How two teenagers living with the incurable genetic disorder cystic fibrosis highlight the risk of contracting life-threatening infections
In the new movie “Five Feet Apart”, Stella and Will are two teenagers confined to a hospital while they battle the genetic disease cystic fibrosis (CF). Although Stella initially dislikes Will’s casual and cocky attitude, the two eventually become friends and fall into a sweet hospital romance. Their relationship is constrained by the fact that they must stay at least 6 feet apart to prevent cross-infection and further lung complications. Will is particularly dangerous because he’s infected with Burkholderia cepacia, a bacteria that is difficult to treat and prevents the possibility of a lung transplant.
We don’t often see Hollywood movies cross paths with the world of microbiology, but this film did exactly that. While we expect an extreme dramatization of any real life situations on the big screen, the directors didn’t have to exaggerate the dangers of B. cepacia to patients with CF. This served as a great reminder to anyone working in pharmaceutical Quality Control that catching contaminations long before products reach patients should always be our goal.
The movie also highlights the difficulty of living with CF. In people with CF, lung function is decreased due to mucus that blocks the airways which also increases their risk of infection. CF can impact the gastrointestinal tract as well, and many people with CF have trouble getting adequate nutrition. In the movie Stella wrestles with the possibility of a shortened life span since her lung function is so low, which is devastatingly common with CF.
Another main component of “Five Feet Apart” is Stella and Will’s detailed treatment regimens. The two have a cart full of medication that they take daily, as well as nebulizer treatments and a vibrating vest that breaks up the mucus. Will is at the hospital specifically for a drug trial to treat his B. cepacia. While the number of effective medications for CF has increased, patients are still waiting for a cure and improved quality of life.
B. cepacia has been responsible for a large number of product recalls in the last few years. As the movie clearly demonstrates, B. cepacia can be very pathogenic, particularly to certain patient populations like those with CF. It is a robust bacteria that can survive in very harsh environments. The FDA even issued an advisory statement to drug manufacturers in May 2017 to warn of the dangers of B. cepacia contamination. In 2018, the USP also drafted a chapter that outlines method suitability for detecting B. cepacia in nonsterile products.
Identifying B. cepacia is difficult because it’s part of a complex of 20 closely-related organisms that have differing pathogenicity. Traditional phenotypic and proteotypic ID methods are unable to distinguish species within the complex. DNA sequencing of the 16S rRNA is also unable to separate out the complex. However, Charles River has developed an alternative gene target that can be sequenced to give a species-level ID. This service, called ProSeq, is a highly discriminatory and accurate sequence-based method. Identification to the species-level is critical for final product release, tracking and trending of the manufacturing flora, and ensuring patient safety.
“Five Feet Apart” was an entertaining and emotionally stirring movie. It brings awareness to cystic fibrosis and the dangers of a specific Burkholderia species. It emphasized the need for safe and effective medication for patients. As a microbiologist, it was fun seeing a small part of my world on the big screen, and I was proud knowing the impact Charles River can have on patients.