Lyme disease, science, and society: Camp Other
Showing posts with label spirochetes. Show all posts
Showing posts with label spirochetes. Show all posts

Sunday, October 28, 2012

0 Symbiotic Spirochetes In Animal Models

Recently, I noticed this intriguing item in the news that is of interest to many medical professionals around the world who are struggling to care for patients' difficult to eradicate C. difficile infections: A recent murine study[1] provided evidence that a simple mixture of six phylogenetically diverse intestinal bacteria - including novel species - can re-establish a health-associated microbiota and clear C. difficile infection from mice.

With this outcome, it's possible that medical professionals will no longer apply the treatment of last resort - fecal transplants - to save human patients' lives. Instead, all patients with raging C. difficile infections will have to do is swallow a pill or consume food that contains the strains of bacteria needed to reverse dysbiosis and rebalance the microbiota in their stomachs so that C. difficile is no longer a threat.

Over time, researchers are uncovering the complicated dynamic between different microorganisms which live inside the human gut. Also, they are refining their understanding of the dynamic between different microorganisms inside animals with increasing speed as more invasive studies can be completed in animals than can be easily completed in humans. Among these studies are those on the relationship between spirochetes and other microorganisms found in ruminants such as cattle and sheep, termites, and molluscs.

Symbiotic Spirochetes In Termites
 

Microscopic image of Mixotricha paradoxa
covered with thousands of Treponema spirochetes
One interesting and complex symbiotic relationship involving spirochetes is found within termites' guts. Spirochetes are one of the most abundant bacteria present in the gut fluid of termites, and the symbiotic relationship between various microbes in termites of all kinds actually predates the evolution of termites from their wood-feeding roach ancestors over 120 million years ago [2].

Most termites have spirochetes which are free-living in the gut fluid, but they have also been found as ectosymbionts attached to protists inside termite guts. Mixotricha paradoxa is protozoa found inside the gut of the Australian termite species, Mastotermes darwiniensis. It was originally thought the long tiny hair-like structures covering the length of its body were short cilia - outgrowths from the protozoa itself. However, upon closer examination years later, scientists Cleveland and Grimstone[3] discovered these were not cilia but a dense carpet of Treponema spirochetes - spirochetes which help propel Mixotricha paradoxa forward while it uses its own anterior flagella to steer in the right direction. How it coordinates this movement is unknown - it is surmised that they automatically synchronize due to their proximity.

These spirochetes not only help Mixotricha paradoxa move forward, though. One thing Mixotricha paradoxa does to help its host, the termite, do is help break down cellulose into sugars and then hydrogen, acetate, and carbon dioxide from the wood it eats. From there, what the Treponema spirochetes are predicted to do is oxidize the acetate which was produced and use it to support 100% of the termite's respiration requirements.[4]

What makes this symbiosis even more complex is that it doesn't stop there. No, not only does Mixotricha paradoxa have a Treponema spirochete helping it survive - but it also has three more bacterial species onboard: A lot of rod-shaped bacteria related to Bacteroides live on its surface, and is suspected to help breakdown cellulose as it sits alongside the Treponema spirochetes; a spherical form of bacteria lives inside Mixotricha which is hypothesized to act as mitochondria for the protozoa (as Mixotricha does not have its own mitochondria); a large spirochete attributed to the genus Canaleparolina.[5]

Not much is known about these three bacterial species' lives in Mixotricha paradoxa, and more research is needed. The most recent research on Mixotricha paradoxa adds to this complex symbiotic dynamic, as it has been discovered that not all glycolytic activities in Mixotricha paradoxa are produced by its microorganisms - cellulases have been detected in the salivary glands of Mastotermes darwiniensis - the termite itself.[6]

Symbiotic Spirochetes In Ruminants

The bovine or cow stomach has a wide variety of organisms inside it - such as fungi, bacteria, archaea, protista, and viruses. All these organisms help break down food, especially plant matter and in particular, cellulose. And like the Mixotricha paradoxa inside the Australian termite, Mastotermes darwiniensis, the organisms are all dependent on each other to some degree and use the byproducts of one another for their own benefit.

Cows - unlike people - have four stomach compartments to digest their food: the rumen, the reticulum, the omasum, and the abomasum. The rumen is the largest compartment, and it contains a huge number of different microbes. The reticulum is responsible for creating cud and trapping indigestible substances like rocks or nails - and unfortunately, can be subject to more injury than the other compartments. The omasum sends large substances to the rumen and reticulum while allowing smaller substances to pass on to the abomasum. And the abomasum is very similar to a human stomach, as it produces stomach acids and enzymes to break down proteins before sending the result to the small intestine.

While the most common bacteria in the bovine stomach are gram-positive cocci and rods, a smaller percentage of their population are spirochetes which play a role in ruminant digestion. Organisms such as Treponema bryantii, a saccharolytic spirochete, enhances the breakdown of cellulose while cellulolytic bacteria of different species break down plant cell walls into soluble sugars.

Two interesting passages from the publication, Interspecies bacterial interactions in biofilms, by James, Beaudette, and Costerton[7], highlight the relationship between Treponema bryantii and other microbes studied in vitro from bovine rumen:
"Observations of biofilms on cellulose particles from the rumen revealed cellulolytic as well as noncellulolytic bacteria enmeshed in the exopolysaccharide matrix of the biofilm. Addition of a noncellulolytic species, Treponema bryantii, to cultures of a cellulolytic species, Fibrobacter succinogenes or Ruminococcus albus, resulted in an enhanced rate of cellulose degradation. Presumably, T. bryantii utilized the hydrolytic products (eg, glucose or cellobiose) from the cellulolytic bacteria which may repress and/or inhibit the cellulolytic enzymes."

"...Microscopy of biofilms formed during protocooperative cellulose digestion by R. flavefaciens and T. bryantii revealed that cellulolytic R. flavefaciens cells were attached directly to cellulose particles, while the spirochete, T. bryantii, was located in the upper biofilm layers. This spatial arrangement and the mobility of spirochetes in viscous environments suggest that this organism may move through the biofilm, scavenging the products of the cellulolytic bacteria."
The first study of Treponema bryantii in 1980, Treponema bryantii sp. nov., a rumen spirochete that interacts with cellulolytic bacteria[8], offers more specifics in its abstract as to its biological requirements:
"...When cocultured in these media the spirochete used, as fermentable substrates, soluble sugars released from cellulose by the cellulolytic bacterium. In cellulose-containing agar medium the spirochete enhanced cellulose breakdown by the Bacteroides succinogenes strain. Electron microscopy showed that the helical spirochete cells possessed an outer sheath, a protoplasmic cylinder, and two periplasmic fibrils. Under a CO2 atmosphere, in a reduced medium containing inorganic salts, rumen fluid, glucose, and NaHCO3, the spirochete grew to a final density of 1.9 X 10(9) cells/ml. Succinate, acetate, and formate were products of the fermentation of glucose by growing cells. CO2 (HCO3-), branched short-chain fatty acids, folic acid, biotin, niacinamide, thiamine, pyridoxal, and a carbohydrate were required for growth of the spirochete."
Spirochete Symbiosis In Molluscs

While so far there is no evidence molluscs harbor spirochetes which have symbiotic relationships with its host or other microorganisms, spirochetes which coexist peacefully within their host are worth noting.

