A serologic assay to measure successful Lyme borreliosis antibiotic therapy

DESCRIPTION provided by applicant Lyme disease LD caused by the Ixodes tick borne spirochete Borrelia burgdorferi Bb is the most common vector borne disease in the United States Despite public health preventive measures the annual confirmed case incidence has risen to over the vast majority of which occur in the Northeast Disseminated infection causes disease in the skin heart joints and nervous system and can be difficult to treat Antibiotics achieve clinical cure in the majority of people when administered in early stages of infection Unexplained symptoms can linger in up to of patients however which may or may not be due to persistence of active infection Current serologic tests that are the mainstay of LD diagnostics cannot be used to assess response to therapy and cannot distinguish previous exposure to Bb from active infection Patients thus often receive unnecessary and potentially dangerous long term antibiotic treatments or other unconventional and unproven treatments This application seeks to improve the current situation by developing a new diagnostic serologic assay based on a novel panel of Bb antigens to which antibody levels decline rapidly after successful elimination of infection by antibiotics We have shown using a mouse model of Lyme borreliosis that successful elimination of infection with antibiotic treatment correlates with declining responses to panel antigens and that failure of antibiotics to completely eliminate infection is associated with maintenance of elevated responses to panel antigens We also demonstrated in a retrospective study of banked human C peptide positive Lyme sera that most human samples react with or more panel antigens We will conduct a prospective study of a large number of newly diagnosed LD patients undergoing antibiotic therapy We will monitor the decline of antibody levels to individual antigens and select from our panel a group of antigens for which this decline best correlates with resolution of symptoms after antibiotic treatment We will also determine if patients with persistent symptoms at months after treatment maintain high levels of antibodies to panel antigens up to one year later As a strategy that complements current serologic tests this assay will provide additional tools for clinicians to objectively base decisions on additional courses of antibiotics for symptoms that may be due to incompletely treated or new Bb infections PUBLIC HEALTH RELEVANCE Lyme disease is an infection caused by the tick transmitted spirochete Borrelia burgdorferi Some people have lingering symptoms even after antibiotic therapy and there is no test to determine the effectiveness of antibiotics at eliminating the infection Our intent is to significantly improve the evaluation of patients treated for Lyme disease through the introduction of new serologic tests that provide an objective laboratory measure for when infection has been cured and which can distinguish a new infection in people with previous exposure