing Awareness' section below.                       
+
−
                        </p>
+
−
                    </div>
+
−
                    <div id="project-viability-the-uti-clinic">
+
−
                        <h3>The UTI Clinic</h3>
+
−
                        <p>
+
−
                        </p>
+
−
                    </div>
+
−
                    <div id="project-viability-delivery-method">
+
−
                        <h3>Delivery Method</h3>
+
−
                        <p>
+
−
                        </p>
+
−
                    </div>
+
−
                    <div id="project-viability-increasing-awareness">
+
−
                        <h3>Increasing Awareness</h3>
+
−
                        <p>
+
−
                            To promote Synthetic Biology and iGEM, we’ve used a variety of approaches.
+
−
                        </p>
+
−
                        <div id="project-viability-increasing-awareness-uniq-workshop">
+
−
                                <h4>UNIQ Workshop</h4>
+
 
                                 <p>
 
                                 <p>
−
                                     We met with 40 prospective Oxford students to teach them about Synthetic Biology. The students had in interest in Biochemistry but knew nothing about iGEM. We hammered home the key message of Synthetic Biology - that we achieve more progress by expanding a registry of standardised biological parts - through a 15 minute introductory presentation on BioBricks. We then split them into groups and gave each one a mentor from our iGEM team. We worked through questions to test their understanding in a tutorial style and asked them to explain the constructs of previous iGEM teams. They finished by presenting their findings to each other.
+
                                     For a description of this option, check out our safety page <a href="https://2015.igem.org/Team:Oxford/Safety#project-safety-within-catheter">here</a>. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.
 
                                 </p>
 
                                 </p>
−
                        </div>
+
                                <h4>Pros:</h4>
−
                        <div id="project-viability-increasing-awareness-utc-oxfordshire">
+
                                <ul>
−
                                 <h4>UTC Oxfordshire</h4>
+
                                    <li>No contact between patient and bacteria (11)</li>
 +
                                    <li>Extra safeguard should the bacteria escape (6)</li>
 +
                                    <li>Good compromise between encasing and ability to sense (3)</li>
 +
                                    <li>Very safe (2)</li>
 +
                                    <li>Simple (1)</li>
 +
                                </ul>
 +
                                 <h4>Cons:</h4>
 +
                                <ul>
 +
                                    <li>Less effective (14)</li>
 +
                                    <li>Long treatment time (6) – cost to NHS (1)</li>
 +
                                    <li>catheter uncomfortable (4)</li>
 +
                                    <li>Bacteria block catheter? (3)</li>
 +
                                    <li>Bacteria can’t be safely replaced (1)</li>
 +
                                    <li>Will agent be able to pass through catheter? (1)</li>
 +
                                    <li>Resistance (1)</li>
 +
                                </ul>
 +
                                <br>
 
                                 <p>
 
                                 <p>
−
                                     A couple of us gave a presentation on antibiotic resistance to a class of GCSE students from UTC Oxfordshire (a local school specialising in science) at the Natural History Museum in Oxford, The Pitt Rivers Museum. Our talk covered the discovery of antibiotics, the advantages of them (including their use in laboratory work), how they work, and how bacteria can evolve to gain resistance to them, as well as concepts such as horizontal gene transfer and the consequences of antibiotic resistance on our everyday lives. It also covered our project outline, and pros and cons of Solution, showing how it should help combat antibiotic resistance. At the end, we held a discussion between the students and our team about antibiotic resistance, and their perception of the concern. We also asked how they would feel about using our engineered bacteria, and the response was positive, with most of the students saying that if their doctor recommended the treatment, they would be open to using it.
+
                                     The most common concern for this option was that it would be less effective than other methods, and would hence have a longer treatment time, causing discomfort to the patient and cost to the NHS. This concern was not outweighed by the number of people who liked that there was no contact between patient and bacteria, suggesting that the public would rather have a more effective treatment than one which was deemed to be “more safe”.
 