Spirochetes from the genus Cristispira have been found inside more than 50 species of 22 families of marine bivalves and 3 freshwater bivalves. It has been shown to be a commensal organism living within molluscs and has not been shown to provide any benefit or disadvantage to molluscs such as Prince Edward Island oysters.

This past May, an interesting paper was published, Spirochetes in gastropods from Lake Baikal and North American freshwaters: new multi-family, multi-habitat host records[9].

The abstract states:
"We describe the first records of spirochetes in the gut of fourteen species of continental gastropods from a range of habitats and representing six families (Amnicolidae, Baicaliidae, Bithyniidae, Pyrgulidae, Lithoglyphidae and Benedictiidae). The bacteria were mainly found in the crystalline style sac, as has been reported in marine bivalves. The surveyed habitats include water bodies in North America and Eurasia, including deep water hydrothermal vent and gas hydrate zones in Lake Baikal. Spirochetes were present both in mature and young snails, but were not detected in embryos before hatching, indicating lateral transfer. The surveyed gastropods range in trophic strategy, including phyto-, detrito- and bacteriophagous grazers and filter feeders. Our results indicate that spirochetes are commensal in the surveyed gastropods with potential limited benefit and no detriment to the host animal. We suggest that the specialized internal habitat of the crystalline style sac in molluscs is likely to reveal unrecognized spirochete diversity that will shed new light on gastropod trophic ecology and spirochete diversity."
More research is needed to determine which limited benefits different spirochetes may provide for their hosts.

Looking at the symbiotic and commensal relationships between animals and spirochetes - or between spirochetes and other microbes - one has to wonder what kind of relationships different spirochetes have with us and microbes within us. Humans already play host to spirochetes which are considered commensal Treponema and unfortunate hosts to spirochetes which are pathogenic such as those which cause syphilis and Lyme disease (Borreliosis). But is there more to this story than is often told? Do these bacteria have deeper relationships?

References:

1) Trevor D. Lawley, Simon Clare, Alan W. Walker, Mark D. Stares, Thomas R. Connor, Claire Raisen, David Goulding, Roland Rad, Fernanda Schreiber, Cordelia Brandt, Laura J. Deakin, Derek J. Pickard, Sylvia H. Duncan, Harry J. Flint, Taane G. Clark, Julian Parkhill, Gordon Dougan. Targeted Restoration of the Intestinal Microbiota with a Simple, Defined Bacteriotherapy Resolves Relapsing Clostridium difficile Disease in Mice. PLoS Pathogens, 2012; 8 (10): e1002995 DOI: 10.1371/journal.ppat.1002995
2) Grimaldi, D. and Engel, MS. Evolution of the insects. 2005. Cambridge University Press, NewYork, NY.
3) Cleveland, L.R., and A.V. Grimstone. The fine structure of the flagellate Mixotricha paraodoxa and its associated micro-organisms. 1964. Society 159:668-686.
4) Leadbetter, J.R. Acotgenesis from H2 Plus CO2 by Spirochetes from Termite Guts. 1999. Science 283:686-689.
5) Brugerolle G. Devescovinid features, a remarkable surface cytoskeleton, and epibiotic bacteria revisited in Mixotricha paradoxa, a parabasalid flagellate. Protoplasma. 2004 Oct;224(1-2):49-59.
6) Konig, H., Li Li, Wenzel, M, Frohlich, J.  Bacterial Ectosymbionts which Confer Motility. p. 86 Molecular Basis of Symbiosis. 2006. Springer-Verlag.
7) G A James, L Beaudette and J W Costerton. Interspecies bacterial interactions in biofilms. Journal of Industrial Microbiology & Biotechnology. Volume 15, Number 4 (1995), 257-262, DOI: 10.1007/BF01569978
8) Stanton TB, and Canale-Parola E. Treponema bryantii sp. nov., a rumen spirochete that interacts with cellulolytic bacteria. Arch Microbiol. 1980 Sep;127(2):145-56.
9) Tatiana Sitnikova,Ellinor Michel, Yulia Tulupova, Igor Khanaev, Valentina Parfenova, Larisa Prozorova. Spirochetes in gastropods from Lake Baikal and North American freshwaters: new multi-family, multi-habitat host records. Symbiosis. May 2012, Volume 56, Issue 3, pp 103-110.

Additional Reading:
Xinning Zhang and Jared R. Leadbetter. Evidence for Cascades of Perturbation and Adaptation in the Metabolic Genes of Higher Termite Gut Symbionts. mBio vol 3. no.4 e00223-12. http://mbio.asm.org/content/3/4/e00223-12.full
Nordhoff M, Wieler LH.Berl Munch Tierarztl Wochenschr. 2005 Jan-Feb;118(1-2):24-36 .[Incidence and significance of treponemes in animals].[Article in German]


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Sunday, July 15, 2012

0 House Subcommittee Hearing On Lyme Disease

In the "this could be interesting to watch" file:

HOUSE SUBCOMMITTEE HEARING ON LYME

The Lyme Disease Association, Inc (LDA) announces that the House Committee on Foreign Affairs, Subcommittee on Africa, Global Health, & Human Rights will hold a hearing 2PM EDT, on Tuesday, July 17, 2012 in 2172 Rayburn HOB in Washington, DC. The hearing, Global Challenges in Diagnosing and Managing Lyme Disease - Closing Knowledge Gaps, will be webcast and available live via the Committee website:

http://foreignaffairs.house.gov/hearings/view/?1455

US Representative Christopher H. Smith (NJ) is chairing the hearing.



UPDATE:

Go here for NOTES from this hearing, posted July 17, 2012:

http://campother.blogspot.com/2012/07/notes-house-subcommittee-hearing-on.html



For those readers who are viewing from outside Eastern Daylight Time (EDT) zone, the following guide may be helpful:

Chicago, Illinois: Tuesday, July 17, at 1:00 PM
Denver, Colorado: Tuesday, July 17, at 12:00 PM
Los Angeles, California: Tuesday, July 17, at 11:00 AM
Honolulu, Hawaii: Tuesday, July 18, at 8:00 AM
London, UK: Tuesday, July 17, at 7:00 PM
Sydney, Australia: Wednesday, July 18, at 4:00 AM

LDA President Pat Smith will be one of the witnesses presenting testimony─problems with doctors diagnosing and treating Lyme and with patients receiving treatment for Lyme.

Lyme disease numbers have continued to rise nationwide and throughout the world, and the Centers for Disease Control & Prevention (CDC) has indicated that in 2009, Lyme disease surpassed HIV in incidence ─ Lyme was the 7th highest in disease incidence reporting. Lyme is no longer a disease of the Northeast. LDA has developed a pie chart using CDC reported case numbers for 2010 showing that 9 Northeastern states had 66% of the case reports, the remainder of the country had 34% of reported Lyme cases─ a 10% increase in disease in the remainder of the country from 2008 figures (see www.LymeDiseaseAssociation.org for pie chart). Experts have been seeing a significant increase in ticks and tick-borne diseases in 2012.

