Recent research has revealed critical information about Borrelia burgdorferi, the bacterium that causes Lyme disease. They underscore its invisible, stealth-like quality, and how it makes it difficult to detect, diagnose, or treat. Scientists have recently discovered some special characteristics of Borrelia that help it get away from the immune system. While this newfound capability is remarkable, it leads to worries over chronic post symptomatic or permanent deficits for a minority of patients. These findings underscore the need for enhanced diagnostics and therapeutics to address this expanding health threat.
Borrelia is the bacteria that causes Lyme disease. Anaplasmosis, a tick-borne communicable disease, has recently experienced a dramatic increase in incidence across much of the country. The particular pathogen of interest, Borrelia burgdorferi, has unique features that make it more challenging both to identify and to treat. Borrelia have a distinctive talent for outsmarting their predators by hiding in the body’s own “reservoirs.” This reflects how SARS-CoV-2 can hide out in people with long COVID.
This pathogen continuously makes these antigens, and it is the chronic presence of these antigens that can produce long-term symptoms like fatigue, brain fog, joint pain, and others. A recent study found that 15% of individuals who develop Lyme disease do not fully recover. As a consequence, they suffer with debilitating and sometimes life-altering symptoms. This chronic expression of Lyme disease may have similarities to syndromes seen with other post-infectious disease.
Borrelia’s cell wall is distinct from other spirochetes in that it has a typical peptidoglycan structure. This substance can remain in the body for weeks post infection. Peptidoglycan has a tendency to accumulate in the liver. This egg-laying creates a dynamic constant source of antigens, which varies the immune response from short-lived to never ending, chronic illness.
This research has used mouse models to explore the role of Borrelia’s biological constructs and the role they play in their ability to persist within the body. As a result, their investigations found that Borrelia’s DNA may be non-existent or undetectable, even using sensitive techniques such as quantitative PCR making diagnosis even more difficult.
“Peptidoglycan can be detected in human patients after oral and/or IV antibiotics. We have previously attempted to detect bacterial DNA from B. burgdorferi in the exact same patient samples tested in manuscript and were unable to do so,” – an anonymous source mentioned in an email to STAT.
The hurdles to effective treatment start with Borrelia’s masterful evasion tactics. To determine a more effective antibiotic regimen, the researchers screened more than 500 approved antibiotics. Their dedication led to the serendipitous discovery of piperacillin, a member of the penicillin family. At lower doses than standard doxycycline, this drug has the potential to provide an equally safe but more effective treatment option.
“We found that the unusual chemical features of the Borrelia burgdorferi peptidoglycan is what makes it able to persist. It looks like the liver is acting as a sink for these unusual pieces of peptidoglycan,” – Brandon Jutras.
The implications of these findings are twofold. Firstly, they underscore the necessity for continued research into Lyme disease, particularly given the increasing number of cases being reported geographically. Second, their poor experience conveys the importance and urgency of developing new treatment options for patients with chronic sequelae from previous infections.
Amy Proal, a researcher in the field, expressed her viewpoint on the matter:
“When we find persistent antigen in patients with long Covid, we interpret our findings differently than this team. I think that’s a key thing to consider.”
She highlighted the importance of further research on Borrelia. This is particularly important given the need to analyze tissue samples from patients who still have symptoms following Lyme disease.
“It is helpful, I guess, to know that peptidoglycan can persist a little bit longer than we thought or something. But to be most comprehensive and fully understand what can happen in people who get Borrelia and get chronic symptoms, there’d have to be some work after this to actually look for Borrelia, including in the tissue of the patients who have symptoms after Lyme disease,” – Amy Proal.
The field is clearly moving forward with the goal of better understanding Lyme disease and its causative agent. Continued research remains key to developing superior diagnostic tests. It will go a long way in producing better targeted therapies for all patients suffering from this challenging disease.