                                 </p>
 
                                 </p>
−
                        </div>
+
                                <h4>Other Concerns</h4>
−
                        <div id="project-viability-increasing-awareness-bbc-radio-oxford">
+
                                <p>
−
                             <h4>BBC Radio Oxford</h4>
+
                                    <em>Will the bacteria block the catheter?</em> We would address this concern in the design of the bacterial compartment in the catheter, so that it does not impede the flow of water and urine.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Can the bacteria be safely replaced?</em> We would investigate this further, and if it turned out that we couldn’t due to lack of sterility, we would suggest that another of our catheters were inserted, as a “disposable” solution.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Will the agent be able to pass through the catheter?</em> We would need to investigate the nature of <a class="definition" title="protein" data-content="An essential part of all living organisms. They are long and fold up into complicated structures and are made up of amino acids.">protein</a> folding in urine-like conditions, something that we haven’t been able to achieve given the timescale of the project, but if the protein folds well, the agent would be able to diffuse out into the urinary tract. If not, it may be worth attempting to modify the protein structure to make it more stable in the conditions of the urinary tract.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Can the <a class="definition" title="pathogen" data-content="Any organism or virus that can cause disease.">pathogen</a>ic bacteria gain resistance?</em> The agents produced by our bacteria are designed to break up the <a class="definition" title="biofilm" data-content="A community of bacteria (or other microorganisms) adhering to a surface and each other, held together by secreted slime-like polymers that create a more favorable environment for the bacteria and protect them from environmental stresses and attack from a host’s immune system (in the case of pathogenic bacteria).">biofilm</a> that gives the pathogenic bacteria protection. Resistance arises when an antimicrobial agent fails to kill the entire population of targeted bacteria. We expect that, due to the design of our system, the entire population would be killed, so that resistance is not a problem.
 +
                                </p>
 +
                            </div>
 +
                            <div id="q3_results_beads">
 +
                                <h3>Beads containing bacteria contained within a section of catheter</h3>
 +
                                <p>
 +
                                    For a description of this option, check out our safety page <a href="https://2015.igem.org/Team:Oxford/Safety#project-safety-beads">here</a>. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.
 +
                                </p>
 +
                                <h4>Pros:</h4>
 +
                                <ul>
 +
                                    <li>Extra degree of containment (12)</li>
 +
                                    <li>Multiple safety measures (3)</li>
 +
                                    <li>Kill switch (2)</li>
 +
                                </ul>
 +
                                <h4>Cons:</h4>
 +
                                <ul>
 +
                                    <li>Less effective (21)</li>
 +
                                    <li>Infection won’t be completely cleared due to dulled sensing capacity (5)</li>
 +
                                    <li>Restriction of flow (4)</li>
 +
                                    <li>Do bead cases break down in body? (3)</li>
 +
                                    <li>Long treatment time (3)</li>
 +
                                    <li>More expensive (2)</li>
 +
                                    <li>catheter uncomfortable (2)</li>
 +
                                    <li>More hospitalisations (1)</li>
 +
                                    <li>Replacement of bacteria (1)</li>
 +
                                </ul>
 +
                                <br>
 +
                                <p>
 +
                                    Again, the most common concern was over the efficiency of this option, with additional related concerns about the number of hospitalisations, length of treatment, and the chance that the infection won’t be completely cleared. This was, as before, not outweighed by those who thought the extra degree of containment was a good idea. This provided further evidence that the public would prefer a more effective treatment.
 +
                                </p>
 +
                                <h4>Other Concerns</h4>
 +
                                <p>
 +
                                    <em>Will flow of water/urine be restricted?</em> We would design the bead compartment around this concern, so that there is plenty of catheter diameter to allow sufficient flow.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Do the beads break down in the body?</em> This is something that we would test. <a class="definition" title="sodium alginate" data-content="Anionic polysaccharide is distributed widely in the cell walls of brown algae, where through binding with water it forms a viscous gum">Sodium alginate</a> (the substance from which the beads are made) is sometimes used in the food industry, which suggests that it could be broken down. What we would need to test is whether the <a class="definition" title="enzyme" data-content="A molecule which speeds up a chemical reaction - a biological catalyst. The reaction does not involve these molecules.">enzyme</a>s involved are only present in the digestive tract, or whether they are present in the urinary tract as well.
 +
                                </p>