Lyme is now found in approximately 65 countries worldwide. From May through mid July of this year, the LDA had an electronic billboard in Times Square, NY, presenting that Lyme disease is found throughout the body and all over the world.

Currently, Congressman Christopher Smith has a bill introduced in the US House of Representatives HR 2557, and Senator Blumenthal has one introduced in the US Senate, S-1381, both calling for a federal advisory committee on Lyme and tick-borne disease with representation from patients, voluntary Lyme organizations, and from doctors and scientists from a broad spectrum of viewpoints on Lyme disease.

The room for the hearing will hold about 150 people and the public is invited to attend. People should arrive 45 minutes early because there are lines for security. The Rayburn House Office Building does have a large cafeteria in basement.

The LDA encourages everyone to contact their federal legislators to encourage their attendance and co-sponsorship of Us House bill HR 2557 (C. Smith-NJ). Also notify your state officials to encourage their attendance or viewing of the hearing and notify other officials such as your State Health Department officials and any other individuals that have an interest in Lyme and other tick-borne diseases. Please distribute and post this release to your websites, blogs, newspapers and any other media.

Stay tuned for an update and action on the Senate Lyme bill S-1381 (Blumenthal-CT) in the next few weeks.

HEARING WITNESSES

Stephen W. Barthold, Ph.D.
Distinguished Professor
Department of Pathology, Microbiology and Immunology
Center of Comparative Medicine, School of Veterinary Medicine University of California, Davis

Raphael Stricker, M.D.
Vice President
International Lyme and Associated Diseases Society

Mark Eshoo, Ph.D.
Director, New Technology Development
Abbott

Ms. Patricia Smith
President
Lyme Disease Association

Mr. Evan White
Lyme Disease Patient

Ms. Stella Huyshe-Shires
Chair
Lyme Disease Action



Of course, of all the speakers who will be presenting that day, I am looking forward to what Stephen Barthold is going to say...

Edited to add: Mark Eshoo may also have something interesting to say about testing for Lyme disease. Refer to this post on LNE for more information on his research: http://www.lymeneteurope.org/forum/viewtopic.php?f=7&t=4014#p30012

UPDATE:

Go here for NOTES from this hearing, posted July 17, 2012:

http://campother.blogspot.com/2012/07/notes-house-subcommittee-hearing-on.html

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Wednesday, April 25, 2012

2 Strange But True Facts About Spirochetes

Image: Kilauea Volcano
by Brian Snelson

I have a few strange but true facts about spirochetes to share which you may not know. A few are ones I have shared here before  - but most are not something about which I've already written. What you read here today may surprise you...




  • Many people call Borrelia burgdorferi spirochetes Gram negative bacteria. However, Borrelia burgdorferi are not Gram-negative bacteria even if a Gram negative stain works on them:

    "Borrelia were thought to be Gram negative because of their double membrane structure, but genetic analysis places them - along with other spirochetes - into a separate eubacterial phylum. Ultrastructural molecular and biochemical studies have emphasized the wide taxonomic gap between spirochetes and Gram-negative bacteria."

    - From "The Genus Borrelia" by Melissa Caimano. Prokaryotes (2006) 7:235-293.
  • Unlike Leptospira and Brachyspira, spirochetes in the Borrelia and Treponema genera appear to have acquired Phenylalanyl-tRNA synthetase (PheRS)  genes from Archaea through horizontal gene transfer. [1] Borrelia and Treponema have Archaea genes.
  • Somewhere along the line, an ancient Spirochaeta relative picked up genes from Archaea's order, Thermococcales. Borrelia and Treponema have close affinities with Thermococcus and Pyrococcus (not depicted on tree).[1]
  •  The fascinating thing about this genetic relationship is that these genes come from organisms which are extremely thermophilic organisms. They are extremophiles - which means they can live in extreme environments. Thermophilic extremophiles thrive in hot environments such as volcanic vents and hot springs. That genes from extremophiles would end up in mesophilic organisms which thrive in lower temperatures - such as in mammalian and acarian hosts - seems surprising. The highest temperature Borrelia garinii can still grow in is around 41-42 C. That's not anywhere near the high temperatures in which one finds Archaean Thermococcales (often over 60 C, sometimes as high as 100 C).
  • This all does seem really weird. But the reason why it isn't too far fetched to see genes from extremely thermophilic organisms in moderately warm Borrelia and Treponema is more easily understood once you know more about the wide diversity found within the genus Spirochaeta in general. A number of Spirochaeta species live in extreme environments and not just in humans, animals, or ticks. For example:
    • S. halophila lives in a high salinity pond on the Sinai shore.[2]
    • S. thermophila lives in marine hot springs in New Zealand and Russia.[3]
    • S. americana lives in alkaline, hypersaline Mono Lake in California.[4]
Champagne PoolWai-O-Tapu, near Rotorua, New Zealand by Christian Mehlführer

  • When looking at a phylogenetic tree, Spirochaeta is at the base of the tree and Borrelia and Treponema branch off later. Based on this, the best assessment one can make about the gene transfer from Archaea to Spirochaeta is that the most recent common ancestor of Spirochaeta, Borrelia, and Treponema had to have been very similar to thermophilic Spirochaeta.
  • My running joke on this is to imagine a pile of thermophilic Archaea and thermophilic Spirochaeta hanging out around a hot spring together, laughing, joking, and flirting. Before you know it, horizontal gene transfer occurs, and a new form of spirochete is born. (This would make for a good Far Side comic, I just know it.)
  • As if having Borrelia acquire Archaea genes wasn't interesting enough, it's been thought that ProS prolyl-tRNA synthetase (BB402) was acquired from a eurkaryote.

  • Treponema spirochetes have a symbiotic relationship with termites. These spirochetes help termites in breaking down cellulose in wood in the termites' guts. So it isn't just ticks which have a symbiotic relationship with spirochetes - termites have one, too.[1, 5]

  • Borrelia burgdorferi survives on the equivalent of tick antifreeze in the tick's midgut inbetween tick blood feeding cycles. Borrelia burgdorferi prefers glucose when in the tick, but it will feast on glycerol instead. See: http://spirochetesunwound.blogspot.com/2011/10/lyme-disease-spirochete-feasts-on-tick.html
  • Both Borrelia hermsii and Borrelia burgdorferi metabolize chitobiose and N acetyl-glucosamine, a nutrient of these spirochetes and the major constituent of chitin for the exoskeletons of ticks.[6]
  • Borrelia have most of the genes required for the enzymes which make up the mevalonate pathway - a metabolic pathway used by the bacteria for synthesis of isoprenoid precursors. Isoprenoids are very important compounds which are found in over 30,000 products from the three domains of life (Eukaryotes, Prokaryotes, and Archaea). One interesting proposal about how Borrelia has the genes required for these enzymes for this pathway is that they come from the genetic cenancestor - an ancestor which predates the split into the three domains.[7]
     
  • In Act II of Samuel Beckett's play, Waiting For Godot, one character, Estragon, curses at the other, Vladimir, by calling him, "Gonococcus! Spirochete!"
Spirochetes continue to hold surprises and mysteries for us all... both good and bad. Another interesting installment of strange spirochete facts could be posted here - probably not too far in the future.

