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Nik Kamarudin NAA, Mawang CI, Ahamad M. Direct Detection of Lyme Borrelia: Recent Advancement and Use of Aptamer Technology. Biomedicines 2023; 11:2818. [PMID: 37893191 PMCID: PMC10604176 DOI: 10.3390/biomedicines11102818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Borrelia burgdorferi sensu lato (B. burgdorferi s.l.), which is predominantly spread by ticks, is the cause of Lyme disease (LD), also known as Lyme borreliosis, one of the zoonotic diseases affecting people. In recent years, LD has become more prevalent worldwide, even in countries with no prior records. Currently, Lyme Borrelia detection is achieved through nucleic acid amplification, antigen detection, microscopy, and in vitro culture. Nevertheless, these methods lack sensitivity in the early phase of the disease and, thus, are unable to confirm active infection. This review briefly discusses the existing direct detection methods of LD. Furthermore, this review also introduces the use of aptamer technology integrated with biosensor platforms to detect the Borrelia antigen. This aptamer technology could be explored using other biosensor platforms targeting whole Borrelia cells or specific molecules to enhance Borrelia detection in the future.
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Affiliation(s)
- Nik Abdul Aziz Nik Kamarudin
- Acarology Unit, Infectious Disease Research Center, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia; (C.I.M.); (M.A.)
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Guérin M, Shawky M, Zedan A, Octave S, Avalle B, Maffucci I, Padiolleau-Lefèvre S. Lyme borreliosis diagnosis: state of the art of improvements and innovations. BMC Microbiol 2023; 23:204. [PMID: 37528399 PMCID: PMC10392007 DOI: 10.1186/s12866-023-02935-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
With almost 700 000 estimated cases each year in the United States and Europe, Lyme borreliosis (LB), also called Lyme disease, is the most common tick-borne illness in the world. Transmitted by ticks of the genus Ixodes and caused by bacteria Borrelia burgdorferi sensu lato, LB occurs with various symptoms, such as erythema migrans, which is characteristic, whereas others involve blurred clinical features such as fatigue, headaches, arthralgia, and myalgia. The diagnosis of Lyme borreliosis, based on a standard two-tiered serology, is the subject of many debates and controversies, since it relies on an indirect approach which suffers from a low sensitivity depending on the stage of the disease. Above all, early detection of the disease raises some issues. Inappropriate diagnosis of Lyme borreliosis leads to therapeutic wandering, inducing potential chronic infection with a strong antibody response that fails to clear the infection. Early and proper detection of Lyme disease is essential to propose an adequate treatment to patients and avoid the persistence of the pathogen. This review presents the available tests, with an emphasis on the improvements of the current diagnosis, the innovative methods and ideas which, ultimately, will allow more precise detection of LB.
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Affiliation(s)
- Mickaël Guérin
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Marc Shawky
- Connaissance Organisation Et Systèmes TECHniques (COSTECH), EA 2223, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Ahed Zedan
- Polyclinique Saint Côme, 7 Rue Jean Jacques Bernard, 60204, Compiègne, France
| | - Stéphane Octave
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Bérangère Avalle
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Irene Maffucci
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France
| | - Séverine Padiolleau-Lefèvre
- Unité de Génie Enzymatique Et Cellulaire (GEC), CNRS UMR 7025, Université de Technologie de Compiègne, 60203, Compiègne, France.
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Kim S, Samanta K, Nguyen BT, Mata-Robles S, Richer L, Yoon JY, Gomes-Solecki M. A portable immunosensor provides sensitive and rapid detection of Borrelia burgdorferi antigen in spiked blood. Sci Rep 2023; 13:7546. [PMID: 37161039 PMCID: PMC10170079 DOI: 10.1038/s41598-023-34108-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
There are no assays for detecting B. burgdorferi antigen in blood of infected Lyme disease individuals. Here, we provide proof-of-principle evidence that we can quantify B. burgdorferi antigen in spiked blood using a portable smartphone-based fluorescence microscope that measures immunoagglutination on a paper microfluidic chip. We targeted B. burgdorferi OspA to develop a working prototype and added examples of two antigens (OspC and VlsE) that have diagnostic value for discrimination of Lyme disease stage. Using an extensively validated monoclonal antibody to OspA (LA-2), detection of OspA antigen had a broad linear range up to 100 pg/mL in 1% blood and the limit of detection (LOD) was 100 fg/mL (= 10 pg/mL in undiluted blood), which was 1000 times lower than our target of 10 ng/mL. Analysis of the two other targets was done using polyclonal and monoclonal antibodies. OspC antigen was detected at LOD 100 pg/mL (= 10 ng/mL of undiluted blood) and VlsE antigen was detected at LOD 1-10 pg/mL (= 0.1-1 ng/mL of undiluted blood). The method is accurate and was performed in 20 min from sample to answer. When optimized for detecting several B. burgdorferi antigens, this assay may differentiate active from past infections and facilitate diagnosis of Lyme disease in the initial weeks of infection, when antibody presence is typically below the threshold to be detected by serologic methods.