 +
                                <p>
 +
                                    <em>This treatment option would be more expensive due to the materials involved.</em> This is true, but we believe that the comparative cost is negligible due to the very low cost of sodium alginate. We would investigate other materials which have the same sort of properties, and whether these materials are any less expensive.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Can the bacteria be safely replaced?</em> Again, something for further investigation. If, like in the option above, it is not possible, we would suggest our catheters are used as disposable, so that when the bacteria need replacing, the whole catheter is replaced.
 +
                                </p>
 +
                             </div>
 +
                            <div id="q3_results_attached">
 +
                                <h3>Attached to the end of a catheter</h3>
 +
                                <p>
 +
                                      For a description of this option, check out our safety page <a href="https://2015.igem.org/Team:Oxford/Safety#project-safety-attached-catheter">here</a>. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.
 +
                                </p>
 +
                                <h4>Pros:</h4>
 +
                                <ul>
 +
                                    <li>More effective (19)</li>
 +
                                    <li>Kill switch (6)</li>
 +
                                    <li>Balance between containment and efficiency (5)</li>
 +
                                    <li>Still physically contained (4)</li>
 +
                                </ul>
 +
                                <h4>Cons:</h4>
 +
                                <ul>
 +
                                    <li>Introduction of another bacteria (8)</li>
 +
                                    <li>Diffusion rate of antibacterial agent (1)</li>
 +
                                    <li>Immune response (1)</li>
 +
                                    <li>Bacteria escape to kidney? (1)</li>
 +
                                    <li>Slower treatment (1)</li>
 +
                                    <li>Resistance (1)</li>
 +
                                    <li>catheter uncomfortable (1)</li>
 +
                                </ul>
 +
                                <br>
 +
                                <p>
 +
                                    The primary concern for this treatment is that if the physical containment fails, another type of bacteria will be introduced to the urinary tract, and since their infection was caused by bacteria, this makes the public more wary. However, this is counteracted by the fact that more than twice as many people think that this treatment is more effective, and roughly the same number feel that it strikes a good balance between containment and efficiency.
 +
                                </p>
 +
                                <h4>Other Concerns</h4>
 +
                                <p>
 +
                                    <em>Will the diffusion rate of the antibacterial agent be too low to be effective?</em> As long as we have enough of our engineered bacteria secreting the agents, we will be able to get a sufficient concentration of antibacterial agent to make this treatment effective. We are <a class="definition" title="model" data-content="A simplified or idealised description of a system or process, usually mathematical, that can be used to predict how it will behave.">model</a>ling how many bacteria would be “enough”.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Will the attached bacteria result in an immune response from the body?</em> This is something that we would test. We don’t believe it would, since the chassis we are using has had all the pathogenic properties removed. We think that the immunogenicity of the agents is more of an issue that the immunogenicity of the bacteria, and an article on that can be found here.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Will the bacteria be able to escape to travel up to the kidney?</em> This would be a long journey for the bacteria to make. They shouldn’t be able to make it, since the kill switches would start to work as soon as they were out of range of the pathogenic bacteria, and result in the deaths of all the escaped bacteria.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Will the distance between the catheter and infected site result in slower treatment?</em> Yes it will, but the treatment will be faster that if the bacteria are contained within the catheter. However, if we had more time, we would also work on improving the efficiency of agent production, so that, whatever the distance, our solution would be more effective.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Can the pathogenic bacteria gain resistance?</em> The agents produced by our bacteria are designed to break up the biofilm that gives the pathogenic bacteria protection. Resistance arises when an antimicrobial agent fails to kill the entire population of targeted bacteria. We expect that, due to the design of our system, the entire population would be killed, so that resistance is not a problem.
 +
                                </p>
 +
                            </div>
 +
                            <div id="q3_results_free">
 +
                                <h3>Free-living Bacteria</h3>
 +
                                <p>
 +
                                      For a description of this option, check out our safety page <a href="https://2015.igem.org/Team:Oxford/Safety#project-safety-free-living">here</a>. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.
 +
                                </p>
 +
                                <h4>Pros:</h4>
 +
                                <ul>
 +
                                    <li>Most effective (23)</li>