References:

1) Cheryl P Andam and J Peter Gogarten. Biased gene transfer and its implications for the concept of lineage. Biology Direct 2011, 6:47 doi:10.1186/1745-6150-6-47
2) Greenberg EP, Canale-Parola E: Spirochaeta halophila sp. n., a facultative anaerobe from a high-salinity pond. Arch Microbiol 1976, 110:185-19
3) Aksenova H, Rainey F, Janssen P, Zavarzin G, Morgan H: Spirochaeta thermophila sp. nov., an obligately anaerobic, polysaccharolytic, extremely thermophilic bacterium. Int J Syst Bacteriol 1992, 42:175-177
4) Hoover RB, Pikuta EV, Bej AK, Marsic D, Whitman WB, Tang J, Krader P: Spirochaeta americana sp. nov., a new haloalkaliphilic, obligately anaerobic spirochaete isolated from soda Mono Lake in California. Int J Syst Evol Microbiol 2003, 53:815-821.
5) Droge S, Frohlich J, Radek R, Konig H: Spirochaeta coccoides sp. nov., a novel coccoid spirochete from the hindgut of the termite Neotermes castaneus. Appl Environ Microbiol 2006, 72:392-397.
6) Tilly, K., Elias, A.F., Errett, J., Fischer, E., Iyer, R., Schwartz, I., et al. Genetics and regulation of chitobiose utilization in Borrelia burgdorferi. J Bacteriol 183: 5544–5553.
7) Jonathan Lombard and David Moreira. Origins and Early Evolution of the Mevalonate Pathway of Isoprenoid Biosynthesis in the Three Domains of Life. Mol Biol Evol  2011, 28 (1): 87-99. doi: 10.1093/molbev/msq177 http://mbe.oxfordjournals.org/content/28/1/87.full


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Thursday, April 12, 2012

0 Commentary: Antibiotics Are Only One Tool - I Want Others.

A few weeks ago, I commented on a Wall Street Journal blog post about chronic Lyme disease. Since then, I have been reflecting on this response to my comments there:
"Camp Other – The cure for chronic Lyme is known. If you want a sustainable, long term cure, you can gamble on long term antibiotics, or can you take an alternative approach, which consists of doing between 20 and 50 different things, including Low Dose Naltrexone. Yes, they get you to a cure, at which point a good alkaline diet, oxygenation, vitamin D, etc etc etc should maintain health.
 Easier said than done though. Even when you cure your Lyme, you need to maintain the healthy diet, and some of the supplements that got you there. You also want to do genetic testing for things like methylation, as part of treament and post-cure maintenance. I’m certainly not banking on the Viral Genetics research. It could be many years before that turns into a drug we could take. I already know people who are fully cured and back to their old lives, so it is curable with current knowledge."
And I also sadly know people who are not fully cured with current knowledge.

Reflecting on this, it's not an easy statement for me to make - but I don't think the cure for chronic Lyme disease is entirely known.

If it were known, then all the patients I know would have had the treatment they needed and would be better now. But some of them are not. And I don't think it's some personal failing that they aren't or that they haven't done the right things - it's that their individual condition is different and may require different treatment - including treatments which haven't even been developed yet.

I can see that long term antibiotics, some alternative medicine, or some combination of the two have helped a number of people improve their condition and alleviate symptoms. Many have gotten their old life back. But it's never been guaranteed that any of these treatments will work for everyone.

 Even the Lyme disease patient support groups have often repeated the statement, "Every patient is different," and Polly Murray herself stated in her book, The Widening Circle:
"I am struck by how Lyme disease never seems to act exactly the way it is supposed to, how each individual seems to respond differently to the spirochete."
I'm a fairly pragmatic person, so my basic position on using antibiotics to treat persisting symptoms related to Lyme disease has been that if they might offer relief and improve your quality of life, if nothing else has helped, and a doctor has agreed to this treatment - then try them. Use them, while being aware that there are risks in taking them longer term - and note that perhaps there are even unforeseen consequences of which scientists are not yet aware.

But while I've been an advocate for the use of longer than standard courses of antibiotics in the subset of patients with Lyme disease who have persisting symptoms and I feel they saved my life, I have never wanted that to be the end of the story. Because it seems to me that even if they do help, if they don't cure everyone then more research is needed for effective treatment which helps all patients.

If there is evidence that comes out of Embers' Rhesus Macaque study - along with others - that Borrelia burgdorferi s.l. does have a persister cell phenotype as part of its pathogenesis, then more antibiotics may only be a maintenance treatment at best. What would really be needed is a treatment which reactivates the dormant persisters and kills them - something which antibiotics alone cannot do.

Persister cells are tolerant to antibiotics. So in theory, it may be that antibiotics of some kind plus a metabolite would be needed to eradicate any remaining spirochetes.

In the long run, I'd like to see more effective, less expensive treatments of shorter duration for my condition.

I'd like to avoid taking antibiotics out of concern for my poor digestive system and my palate, which is disgusted with bitter tasting substances rolled into barely swallowable pills in general.

I'd like to avoid the strange side effects which I have experienced which, thankfully, in most cases abated after the first week or two of treatment - yet they inexplicably seemed to be those which are less common to experience and more difficult to cope with.

Antibiotics are great tool and have helped a great number of people - and they have helped me, too. But I think it's time to look past long term antibiotics alone and push for research on other avenues of treatment.

Researching them doesn't mean abandoning antibiotic use entirely - they are scientifically proven effective against Lyme disease and its coinfections. Researching other avenues means investigating what else can be done to help patients improve their quality of life and to find something that could cure them in less time. It means exploring more options, not fewer. It means more patient freedom, not less.

 If at one point I seemed to strongly advocate Viral Genetics' VGV-L candidate for the treatment of chronic Lyme disease, it isn't because I am certain it will work. I don't know for sure that it will. I am hoping, though, that it will help at least some portion of those of us suffering and will not have serious side effects.

And I'm hoping it marks the beginning of more research into different ways to treat patients who are suffering with persistent symptoms. The antibiotics will still be there if you need them - and after how much of them I've already consumed, I'd rather not need them. I'd like to try something else if I can. A round of Buhner's herbs, perhaps - or perhaps something entirely new.


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Thursday, April 5, 2012

3 Abstract: Population Dynamics Of Borrelia burgdorferi In Lyme Disease.

Credit goes to Joanne, of the Looking at Lyme blog, for mentioning this abstract: It describes a response to Borrelia burgdorferi infection in mice where the first immune response almost clears the infection - but approximately 1 week post infection, the bacterial population recovers and reaches an even larger size before entering the chronic phase.

