Antibodies linked to long-term Lyme symptoms

Source:  http://www.nature.com/news/2011/110805/full/news.2011.463.html

August 5th 2011

Some patients with Lyme disease still show symptoms long after their treatment has finished. Now proteins have been discovered that set these people apart from those who are easily cured.

People who experience the symptoms of Lyme disease, which include fatigue, soreness and memory or concentration loss, after treatment for the disorder are sometimes diagnosed as having chronic Lyme disease or post-Lyme disease syndrome. But these diagnoses are difficult to make, because the individuals no longer seem to harbour the bacteria that cause Lyme disease. And the symptoms could instead be indicative of chronic fatigue syndrome or depression.

Now Armin Alaedini at Weill Cornell Medical College in New York and his colleagues have found that patients diagnosed with post-Lyme disease syndrome have antibodies that suggest they carried the infection for an unusually long time. The finding, published in Clinical Immunology1, might help the syndrome to be better understood, diagnosed and treated.

Alaedini's team looked at antibodies made in response to a protein called VlsE, which is found on the surface of Borrelia burgdorferi, the tick-borne bacterium that causes Lyme disease.

The antibodies recognize a snippet of the protein called an epitope, and recruit the immune system to attack the bacterium. The researchers found that post-Lyme sufferers have a greater variety of antibodies to this epitope than patients whose infection cleared up quickly.

This finding suggests that patients with chronic symptoms have experienced a prolonged infection, caused by microbes that have evaded the immune system by varying the epitopes they carry. As a result of these variations, the body makes new antibodies targeting the modified protein. The longer the microbe manages to keep changing, the more diverse its host's antibodies become.

Some post-Lyme sufferers had varied antibodies against VlsE epitopes despite being diagnosed and treated early, says Alaedini. "That could mean they naturally have a different antibody response to the infection than most people; it could mean they weren't treated properly; or it's possible they were reinfected and the second infection was never treated," he says.

Inflammatory role

"This is the first study I've seen that shows some immunologic difference between someone who resolves their Lyme and someone who develops post-Lyme disease syndrome," says Linda Bockenstedt, a rheumatologist and immunologist at Yale School of Medicine in New Haven, Connecticut.

The presence of varied antibodies hints that the chronic symptoms could be caused by an ongoing inflammatory response caused by antibodies mistakenly reacting to the body's own proteins, Bockenstedt suggests.

"The big question to me is whether this can lead to an autoimmune phenomenon," says Bockenstedt. "But if that were the case, I'd expect the disease to worsen without immune-modulating treatment, and it doesn't."

Alaedini suggests that higher levels of antibodies could increase the body's levels of cytokines, immune-system proteins that can trigger the symptoms experienced by patients with post-Lyme disease syndrome. "Various cytokine profiles have been associated with fatigue, anxiety and depression," he explains.

If these antibodies are unique to people with chronic Lyme disease, it could lead to a test and treatments for the disorder, Alaedini says. It could also guide treatment of the disease itself. "If patients with an acute infection develop antibodies to these epitopes, perhaps they require a more aggressive course of therapy," he adds.

But a predictive marker won't be useful without new therapies for the persistent symptoms, says Henry Feder Jr, a physician specializing in infectious diseases at the University of Connecticut Health Center in Farmington. If an immune response problem leads to the syndrome, antibiotics won't help. "I guarantee you that if you tell a patient they won't feel better after antibiotics, they won't," Feder says. "We need to know what's going on."

References
Chandra A. et al. Clin. Immunol. http://dx.doi.org/10.1016/j.clim.2011.06.005 (2011).

[dazza3]

hi there
thank you for the information

[JackieCalifornia]

Mmmm, interesting!  

This straddles the chasm between (1) those who say Lyme is cured (badda-bing) after a few weeks of antibiotics, and any remaining symptoms are an over-active immune system, and (2) those who say that Lyme is difficult to eradicate because of its slow reproductive cycle, use of biofilms in which to evade detection by the immune system, and Lyme's ability to modulate the endocrine system to assist in its own survival.

It will be interesting to see how the warring factions sort out this new data.  

Thanks for the post!

[ewford]

This also could be a set up for giving all dr's a reason for not prescribing ABX to cure any microbial Borellia or Mycoplasma.  Notice how you don't see ANYTHING about myco's in any recent Gov't funded research. Still makes me wonder.

[nutrinut_bob]

Thanks for posting this!  Now I know I can go ahead and kill the vermin, and be able to later prove that I did indeed once have it, for possible future disability considerations.  

[Ness78]

Hi Jackie, Would you mind explaining this to me a little bit...

"Lyme's ability to modulate the endocrine system to assist in its own survival".

Thanks :)

[Ness78]

"The big question to me is whether this can lead to an autoimmune phenomenon," says Bockenstedt. "But if that were the case, I'd expect the disease to worsen without immune-modulating treatment, and it doesn't."

I wonder if docs in the IDSA camp treat post lyme syndrome with steroids since they believe it to be autoimmune.  Wouldn't that be a matter of literally putting the money where their mouth is. Also, wouldn't that be a huge tell tale sign if either the bacteria is still wreaking havoc or there is an autoimmune response to it. I wonder if the insurance companies accept or reject a lifetime on immune modifying drugs.  

Maybe if it were protocol to prescribe a lifetime of immune modify drugs, insurance companies would be more open to more aggressive longer term treatment of antibiotics to try to eradicate the bacteria instead.

Does anyone know if long term use of steriods is used for 'post lyme syndrome'?

[JackieCalifornia]

"Hi Jackie, Would you mind explaining this to me a little bit... 'Lyme's ability to modulate the endocrine system to assist in its own survival' ".

===================================================
I don't have a specific reference or quote at hand, but have read in various places that Lyme bacteria have the ability to mess with the endocrine system (including thyroid) to modulate the body's actions and reactions in a way that makes it more comfortable for the bacteria to live.  My body temp was down by several degrees constantly when I was quite ill, like someone was messing with my theromostat.  I couldn't tell those effects from the other effects of my illness, so it was just one big ball of misery.

Finally my doc talked me into trying thyroid meds, and while I stopped them within a couple of days due to side effects, another doc down the line persuaded me to try again, this time in smaller, divided doses and taking them with food (the directions say 'on an empty stomach'), and that has worked miracles.  It's possible that my thyroid would have failed anyway, but there's no telling, so I will blame it on LYME!!!  

Every time I try to read up on the endocrine system, my eyes start going around in circles, because it is such a mass of feedback loops all hooked together and interacting.  In what exact way Lyme messes with it all, I don't know, but have read in multiple places that it can do so.

==================

About whether steroids are used to treat 'post Lyme', I don't know.  My impression has been that the shrug that accompanies a diagnosis of post-Lyme syndrome means 'tough luck, go home and get over yourself', but someone else here may have specific experience in this regard.  If steroids are given, I would anticipate that symptoms get worse and don't stabilize or go away, which would throw open again the whole larger question of whether one was cured or not.  Don't know how nonLLMDs react to that.