 +
                                    <li>Safe kill switch (11)</li>
 +
                                    <li>Swift treatment (6)</li>
 +
                                    <li>Two types of bacteria (5)</li>
 +
                                    <li>More comfortable for patient (4)</li>
 +
                                    <li>Prevention (1)</li>
 +
                                    <li>No need to be in hospital (1)</li>
 +
                                </ul>
 +
                                <h4>Cons:</h4>
 +
                                <ul>
 +
                                    <li>Side effects of engineered bacteria colonisation (11)</li>
 +
                                    <ul>
 +
                                        <li>just want a clear explanation from health care professional (8)</li>
 +
                                    </ul>
 +
                                    <li>Kill switch concerns (5)</li>
 +
                                    <li>Opportunistic pathogens (2)</li>
 +
                                    <li>Any self-sacrificing bacteria left once all UTI-causing bacteria are killed? (1)</li>
 +
                                    <li>More difficult to monitor (1)</li>
 +
                                </ul>
 +
                                <br>
 +
                                <p>
 +
                                    The public’s biggest concern for this option is side effects from the engineered bacteria colonising the urinary tract. However, over 2/3 of the people who raised this concern said that they would be happy to use the method if they got a clear explanation of how it worked from a health care professional. Additionally, the concern was outweighed by the public’s opinion of having a safe kill switch, and that this treatment is the most effective.
 +
                                </p>
 +
                                <h4>Other Concerns</h4>
 +
                                <p>
 +
                                    <em>How do you know whether the kill switch will be effective?</em> The kill switch we have designed works in theory, but we will not know properly until it is tested. However, many other teams have used similar kill switches, and they have worked, so we don’t have a reason to suggest that it won’t work. The people who wrote this as a concern said that “if it can be proved to work, I’d be happy with it”, suggesting that their concern is that they haven’t heard of this type of thing before, and are wary of it for that reason, since it is harder to visualise than, for example, a physical containment option.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Will opportunistic pathogens take advantage of the niche that was previously occupied by the pathogenic bacteria?</em> We are hoping that our bacteria will occupy that niche until the infection has been cleared up, and then allow the urinary tract’s natural flora to recolonise. Obviously, we would need to test this in vivo, but we think it would be good to use this treatment in combination with a preventative treatment against opportunistic pathogens, at least until conclusive evidence has been collected.
 +
                                </p>
 +
                                <p>
 +
                                    <em>What will happen if there are any self-sacrificing bacteria left once all the pathogenic bacteria are killed?</em> We would use a very basic additional kill switch where we could get rid of any remaining engineered bacteria at the end of treatment by adding IPTG.
 +
                                </p>
 +
                                <p>
 +
                                    <em>Won’t this make the bacteria more difficult to monitor?</em> If this solution were to proceed to clinical trials, one of the things we would test would be how long it took to clear up an infection, so we could base treatment courses on this. We would be more likely to monitor the symptoms of the infection rather than the bacteria themselves.
 +
                                </p>
 +
                            </div>
 +
                            <div id="q3_preferred">
 +
                                <h3>The Public's preferred method of treatment</h3>
 +
                                <div class="image image-right">
 +
                                    <img src="https://static.igem.org/mediawiki/2015/7/7b/Ox_public_preference.png">
 +
                                </div>
 +
                                <p>
 +
                                    From the survey results, we found that the public were most happy with the free living bacteria option (44%), due to it's effectiveness at treating the infection, resulting in greater comfort for the patient. The next most popular option with 20% was sealed within a catheter, since this balanced efficiency with safety. Attached to a catheter and bacteria contained within beads both got 16%, these being less popular because one aspect (safety or efficiency) outweighed the others too heavily. Only 4% said that none of the options appealed, which is very encouraging for our treatment, since treatment of infections with engineered bacteria is a very new concept. It gives our project and synthetic biology as a whole a confident outlook that the public are so receptive to this idea.
 +
                                </p>
 +
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                    <li>
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                <li><a href="#introduction">Introduction</a></li>
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                        <a href="#first_questionnaire">First Questionnaire</a>
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                            <li><a href="#q1_aim">Aim</a></li>
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                        <li><a href="#project-choice-approaching-the-public">Approaching the Public</a>