Front Microbiol. 2012;3:104. Epub 2012 Mar 22.
Population Dynamics of Borrelia burgdorferi in Lyme Disease.
Binder SC, Telschow A, Meyer-Hermann M.

Source
Department of Systems Immunology, Helmholtz Centre for Infection Research Braunschweig, Germany.

Abstract

Many chronic inflammatory diseases are known to be caused by persistent bacterial or viral infections. A well-studied example is the tick-borne infection by the gram-negative spirochaetes of the genus Borrelia in humans and other mammals, causing severe symptoms of chronic inflammation and subsequent tissue damage (Lyme Disease), particularly in large joints and the central nervous system, but also in the heart and other tissues of untreated patients.

Although killed efficiently by human phagocytic cells in vitro, Borrelia exhibits a remarkably high infectivity in mice and men. In experimentally infected mice, the first immune response almost clears the infection. However, approximately 1 week post infection, the bacterial population recovers and reaches an even larger size before entering the chronic phase.

We developed a mathematical model describing the bacterial growth and the immune response against Borrelia burgdorferi in the C3H mouse strain that has been established as an experimental model for Lyme disease.

The peculiar dynamics of the infection exclude two possible mechanistic explanations for the regrowth of the almost cleared bacteria.

Neither the hypothesis of bacterial dissemination to different tissues nor a limitation of phagocytic capacity were compatible with experiment.

The mathematical model predicts that Borrelia recovers from the strong initial immune response by the regrowth of an immune-resistant sub-population of the bacteria. The chronic phase appears as an equilibration of bacterial growth and adaptive immunity.

This result has major implications for the development of the chronic phase of Borrelia infections as well as on potential protective clinical interventions.

(Special thanks to Frontiers in Microbiology journal for having what appears to be a solid peer review process and Creative Commons license.)

Comments:


I can't wait to read the full text of this paper. This is an intriguing abstract and it leads to more questions.

How did these researchers come up with their mathematical model? Have other researchers previously observed this second wave of bacteria during infection? What about evidence of peaks in immune response in Borrelia burgdorferi infected animal models which have been documented?

In which way, precisely, is the regrowing immune-resistant sub-population actually immune-resistant? What is happening to B cells and T cells in relationship to this second phase of Borrelia?


From Fig. 3 of Tunev et al., 2011.  Day 8 of infection.  The arrows point to intact extracellular B. burgdorferi in the subcapsular sinus of the lymph node, which was culture positive beginning on day 1 of infection.   Source

Do these phases respond with plasma B cells containing low quality antibodies in germinal centers?

Is there typical somatic hypermutation and antigen affinity or not? What is happening to the T-cell independent response?

And does this model have any implication for antibiotic treatment? As in: Does this second immune-resistant sub-population also have a different response to antibiotics than the initial wave? This model is about infection without treatment, and it is not discussed what the implications could be.

Lots of questions here...


UPDATE: Joanne has informed me the free full text is available online. See: http://www.frontiersin.org/Microbial_Immunology/10.3389/fmicb.2012.00104/full



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Sunday, March 25, 2012

0 Lyme Disease Presents Differently In Women Compared To Men

Recently, Lauren A. Crowder, M.P.H. reported observations on some differences between women and men in response to Lyme disease in a poster at the International Conference on Emerging Infectious Diseases.

The short story: Women with Lyme disease display more clinical symptoms than do men with the disease and also are less likely to seroconvert following treatment, according to findings from a prospective cohort study involving 77 patients.


The study revealed the following observations:

  • Significantly more women than men reported joint pain, muscle pain, headache, back pain, heart palpitations, nausea, vomiting, anxiety, numbness and tingling, and changes in vision during at least one of six preplanned study visits with a physician.
  • At the initial study visit, a similar proportion of men and women (about 60% of each) tested negative for Lyme disease using the Centers for Disease Control and Prevention’s recommended two-tier testing criteria for serodiagnosis. At the first post-treatment interview, 70% of women who tested negative at the first pre-treatment visit remained negative, compared with only 35% of the men who initially tested negative.
Read more about this Lyme Disease Foundation funded study here:
http://www.internalmedicinenews.com/news/infectious-diseases/single-article/lyme-disease-presents-differently-in-men-and-women/1bf48578d5.html

And see the original source with study here:

SEE page 151 of ICEID 2012 Abstracts
March 11-14, 2012 | Hyatt Regency Atlanta | Atlanta, Georgia
(PDF) http://www.iceid.org/images/iceid_2012_finalprogram_final.pdf

Board 264. Another Difference between Boys and Girls: Sex-Based Differences in Lyme Disease.
L.A. Crowder, A. Rebman, V. Yedlin, M. Soloski, J.N. Aucott; Lyme Disease Research Foundation of Maryland, Lutherville, MD, USA, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.

This isn't the first time, however, that someone observed a difference between men and women's immune responses in relation to Borrelia burgdorferi.

Let's take the time machine back to Sweden, in 2004...

Lyme borreliosis reinfection: might it be explained by a gender difference in immune response?
Sara Jarefors, Louise Bennet, Elin You, Pia Forsberg, Christina Ekerfelt, Johan Berglund, and Jan Ernerudh
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1782288/

This study had a different goal than Ms. Crowder's in that it was intended to measure the difference in immunological response between people of both genders who had only been infected once and those who had been reinfected with Lyme disease within a five year period.

The findings relevant to women in this case:
"...for the immunological response there were major differences between men and women. The women displayed higher spontaneous secretion of all cytokines measured, i.e. IL-4, IL-6, IL-10, IFN-γ and TNF-α. Spontaneous secretion, at an infection-free time-point, reflects the habitual immune status and may suggest what type of immunological defence an individual generally displays. For instance, allergy has been considered a Th2-type related condition and, accordingly, atopic individuals have higher spontaneous IL-4 expression than non-atopic controls.

Women of reproductive age are believed to handle infections better than men, having a stronger tendency to show Th1-type responses and expression of higher levels of pro-inflammatory cytokines, and they also develop higher antibody titres than men when vaccinated. However, the female immune response fluctuates with the menstrual cycle. In general, oestrogen has a stimulatory effect on the immune system whereas testosterone acts as a suppressor. When women enter the menopause their levels of oestrogen decrease and thereby the stimulatory effect diminishes, leading to an altered immune status. All except one of the women in our study were postmenopausal, and this could be a factor explaining why more women than men became reinfected with B. burgdorferi."
And...
"Serology was not performed on the individuals in this study because, at the time of EM diagnosis, only 30–40% of patients displayed antibodies to Borrelia. Studies following patients with culture-confirmed EM have shown that, although antibodies can be detected 10–20 years after initial infection, titres decline gradually during the first year."
A paper which cited the previous one discusses the functions of IL-10 in relationship to Borrelia burgdorferi:

Interleukin-10 alters effector functions of multiple genes induced by Borrelia burgdorferi in macrophages to regulate Lyme disease inflammation.
Gautam A, Dixit S, Philipp MT, Singh SR, Morici LA, Kaushal D, Dennis VA.

