Cholera and syphilis captured in BioArt

Nick Thomson, Head of the Parasites and Microbes Programme at the Wellcome Sanger Institute, and Anna Dumitriu, an internationally renowned artist, met at an event marking 100 years of the National Collection of Type Cultures (NCTC) – a bank of thousands of bacterial strains. The occasion noted those people a century ago who began the collection, preserving bacterial specimens for study. This was before genetics and genomics as we know them today, but they had the foresight to create historical bioarchives for the future understanding of health.

The celebration resonated with both Anna and Nick, who saw how looking at historical artefacts can highlight the progression of science and medicine. They decided to collaborate on a BioArt project. In 2022, Anna spent time in Nick’s group, learning about the team’s research, and extracting DNA from Treponema pallidum sp. pallidum and Vibrio cholerae – the organisms that cause syphilis and cholera.

She has now created two dresses that form part of her series, Collateral Effects, funded by Arts Council England. The cholera dress is from 1840 when cholera was rife in London, and the syphilis dress is an Edwardian woman’s cotton underskirt. Anna has patched, embroidered, dyed and altered the dresses - there is a historical story and meaning behind each process. The dresses also both incorporate DNA from the bacteria that causes each disease, which Anna extracted in the Sanger Institute laboratories.

“I think we, as scientists, forget what a creative industry science actually is. And I think there is huge resonance and huge parallels between art and science. Anna gave us an opportunity to release some of that trapped creativity, vicariously.” – Nick Thomson.

Cholera Dress (detail). Credit: Anna Dumitriu

Syphilis – a modern disease

At a recent event at the Sanger Institute, Anna talked with Nick and Linda Grillova, a Postdoctoral Fellow in Nick’s group. Anna spoke about her interest in micro-organisms, originally sparked in junior school where she recalls studying the plague for three weeks, at the same time as reading a (child’s version) of Dracula, a tale whose mythology is grounded in the spreading of infectious diseases.

“I’m interested in how infectious diseases have a cultural impact on the world,” she said. “Modernist architecture and many of the buildings we see around us, for example, were influenced by attempts to prevent tuberculosis.”

She also shared the example of powdered wigs, which were trendy in the 1700s in Europe as syphilis swept across the continent. Popularised by royalty, the wigs were worn to hide hair loss and sores caused by the disease.

Despite the fact that syphilis, and the T. pallidum sp. pallidum bacterium that causes it, have been with humans for centuries, little is known about the disease. Linda spoke about why she studies it.

“Firstly, of course, it’s important. Many people think this disease belongs to history, but it's actually quite a modern disease, and the incidence is still increasing. Secondly, there is little to no knowledge of the bacterium’s basic biology or pathogenesis, how we can prevent disease, and there’s no vaccine. The last reason why we like to study it is because these bacteria have several characteristics which make them unique. For example, T. pallidum has this special spiral shape, which enables the bacterium to infect any organ.”

The bacterium also has a very small genome, indicating there are many genes ‘missing’ in metabolic pathways. The bacterium has to rely on the host cell and has to be provided with several nutrients, and this means it is very difficult to grow in a laboratory. It was only in 2018 that researchers found a way, using horse cells. There are just four places and a handful of people in the world who can grow it, including Linda, and now Anna. “The fact that until a few years ago, a 1912 strain of syphilis was being kept alive by a series of researchers in the USA in rabbits is fascinating to me,” said Anna. “A bit like the Knights Templar, guarding a relic over centuries.”

Anna extracted syphilis DNA in the laboratory and impregnated an antique Edwardian woman’s cotton underdress with it. The garment adds historical context, as syphilis was often veiled and highly stigmatised.

Nick says, “I love the syphilis underskirt because it highlights the hidden aspect of STIs, which really resonates at a genomic level too. We struggle to find epidemiological data to link people and study the spread of syphilis, and that's because of the scourge of this disease. There's huge sensitivity in Anna's work.”

Syphilis Dress detail with DNA. Image credit: Anna Dumitriu

Communicating cholera

“Amongst the NCTC strains is the oldest living example of cholera. It was taken from a soldier who was a patient in Alexandria, Egypt in 1916,” says Anna.

“I have a tendency to stalk sites like eBay for weird antiques, and I stumbled upon a purse made by a convalescent soldier in Egypt in 1916. And he embroidered on it ‘souvenir of Egypt 1916’. I thought this is the perfect object that we have to impregnate with the extracted DNA.”

“The idea is that there are layers of relics in the works, and the history of that organism.”

Nick commented on how the historical perspective on disease makes us rethink current notions.

“The strain in the NCTC collection, it's a weird strain. It has suffered a little bit over 100 years in storage, but what's interesting about it is that it's resistant to beta-lactam antibiotics. In 1916, we didn't even know about the existence of antibiotics, and we certainly hadn’t produced any – that was not for another few decades.”

Work by Matt Dorman, Senior Staff Scientist in Nick’s team, has shown that the resistance gene present in the 1916 strain of cholera is functional – it confers resistance to current therapeutic levels of beta-lactam antibiotics.

“There's this notion that we've invented superbugs and antimicrobial resistance. While we certainly didn’t invent them they have mostly been there long before we discovered antibiotics and have been adapting therapies to overcome high levels of resistance in these bugs,” says Nick. “Overall what we've done is just to encourage them to gain more and more complex patterns of resistance.”

The same is true of other bacteria, too. Genes that confer drug resistance are often found on plasmids, genetic elements that can transfer between bugs, and sometimes species.

“What humans have done is apply selective pressure. And that's really key. Because it also explains why, when we introduce a new antibiotic, about two years later we see the emergence of drug-resistant bugs that are disseminated around the world. They were already there.”

“This artwork grounds us, gives us an anchor point in time to frame our current questions.”

The 1840s cholera dress Anna worked on is also impregnated with the cholera DNA. It alludes to the Broad Street pump moment, when John Snow removed the handle from the water pump in Soho, London, to stop people from drinking the infected water after deducing it was the source of the cholera epidemic. His work is regarded as the founding of modern epidemiology. “It was mostly [sex workers] who drank from the Broad Street pump, apparently, and I did some research that showed that they'd be wearing slightly out-of-date clothes,” says Anna, “and so the dress is from five or ten years before that moment.”

“I've embroidered the pump on it, and I've embroidered the cholera bacterium on it. And there's a tiny little bacteriophage if you look really closely, on the bacterium. Because cholera, which was a complete revelation to me, it doesn't have a toxin - it is produced from a virus which it has to catch.”

Art and science

Anna’s work has been displayed in museums and galleries around the world, bringing new audiences to frequently forgotten diseases. “The works are beautiful in their own right. And, they give us a different way to talk about our research. In science, uncommunicated findings are no findings at all,” says Nick.

Anna spoke about the integration of history and science. “I love like finding out the real stories,” she said. “I love talking to scientists, while being on a journey. History and science are mixed up together. And then there is the important story of the future. Where are we going with this research?”