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                            <li><a href="#q1_introduction">Introduction</a></li>
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                            <li><a href="#q1_results">Results</a></li>
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                                <li><a href="#project-choice-approaching-the-public-initial-feedback">Initial Feedback</a></li>
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                        <li><a href="#project-choice-our-inspiration">Our Inspiration</a>
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                        <a href="#second_questionnaire">Second Questionnaire</a>
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                                <li><a href="#project-choice-our-inspiration-jorge-talk">Jorge Talk</a></li>
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                            <li><a href="#q2_aim">Aim</a></li>
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                                <li><a href="#project-choice-our-inspiration-churchill">Churchill Hospital, Oxford</a></li>
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                            <li><a href="#q2_introduction">Introduction</a></li>
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                                <li><a href="#project-choice-our-inspiration-jr">John Radcliffe Hospital, Oxford</a></li>
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                                    <li><a href="#q2_age">Ages of Participants</a></li>
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                        <li><a href="#project-choice-the-problem">The Problem</a>
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                                <li><a href="#project-choice-the-problem-experts">Feedback from Oxford Experts</a></li>
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                                            <li><a href="#q2_antibiotic_resistance">To what extent do you feel that antibiotic resistance is aproblem that needs addressing in society today</a></li>
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                                            <li><a href="#q2_hospital_infection">Which of these do you think is the most common infection acquired in hospitals?</a></li>
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                                            <li><a href="#q2_genetic_engineering">Have you heard of genetic engineering?</a></li>
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                        <li><a href="#project-choice-our-solution">Our Solution</a></li>
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                                            <li><a href="#q2_synthetic_biology">Have you heard of synthetic biology, before this questionnaire?</a></li>
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                <li><a href="#project-viability">Project Viability</a>
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                                    <li><a href="#q2_treatment">Treatment</a>
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                          <li><a href="#project-viability-will-our-idea-work">Will Our Idea Work?</a></li>
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                                            <li><a href="#q2_options">If you had the option of using two treatments for an infection, where one was antibiotics and one was bacteria that were designed to cure the infection, which would you choose?</a></li>
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                          <li><a href="#project-viability-ethics">Ethics</a></li>
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                                            <li><a href="#q2_doctor_recommendation">If your doctor recommended a treatment for an infection, which involved the use of bacteria that had been engineered to treat the infection, would you use it?</a></li>
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                          <li><a href="#project-viability-the-uti-clinic">The UTI Clinic</a></li>
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                          <li><a href="#project-viability-delivery-method">Delivery Method</a></li>
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                                    </li>
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                          <li><a href="#project-viability-increasing-awareness">Increasing Awareness</a>
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                            </li>
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                                  <li><a href="#project-viability-increasing-awareness-uniq-workshop">UNIQ Workshop</a></li>
+
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                                  <li><a href="#project-viability-increasing-awareness-utc-oxfordshire">UTC Oxfordshire</a></li>
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                    </li>
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                                  <li><a href="#project-viability-increasing-awareness-bbc-radio-oxford">BBC Radio Oxford</a></li>
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                            <li><a href="#q3_intro">Introduction</a></li>
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                                    <li><a href="#q3_results_sealed">Sealed within a section of catheter</a></li>
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                                    <li><a href="#q3_results_attached">Attached to the catheter</a></li>
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Latest revision as of 00:54, 19 September 2015

