Lyme disease, which is caused by the tick-borne spirochete Borrelia burgdorferi, can usually be treated successfully with 2-4 week courses of oral or intravenous antibiotic therapy. However, approximately 10% of patients with Lyme arthritis have persistent synovial inflammation despite such courses of therapy. To explain antibiotic-refractory Lyme arthritis after 2-3 month courses of oral and IV antibiotics, the competing hypotheses of persistent infection or infection-induced autoimmunity have been proposed. In the absence of an animal model, clinical correlations in human patients are required to address these hypotheses. To date, most patients with antibiotic-refractory Lyme arthritis have had negative PCR results for B. burgdorferi DNA in joint fluid after antibiotic treatment;they have had HLA-DRB molecules that bind the OspA163-i75 epitope of the spirochete, particularly the DRB1*0401, 0404 and 0101 molecules, and T cell reactivity with this epitope. Our goals in the next grant cycle include an assessment of antibody responses to lipid and carbohydrate antigens of B. burgdorferi to determine whether a decline in one of these responses after antibiotic therapy might serve as a practical surrogate marker for spirochetal killing in Lyme disease. The precursor frequencies of T cells specific for OspA163-i75 or implicated autoantigens will be determined in both the infectious and post-antibiotic periods of the illness, the clonal characteristics of these cells will be delineated, and the numbers and function of T regulatory cells will be determined during active arthritis through arthritis resolution. To broaden the search for candidate autoantigens beyond those identified by sequence homology with the OspA-,63-175 epitope, B cell epitopes of putative autoantigens will be sought using patient sera to screen a large array of expressed human proteins, and T cell epitopes will be sought using patient synovial tissue as a source of naturally processed MHC complexes from which peptides will be eluted and identified using tandem mass spectrometry. The knowledge gained from these studies is likely to aid in more accurate diagnosis and more effective treatment of antibiotic-refractory Lyme arthritis. Of greater general importance, antibiotic-refractory Lyme arthritis, which shares similar HLA associations with rheumatoid arthritis, may serve as a model of infection-induced autoimmunity. Furthermore, this work brings us closer to the long-term goal of direct comparisons of antigens in Lyme arthritis and rheumatoid arthritis synovia.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR020358-35
Application #
7667282
Study Section
Arthritis, Connective Tissue and Skin Study Section (ACTS)
Program Officer
Witter, James
Project Start
1987-07-01
Project End
2011-07-31
Budget Start
2009-08-01
Budget End
2010-07-31
Support Year
35
Fiscal Year
2009
Total Cost
$329,723
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Vudattu, Nalini K; Strle, Klemen; Steere, Allen C et al. (2013) Dysregulation of CD4+CD25(high) T cells in the synovial fluid of patients with antibiotic-refractory Lyme arthritis. Arthritis Rheum 65:1643-53
Drouin, Elise E; Seward, Robert J; Strle, Klemen et al. (2013) A novel human autoantigen, endothelial cell growth factor, is a target of T and B cell responses in patients with Lyme disease. Arthritis Rheum 65:186-96
Katchar, Kia; Drouin, Elise E; Steere, Allen C (2013) Natural killer cells and natural killer T cells in Lyme arthritis. Arthritis Res Ther 15:R183
Li, Xin; Strle, Klemen; Wang, Peng et al. (2013) Tick-specific borrelial antigens appear to be upregulated in American but not European patients with Lyme arthritis, a late manifestation of Lyme borreliosis. J Infect Dis 208:934-41
Strle, Klemen; Shin, Junghee J; Glickstein, Lisa J et al. (2012) Association of a Toll-like receptor 1 polymorphism with heightened Th1 inflammatory responses and antibiotic-refractory Lyme arthritis. Arthritis Rheum 64:1497-507
Seward, Robert J; Drouin, Elise E; Steere, Allen C et al. (2011) Peptides presented by HLA-DR molecules in synovia of patients with rheumatoid arthritis or antibiotic-refractory Lyme arthritis. Mol Cell Proteomics 10:M110.002477
Li, Xin; McHugh, Gail A; Damle, Nitin et al. (2011) Burden and viability of Borrelia burgdorferi in skin and joints of patients with erythema migrans or lyme arthritis. Arthritis Rheum 63:2238-47
Steere, Allen C; Drouin, Elise E; Glickstein, Lisa J (2011) Relationship between immunity to Borrelia burgdorferi outer-surface protein A (OspA) and Lyme arthritis. Clin Infect Dis 52 Suppl 3:s259-65
Strle, Klemen; Jones, Kathryn L; Drouin, Elise E et al. (2011) Borrelia burgdorferi RST1 (OspC type A) genotype is associated with greater inflammation and more severe Lyme disease. Am J Pathol 178:2726-39
Yakimchuk, Konstantin; Roura-Mir, Carme; Magalhaes, Kelly G et al. (2011) Borrelia burgdorferi infection regulates CD1 expression in human cells and tissues via IL1-?. Eur J Immunol 41:694-705

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