Source: http://www.ncbi.nlm.nih.gov/pubmed/21947773

To sum it up: IL-10 (an interleukin) which is produced in higher amounts in women than it is in men, is responsible for inhibiting the actions of some genes in Borrelia burgdorferi - but it is also responsible for empowering the actions of some genes, too.

What implication this has on infection in different genders remains to be seen and requires more study.

But what is already known about the role of inflammation in the presence of Borrelia burgdorferi is important to take note of here: Inflammation facilitates Borrelia burgdorferi's adaptation to its host; it stimulates antigenic variation and it leads to increased spirochetal burden in mice. So if this applies to humans: All that pain, swelling, and inflammation patients feel? It is good for the spirochetes, and it is bad for you.


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Friday, March 9, 2012

10 Dr. Barthold Discusses Persistence On Diane Rehm Show

Several days ago,  Dr. Barthold was interviewed on the Diane Rehm Show on NPR. A full transcript to that show can be found on the WAMU radio/NPR web site, if you are interested in seeing what Dr. Auwaerter, Dr. Fallon, and Dr. Shor had to say about chronic Lyme disease.

I find what Dr. Barthold had to say about persistence to be very interesting.

(EDIT: Unfortunately, the strict terms about republishing any portion of the transcript were pointed out to me and I had to remove Barthold's quotes from this page - please refer to the transcript above in following what I say below.)

Did anyone else listen to the show or read the transcript and catch what he said about this:

The remaining organisms - potentially these persister cells - are in connective tissue and not eliciting inflammatory change. He sees very little inflammation in the animals he has tested and in which he found persistent spirochetes.

Yet when he removes the bacteria from a mouse and puts it in a new mouse, the spirochetes cause inflammation all over again.

What's up with that? Pretty strange, isn't it?

Can one form a hypothesis about why this is happening or at least take a shot at it?

I have a few ideas about this and will be putting them in comments in this post over the next few days, providing readers with the disclaimer that they are hypothetical and not to be taken as confirmed fact. Someone else will need to do the research on this issue.

Does anyone else here reading along have their own hypothesis about why this is happening - why after antibiotic treatment, he found persistent bacteria in these animals - yet they are not causing inflammation?

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Friday, March 2, 2012

64 Embers et al Issues Statement On PLoSONE

Embers et al has issued the following author statement on PLoSONE:

Persistence of Borrelia burgdorferi in Rhesus Macaques Following Antibiotic Treatment of Disseminated Infection

Author statement
Posted by membersla on 02 Mar 2012 at 15:19 GMT

We recently published this article entitled “Persistence of Borrelia burgdorferi in Rhesus Macaques Following Antibiotic Treatment of Disseminated Infection.” The subject and content of this work may be viewed very divergently, given the controversy surrounding Lyme disease treatment. Specifically, the phenomenon of post-treatment Lyme disease syndrome and its cause (s) have been viewed with much contention.

Our work, which was funded by several grants from the National Institutes of Health, is composed of two major experiments. Experiment 1 entailed a very comprehensive and time-consuming study that indicated the possibility that spirochetes could persist after antibiotic treatment, but only nucleic acid or antigen of these bacteria were detected, leaving open the question of persistence by intact organisms. Experiment 2 was intended to answer that question. The authors elected to publish these 2 studies together, as they mutually enhance the validity and scientific merit of the work.

In our study, we provide evidence demonstrating the post-treatment persistence of the B. burgdorferi spirochete that has been reported previously in a mouse model. We further demonstrate through multiple detection methods that intact spirochetes can survive antibiotic treatment in a nonhuman primate host. It is not our intent to present data in opposition of current antibiotic treatment regimens for humans, but rather to report what we believe to be objective, well-performed experiments on antibiotic efficacy in a nonhuman primate model.

These data are by no means a referendum on long-term antibiotic therapy, nor should they serve to oppose current IDSA guidelines for the treatment of Lyme disease. From the medical standpoint, these results may or may not warrant testing of additional treatments or regimens. This depends heavily on the results of further inquiry as to the duration of persistence, the viability and phenotype of persistent organisms, and the answer to the key question of whether persisters are pathogenic. Current practices could only be challenged by solid proof of better treatment options; these are currently not available.

For several decades, basic scientists and medical doctors have collaborated to understand and improve Lyme disease treatment, diagnosis and prevention. As we proceed with further inquiry into the phenomenon of PTLDS, these collaborations are essential. The continued discussion, commentary and debate will additionally be of benefit when conducted without bias.

Source Link: http://www.plosone.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2Fbe820481-edcb-457e-8d20-c0a904b91607&root=info%3Adoi%2F10.1371%2Fannotation%2Fbe820481-edcb-457e-8d20-c0a904b91607

Bolded emphasis mine.

My comments? I could have predicted that such a statement would be issued. The researchers in question are making a string of inquiries where they must be certain of the outcome and not make a statement about the nature of Lyme disease prematurely - even if the chronic infection model of Lyme disease makes sense to many people and is the experience which a number of patients report having.

It comes as a disappointment to many patients that there is a specific statement here against long term antibiotic treatment, with the explicit statement that the results of this study are not intended to oppose current IDSA treatment guidelines. However, it is also stated that "these results may or may not warrant testing of additional treatments or regimens". The future regarding changes in antibiotic usage is uncertain.

Statements above and within the original study reflect a certain amount of uncertainty.

And in order for this team to avoid becoming cargo cult scientists, they must be willing to look at all the possible causes for persisting symptoms. They must be willing to challenge themselves and question the strength of their suspicions and poke holes at their assumptions. This must be done not only to assure them they are on the right track - but to be prepared to answer questions coming from any critics.

They may repeat their experiments to confirm their findings and conduct another study where tick inoculation is used and not needle inoculation. A study is needed that examines what would happen in an actual case of infection under conditions found in nature - not in a lab. This experiment would not only involve the use of ceftriaxone and doxcycline - but use infected ticks on hosts and involve the complex immune interactions that take place after a tick infection which do not occur the same way as they would after injection with a bacteria-laiden needle.

I'm looking forward to more research from Embers et al. That they close their statement with the phrase, "The continued discussion, commentary and debate will additionally be of benefit when conducted without bias," means a lot to me. It indicates to me that they are seeking the truth - which is something I can get behind. I only hope they find it soon.

Image credit: Morphology of Borrelia burgdorferi by Jeffrey Nelson, Microbe Library. Use under Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.



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Saturday, February 25, 2012

5 Debate About Embers Non-Human Primate Chronic Lyme Disease Study Continues

UPDATE - Feb. 27:  I did receive a response from Dr. Baker. See comments below this post.

There is some heated discussion going on at CALDA's web site regarding Embers et al study, "Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection (2012)".

I wrote about this study last month and commented on some of the findings and the need for further research and confirmation of the findings in this study. (I recommend reviewing that post and comments made on it.)

CALDA's Lorraine Johnson has questioned Dr. Phillip Baker, who was Program Officer for the NIH's Lyme disease research division at the time the Embers study began (then known as Mario Phillip's study; Baker retired from NIH in 2007 and is now in charge at the ALDF), over the 12 year delay of Embers et al publishing the results of this study.