Questionnaire Results

First Questionnaire

Aim:

To find out what the public want synthetic biology to do for them.

Introduction

We conducted this survey in the Christmas vacation, with the idea that the results from this survey could inform our choice of project. The responses we got back were very varied, with some very interesting and detailed possibilities, and other, less thought-through options, such as "stop racism".

Results

We decided to display the responses from this questionnaire as a word cloud. The size of each word in the word cloud is proportional to the frequency of its occurrence in the questionnaire responses, so that it is clear what the public consensus of useful project ideas is.

Second Questionnaire

Aim:

To find out the public's thoughts on genetic modification, and see whether they would consider a treatment involving modified bacteria if they were suffering with a UTI , as well as gauging their opinion as to whether antibiotic resistance is a problem.

Introduction

Throughout our project, we have been determined to engage with the public so that we can develop a project which will be as useful to as many people as possible. These questionnaires, along with interviews with medical professionals and posts on social media, comprise a dialogue that we have maintained with the public for the duration of our project.

Questions

Ages of participants

We included age brackets as part of the survey so that we could check that our data is roughly representative, and so that we could see to what extent people of different ages are informed about genetic modification and antibiotic resistance. We found that most older people (31+) have heard of genetic modification but not synthetic biology, and are less likely to allow genetically modified bacteria to be used as a treatment. Younger people (up to 30) tend to be more open to the new treatment ideas, and more of them have heard of synthetic biology. However, our results may be biased, due to the high proportion of our participants aged under 30. Different generations are likely to have had different educations; synthetic biology is a very new field, so it is likely not to have been taught in schools yet. Similarly, older people may be more aware, and sceptical, due to the previous GM food scare.

Awareness

To what extent do you feel that antibiotic resistance is a problem that needs addressing in society today?

Our survey clearly shows that the public think that antibiotic resistance is an important problem that needs solving, therefore we feel that it is an appropriate and useful area to direct our project towards. One of our team members, George, worked in a UTI clinic last summer, so he knows first-hand that UTIs are a big problem for a lot of people, with current methods of treatment still being inadequate in severe cases. When he brought this to our attention while we were trying to decide on a project, we thought it was worthwile trying to find a solution to this problem.

Which of these do you think is the most common infection acquired in hospitals?

Most of the public (45.5%) thought that MRSA is the most commonly acquired infection in hospitals, showing that they think that antibiotic resistance is a problem. However, with UTIs coming in quite far behind this (19.5%), it seems that the public are not aware of the risk of getting UTIs in hospital due to urinary catheterisation. This could be due to the fact that UTIs are advertised less than MRSA, but since this is an important issue, we looked into educating the public through sessions with summer schools and school students, as well as getting in touch with local media, such as BBC Radio Oxford, ad promoting our project across social media. We believe that this has helped raise awareness of problems associated with catheter-based infections, not only in the urinary tract, but also due to other catheterised parts of the body.

Have you heard of genetic engineering?

96.5% of the people we surveyed had heard of genetic engineering. However, we did not collect data for whether people thought it was a good thing or not. This would be something to pursue in further surveys.

Have you heard of synthetic biology, before this questionnaire?

Compared to the question about genetic modification, the results for this question were much more evenly spread between yes and no, with 58% saying they had heard of synthetic biology. Again, it would be interesting to see whether those who have heard of synthetic biology have a good opinion of it or not, and this would be an avenue for future surveys.

Treatment

If you had the option of using two treatments for an infection, where one was antibiotics and one was bacteria that were designed to cure the infection, which would you choose?

The majority (70%) of the people we surveyed said that they would take the advice of their doctor on this. This means that it is important that we talk to and get advice from doctors as to how we can improve out treatment, since if we can't convince doctors that this is a better treatment than any current treatment, the patients won't take it either. However, encouragingly, of those who wouldn't take the advice of their doctor, our treatment was favourite with just under half saying they would prefer the designed bacteria (48%), compared to 40% who would prefer antibiotics.

If your doctor recommended a treatment for an infection, which involved the use of bacteria that had been engineered to treat the infection, would you use it?

Our survey showed that if a doctor recommended our treatment, only 6% would not consider it. This is very encouraging data for our project, but again highlights the importance of gaining support from doctors, because without their backing, this project is likely never to become as common a treatment as antibiotics.

Third Questionnaire

Aim:

To return to the public with a variety of delivery methods for our bacteria, so that they can provide feedback on what they like and don’t like about the options, and to see which they would like to see in use.

Introduction:

Having last surveyed the public on how receptive they would be to treatments involving engineered bacteria, and received very positive results, we decided to work on a selection of delivery options. Having designed several containment options with physical and molecular barriers to unwanted colonisation, we returned to the public to see which they would prefer.

Results

Sealed within a section of catheter

For a description of this option, check out our safety page here. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.

Pros:

  • No contact between patient and bacteria (11)
  • Extra safeguard should the bacteria escape (6)
  • Good compromise between encasing and ability to sense (3)
  • Very safe (2)
  • Simple (1)

Cons:

  • Less effective (14)
  • Long treatment time (6) – cost to NHS (1)
  • catheter uncomfortable (4)
  • Bacteria block catheter? (3)
  • Bacteria can’t be safely replaced (1)
  • Will agent be able to pass through catheter? (1)
  • Resistance (1)

The most common concern for this option was that it would be less effective than other methods, and would hence have a longer treatment time, causing discomfort to the patient and cost to the NHS. This concern was not outweighed by the number of people who liked that there was no contact between patient and bacteria, suggesting that the public would rather have a more effective treatment than one which was deemed to be “more safe”.

Other Concerns

Will the bacteria block the catheter? We would address this concern in the design of the bacterial compartment in the catheter, so that it does not impede the flow of water and urine.

Can the bacteria be safely replaced? We would investigate this further, and if it turned out that we couldn’t due to lack of sterility, we would suggest that another of our catheters were inserted, as a “disposable” solution.

Will the agent be able to pass through the catheter? We would need to investigate the nature of protein folding in urine-like conditions, something that we haven’t been able to achieve given the timescale of the project, but if the protein folds well, the agent would be able to diffuse out into the urinary tract. If not, it may be worth attempting to modify the protein structure to make it more stable in the conditions of the urinary tract.

Can the pathogenic bacteria gain resistance? The agents produced by our bacteria are designed to break up the biofilm that gives the pathogenic bacteria protection. Resistance arises when an antimicrobial agent fails to kill the entire population of targeted bacteria. We expect that, due to the design of our system, the entire population would be killed, so that resistance is not a problem.

Beads containing bacteria contained within a section of catheter

For a description of this option, check out our safety page here. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.

Pros:

  • Extra degree of containment (12)
  • Multiple safety measures (3)
  • Kill switch (2)

Cons:

  • Less effective (21)
  • Infection won’t be completely cleared due to dulled sensing capacity (5)
  • Restriction of flow (4)
  • Do bead cases break down in body? (3)
  • Long treatment time (3)
  • More expensive (2)
  • catheter uncomfortable (2)
  • More hospitalisations (1)
  • Replacement of bacteria (1)

Again, the most common concern was over the efficiency of this option, with additional related concerns about the number of hospitalisations, length of treatment, and the chance that the infection won’t be completely cleared. This was, as before, not outweighed by those who thought the extra degree of containment was a good idea. This provided further evidence that the public would prefer a more effective treatment.

Other Concerns

Will flow of water/urine be restricted? We would design the bead compartment around this concern, so that there is plenty of catheter diameter to allow sufficient flow.

Do the beads break down in the body? This is something that we would test. Sodium alginate (the substance from which the beads are made) is sometimes used in the food industry, which suggests that it could be broken down. What we would need to test is whether the enzymes involved are only present in the digestive tract, or whether they are present in the urinary tract as well.

This treatment option would be more expensive due to the materials involved. This is true, but we believe that the comparative cost is negligible due to the very low cost of sodium alginate. We would investigate other materials which have the same sort of properties, and whether these materials are any less expensive.

Can the bacteria be safely replaced? Again, something for further investigation. If, like in the option above, it is not possible, we would suggest our catheters are used as disposable, so that when the bacteria need replacing, the whole catheter is replaced.

Attached to the end of a catheter

For a description of this option, check out our safety page here. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.

Pros:

  • More effective (19)
  • Kill switch (6)
  • Balance between containment and efficiency (5)
  • Still physically contained (4)

Cons:

  • Introduction of another bacteria (8)
  • Diffusion rate of antibacterial agent (1)
  • Immune response (1)
  • Bacteria escape to kidney? (1)
  • Slower treatment (1)
  • Resistance (1)
  • catheter uncomfortable (1)

The primary concern for this treatment is that if the physical containment fails, another type of bacteria will be introduced to the urinary tract, and since their infection was caused by bacteria, this makes the public more wary. However, this is counteracted by the fact that more than twice as many people think that this treatment is more effective, and roughly the same number feel that it strikes a good balance between containment and efficiency.

Other Concerns

Will the diffusion rate of the antibacterial agent be too low to be effective? As long as we have enough of our engineered bacteria secreting the agents, we will be able to get a sufficient concentration of antibacterial agent to make this treatment effective. We are modelling how many bacteria would be “enough”.