Dr. Baker himself decided to respond to Lorraine's questions and respond to a number of the comments and questions patients and advocates shared on CALDA's Lyme Policy Wonk blog.

Interestingly, a number of people have discussed this study on Lymenet Europe - with one member, Henry, questioning the use of ceftiofur when Embers study was supposed to emulate Klempner's chronic Lyme study. This issue happens to be one of of main issues Dr. Baker also raises on the Wonk blog about the Embers study. (Warning: There are seven pages of spirited discussion on this topic at LNE thus far - some of which may raise blood pressure in readers.)

To follow the discussion and see an example of different points of view over the issue of chronic Lyme disease, read here: http://lymedisease.org/news/lymepolicywonk/lymepolicywonk-was-this-important-lyme-study-hidden-for-12-years.html

In the meantime, I have submitted my own questions and comments to CALDA's web site for Dr. Baker. As of this writing, my post has just cleared moderation and I await a response from Dr. Baker.

I want some answers. Not just about oversight for how the study was designed but about the lack of treatment studies for chronic Lyme disease patients.

Even if your position is that chronic Lyme disease is not caused by a persisting Borrelia infection, there is no reason why more research cannot be completed to provide evidence that this is or is not the case in some circumstances. And even if your position is that chronic Lyme disease's persisting symptoms may be caused by other factors, there is no reason why more treatment research cannot be completed to provide evidence either for or against these factors playing a role...



Dr. Baker,

First of all, I want to thank you for being here and presenting your view in the presence of Lyme disease patients who have different points of view than your own and who are at a minimum questioning your opinion about Lyme disease and at a maximum - quite angry.

This isn't an easy thing to do. I recognize that. But this is a necessary thing to do, and I wish that more dialog occurred between people with differing views even at the risk of it becoming contentious. It is often the only way opinions get aired and heard and questions get answered - even if we don't like the answers we hear.

I have a few questions for you, and hope I did not miss the boat on getting a response from you at this late hour:

1) Just so the storyline is clear: Who determined that ceftiofur should have been used in Embers et al study on NHP and is this decision something that NIH would have had to give approval - or is this a decision that would have been made at the individual level of the PI/researcher and not require any approval from the NIH? Would any independent governing scientific board outside the NIH been expected to approve of the study design including methods and materials? It seems that in order to emulate the Klempner study, the antibiotic chosen should either be the same as used in the original study or have, as you've stated, PK and PD that are pretty much indistinguishable from ceftriaxone.

2) In your opinion - and in the opinion of others at the ALDF - would you have to see studies separately completed on ceftiofur that provide you with evidence that its PK and PD in NHP are functionally equivalent to the use of ceftriaxone in humans? If these studies are conducted and they are found to be equivalent, then would you say that the results of the Embers et al study are valid? (Even if - according to your position - they don't yet prove a persistent infection/persister cells are the cause of patients' symptoms.)

3) The central point on which a lot of this debate hinges is whether or not spirochetes which remain after antibiotic treatment are viable and infectious. I've never gotten the impression that the majority of researchers out there have debated the existence of spirochetes after abx treatment - the impression I've had is that they either didn't think they were the cause of persisting symptoms in patients or did not know one way or the other if they were the case of persisting symptoms.

Parallel to demonstrated survival of some spirochetes after abx treatment, some research has indicated that a combination of Borrelial strain, host genetics, immune system response, and in some cases, molecular mimicry - may be causative factors for persisting symptoms. I myself think that based on evidence I've read to date, both persisting spirochetes and immune system changes can lead to persisting symptoms. I am particularly intrigued by HLA-DRs and variable immune response in this regard (see "HLA-DR alleles determine responsiveness to Borrelia burgdoferi antigens" by Bettina Panagiota Iliopoulou, Mireia Guerau-de-Arellano, and Brigitte T. Huber. Arthritis Rheum. 2009 December; 60(12): 3831–3840.).

My questions are:

When is the NIH-NIAID going to conduct more studies aimed towards this end? And also, if you and others are convinced that chronic Lyme disease patients are not suffering from persisting infections - why hasn't more treatment research been conducted that supports your point of view of what is or what are the causative factors for such symptoms?

Why are patients, advocates, and Lyme disease advocacy organizations having to donate money to Dr. Karen Newell Rogers and Viral Genetics to find alternative treatments to long-term antibiotics - why isn't the NIH-NIAID pursuing these alternative approaches now, if the argument is that long term antibiotics do not work and you consider them unsafe (Which in my opinion debatable in my eyes - I have personally benefited from more than the guidelines recommend - and I do not think the use for or against more abx is applicable to everyone because this is a heterogenous patient population. The patients need to be characterized into subgroups first rather than boxed into meeting CDC specific requirements before designing new trials.)?

I have been offended with the letter to the Lancet about Lyme disease patients and advocates supporting pseudoscience when so many of us have wanted to fund more research and get answers. When a number of our friends and families have donated their money to research even when they have already paid so much for treatment.

Some of the answers are already there. If more than one hypothesis is solid enough for testing, I'm for it. Test different combinations of antibiotics. Create drugs which have the anti-inflammatory properties of these antibiotics and use them as a control against combinations of antibiotics. Use higher doses of orals, if the fear of line sepsis freaks you out (it does me, and I have not had a PICC line by choice). Try testing thymus peptides and altering the distribution of B cells to see if that helps patients.

What I see as an observer is that Lyme disease treatment research has been shut down unless it's for acute Lyme disease. We need more late stage untreated Lyme disease research, and I'm with Fallon on this one - more specific neuroborreliosis research. His suggestions for those trials seem worthwhile.

But for God's sake, something has to be done. Some people are seriously impaired. I am doing somewhat better now and have my mind back to a large degree and don't need a wheelchair. But I am not yet well enough to work due to pain and fatigue with normal amounts of exertion. Something is broken there.



Dr. Baker's response to me:


Hi Campother,
Even though I feel that some have their minds made up and will not believe anything that I have to say, I will try to answer your questions:
1. Dr. Philipp received a small grant (AI042352) to conduct an experiment in NHPs to replicate the Klempner clinical trial, except of course for the manner in which the NHPs were infected. Because the grant was a small one (about $250K as I recall), Dr. Klempner was able — with support from the drug company– to provide him with the ceftriaxone and doxycycline to be used; these antibiotics were from the same lots used in the human study. Fair enough? That made working on a small grant a bit easier. 
Since NHPs are rather expensive to use and maintain, not too many could be used in the Philipp study because of limited funding. Furthermore, NHPs were in short supply at that time because of increase competition for use in studies on AIDS. The grant was funded for a 4 year period of time, during which time Dr. Philipp reported to me that he was having technical problems, especially with the strain of Borrelia that he had been using in past experiments; it appeared to have “lost its punch” and was no longer eliciting an infection of the same magnitude and character as noted in previous studies. This meant that he would have to re-drive the strain and test it in other NHPs to confirm that it was suitable for use in the definitive studies planned for the grant; that of course would take a great deal of time — and additional NHPs–to do. 
Although situations like this are unfortunate, they do happen and are part and parcel of the realities of doing scientific research — if you want to do it right. 
So, as far as Dr. Philipp’s original grant is concerned, it expired — after the 4 year period– with no data that he felt was was ready and complete for publication at that time. Obviously he continued with his NHP studies and apparently received funding from other sources; note that research Resources grants like RR00164 are designed for the purchase materials, equipment, and supplies, in this case, more NHPs I assume. But, I was “out of the picture” at that point — as far as Dr. Philipp’s research on NHPs was concerned. Keep in mind that as Program Officer, I was not the czar of NIH’s entire research program on Lyme disease, even though so people have the mistaken notion that I had such “power”.
So, you ask who made the decision to use ceftiofur instead of ceftriaxone? I honestly don’t know. 
You will have to ask Dr. Philipp, whose e-mail address is provided in the Embers paper. During the time that Dr. Philipp was doing his work under AI042352, it was being done in accordance with the terms of that grant indicated above. Whatever else he did — or may have done– must have been accomplished afterwards and with other support that did not involve me or NIAID. I must say that I find it strange that the term ceftriaxone is used throughout the Embers et al. paper, and it is only in the first paragraph on page 9 that it is first mentioned that ceftiofur was actually used. I find that very strange indeed.
As stated before and in other postings on this site, I have two major — and legitimate– concerns with the work reported by Embers et al. . First, since so little is known about the PK, PD, and MIC of ceftriofur, was the treatment adequate to eliminate the massive infection induced by needle inoculation? Since the author did not provide such assurances, that is a major and significant unknown. Second, if the therapy was adequate, there is no evidence to indicate that the “persistors” are able to infect other animals and produce disease. They might just be sitting there, for all we know, doing nothing harmful to the host. In view of these considerations, the PCR, RT-PCR, and xenodiagnosis data are not informative. In fact, there are no real differences between the antibiotic treated and sham-treated groups in terms of the objective signs of infection (pathology) noted ; that makes me wonder if the therapeutic regimen was truly effective. So, if I were reviewing this paper for publication in a journal, I would have to reject it publication for these and other deficiencies that I will not elaborate on at this time.
2. Since ceftiofur and cetriaxone differ significantly in chemical structure, I would not be at all surprised if they had different PD/PK properties; those who do drug design research find that the addition of a single chloride atom is enough to alter the properties of some drugs. What is certain is that ceftiofur is not approved for use in humans and there is no published evidence on its efficacy for treating borreliosis in animal models. Obviously, the use of ceftiofur is a big unknown. My best advice, if someone wanted to replicate the Klempner studies in an animal model would be to use ceftriaxone and doxycycline in the same manner that he did and not introduce another variable like ceftiofur– unless you plan to get the FDA to approve the use of ceftiofur in human studies. That may take a long time to do….

3. Since I have retired from the NIH, I don’t know what their plans are for future research on Lyme disease. But, I can tell you that about 90% of the research that NIH supports is driven by proposals submitted as investigator initiated grant applications — the RO1 grants. 
So, if anyone has any good ideas, they are always welcome to submit a grant application, although competition for grants is very keen and only about 25% of all applications submitted are funded. One has to be persistent as most of my colleagues are to make it in science. 
Although I am not opposed to conducting another clinical trial, the odds for such a proposal getting funded are rather slim, especially since NIH has already supported 4 trials indicating that extended antibiotic therapy is not beneficial. 
Obviously, I would like to see more work done on whether the “persistors” Bockenstedt and Barthold noted in mice are infective and can cause disease, as well as whether they can stimulate a local inflammatory response. But, I think we would be making a big mistake by not considering other possibilities as I’ve mentioned in a recent article (http://www.fasebj.org/content/26/1/11.long). 
There are MANY people who believe that they have “chronic Lyme disease” with no evidence that they ever had Lyme disease in the first place. Some have been misdiagnosed and are being subjected to all sort of unproven therapy. Also, there are individuals who go from one doctor to another seeking a “cure” and who often are victims of “quack” remedies. 
One reason we had so much difficulty enrolling patients into the Klempner study was that only about 5-8% of those who presented themselves for enrollment had unequivocal evidence in their medical record of having been diagnosed correctly for Lyme disease in the first place. Obviously, one can not have a chronic infection without first having an active and correctly diagnosed infection in the first place. That was made a criterion for enrollment to ensure that we would have a cohort of patients with a reasonably high — though still not absolutely certain– probability of having a persistent infection — if one were present. I assure you, and you can ask Brian Fallon and Lauren Krupp, such people are NOT easy to find.
But, I have said enough. The biggest obstacle to making any progress is the lack of trust and the tendency to condemn anyone in the scientific community who disagrees with the unproven concept of others. Some simply have no understanding of evidence-based research and how it works, let alone things like the placebo effect. There is just too much misinformation being spread on the internet — and too many people gobbling it up as though it were fact. It’s an ideal environment for all the “quacks” to thrive — and they surely do. And that is what disturbs me the most………



So, there you have it - that's his response, and while I posted a response to the Wonk blog, because my response was too lengthy it has not been posted there. So I posted it to comments below, after an explanation of why my response was not posted there.

The moderator emailed me personally and said that I could post another 150 word comment of my choosing, but I have declined for now because I don't think what I can say in response to Dr. Baker is adequately summed up in 150 words.

There was a second comment with other content which I submitted that I later decided needed a serious rewrite before posting - I won't be posting that here now and am okay with the moderators not publishing it (good job, mods - thanks).

I just want to take a moment here to acknowledge those who left intelligent and insightful questions and comments on the Wonk blog - even when addressing someone with whom they vehemently disagree. I would like to see more dialog such as this, but even more so I would like to see more thorough education and outreach going on which deconstructs all the hypotheses behind why chronic Lyme disease patients have persisting symptoms and what research is required to resolve the debate over cause.

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Monday, January 16, 2012

0 Dr. Alan MacDonald Discussing Spirochetal Biofilms on LNE

There are a series of discussions going on right now on Lymenet Europe I want to point out.

It looks like Dr. Alan Macdonald is having an involved exchange about biofilms in different spirochetes with someone (Henry) who has identified as a microbiologist in previous entries.

You might want to check out this thread now:

Biofilms of still yet spirochetal type - Treponema:
http://www.lymeneteurope.org/forum/viewtopic.php?f=5&t=3607

Also follow the following related threads:

Structure of Biofilms of Borrelia Lecture link:
http://www.lymeneteurope.org/forum/viewtopic.php?f=5&t=3602

Biofilms of yet another spirochetal species - Leptospira:
http://www.lymeneteurope.org/forum/viewtopic.php?f=5&t=3606

I would like to see more doctors and microbiologists engage in discussion about Borrelia and other spirochetes more often - especially if the implications have an impact on translational medicine and clinical outcome. Obviously some of this discussion is going to be purely speculative, but it is interesting to hear different points of view.

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