Will the attached bacteria result in an immune response from the body? This is something that we would test. We don’t believe it would, since the chassis we are using has had all the pathogenic properties removed. We think that the immunogenicity of the agents is more of an issue that the immunogenicity of the bacteria, and an article on that can be found here.

Will the bacteria be able to escape to travel up to the kidney? This would be a long journey for the bacteria to make. They shouldn’t be able to make it, since the kill switches would start to work as soon as they were out of range of the pathogenic bacteria, and result in the deaths of all the escaped bacteria.

Will the distance between the catheter and infected site result in slower treatment? Yes it will, but the treatment will be faster that if the bacteria are contained within the catheter. However, if we had more time, we would also work on improving the efficiency of agent production, so that, whatever the distance, our solution would be more effective.

Can the pathogenic bacteria gain resistance? The agents produced by our bacteria are designed to break up the biofilm that gives the pathogenic bacteria protection. Resistance arises when an antimicrobial agent fails to kill the entire population of targeted bacteria. We expect that, due to the design of our system, the entire population would be killed, so that resistance is not a problem.

Free-living Bacteria

For a description of this option, check out our safety page here. Here is a list of the pros and cons of this treatment, as identified by the members of the public we surveyed, along with the frequency with which these were mentioned.

Pros:

  • Most effective (23)
  • Safe kill switch (11)
  • Swift treatment (6)
  • Two types of bacteria (5)
  • More comfortable for patient (4)
  • Prevention (1)
  • No need to be in hospital (1)

Cons:

  • Side effects of engineered bacteria colonisation (11)
    • just want a clear explanation from health care professional (8)
  • Kill switch concerns (5)
  • Opportunistic pathogens (2)
  • Any self-sacrificing bacteria left once all UTI-causing bacteria are killed? (1)
  • More difficult to monitor (1)

The public’s biggest concern for this option is side effects from the engineered bacteria colonising the urinary tract. However, over 2/3 of the people who raised this concern said that they would be happy to use the method if they got a clear explanation of how it worked from a health care professional. Additionally, the concern was outweighed by the public’s opinion of having a safe kill switch, and that this treatment is the most effective.

Other Concerns

How do you know whether the kill switch will be effective? The kill switch we have designed works in theory, but we will not know properly until it is tested. However, many other teams have used similar kill switches, and they have worked, so we don’t have a reason to suggest that it won’t work. The people who wrote this as a concern said that “if it can be proved to work, I’d be happy with it”, suggesting that their concern is that they haven’t heard of this type of thing before, and are wary of it for that reason, since it is harder to visualise than, for example, a physical containment option.

Will opportunistic pathogens take advantage of the niche that was previously occupied by the pathogenic bacteria? We are hoping that our bacteria will occupy that niche until the infection has been cleared up, and then allow the urinary tract’s natural flora to recolonise. Obviously, we would need to test this in vivo, but we think it would be good to use this treatment in combination with a preventative treatment against opportunistic pathogens, at least until conclusive evidence has been collected.

What will happen if there are any self-sacrificing bacteria left once all the pathogenic bacteria are killed? We would use a very basic additional kill switch where we could get rid of any remaining engineered bacteria at the end of treatment by adding IPTG.

Won’t this make the bacteria more difficult to monitor? If this solution were to proceed to clinical trials, one of the things we would test would be how long it took to clear up an infection, so we could base treatment courses on this. We would be more likely to monitor the symptoms of the infection rather than the bacteria themselves.

The Public's preferred method of treatment

From the survey results, we found that the public were most happy with the free living bacteria option (44%), due to it's effectiveness at treating the infection, resulting in greater comfort for the patient. The next most popular option with 20% was sealed within a catheter, since this balanced efficiency with safety. Attached to a catheter and bacteria contained within beads both got 16%, these being less popular because one aspect (safety or efficiency) outweighed the others too heavily. Only 4% said that none of the options appealed, which is very encouraging for our treatment, since treatment of infections with engineered bacteria is a very new concept. It gives our project and synthetic biology as a whole a confident outlook that the public are so receptive to this idea.