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Affiliation(s)
- Sangsik Kim
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA
| | - Kamalika Samanta
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Merck & Co., West Point, PA, 19486, USA
- Immuno Technologies, Inc, Memphis, TN, 38103, USA
| | - Brandon T Nguyen
- College of Medicine, The University of Arizona, Tucson, AZ, 85724, USA
| | - Samantha Mata-Robles
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA
| | - Luciana Richer
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Immuno Technologies, Inc, Memphis, TN, 38103, USA
- US Biologic, Inc, Memphis, TN, 38103, USA
| | - Jeong-Yeol Yoon
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA.
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
- Immuno Technologies, Inc, Memphis, TN, 38103, USA.
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4
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Goff NK, Dou T, Higgins S, Horn EJ, Morey R, McClellan K, Kurouski D, Rogovskyy AS. Testing Raman spectroscopy as a diagnostic approach for Lyme disease patients. Front Cell Infect Microbiol 2022; 12:1006134. [PMID: 36389168 PMCID: PMC9647194 DOI: 10.3389/fcimb.2022.1006134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Lyme disease (LD), the leading tick-borne disease in the Northern hemisphere, is caused by spirochetes of several genospecies of the Borreliella burgdorferi sensu lato complex. LD is a multi-systemic and highly debilitating illness that is notoriously challenging to diagnose. The main drawbacks of the two-tiered serology, the only approved diagnostic test in the United States, include poor sensitivity, background seropositivity, and cross-reactivity. Recently, Raman spectroscopy (RS) was examined for its LD diagnostic utility by our earlier proof-of-concept study. The previous investigation analyzed the blood from mice that were infected with 297 and B31 strains of Borreliella burgdorferi sensu stricto (s.s.). The selected strains represented two out of the three major clades of B. burgdorferi s.s. isolates found in the United States. The obtained results were encouraging and prompted us to further investigate the RS diagnostic capacity for LD in this study. The present investigation has analyzed blood of mice infected with European genospecies, Borreliella afzelii or Borreliella garinii, or B. burgdorferi N40, a strain of the third major class of B. burgdorferi s.s. in the United States. Moreover, 90 human serum samples that originated from LD-confirmed, LD-negative, and LD-probable human patients were also analyzed by RS. The overall results demonstrated that blood samples from Borreliella-infected mice were identified with 96% accuracy, 94% sensitivity, and 100% specificity. Furthermore, human blood samples were analyzed with 88% accuracy, 85% sensitivity, and 90% specificity. Together, the current data indicate that RS should be further explored as a potential diagnostic test for LD patients.
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Affiliation(s)
- Nicolas K. Goff
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, United States
| | - Tianyi Dou
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, United States
| | - Samantha Higgins
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, United States
| | | | - Rohini Morey
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, United States
| | - Kyle McClellan
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, United States
| | - Dmitry Kurouski
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, United States
- *Correspondence: Dmitry Kurouski, ; Artem S. Rogovskyy,
| | - Artem S. Rogovskyy
- Department of Veterinary Pathobiology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
- *Correspondence: Dmitry Kurouski, ; Artem S. Rogovskyy,
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Tabb JS, Rapoport E, Han I, Lombardi J, Green O. An antigen-targeting assay for Lyme disease: Combining aptamers and SERS to detect the OspA protein. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 41:102528. [PMID: 35104673 DOI: 10.1016/j.nano.2022.102528] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/25/2022]
Abstract
Lyme disease is the fastest growing vector-borne disease in the United States. However, current testing modalities are ill suited to detection of Lyme disease, leading to the diagnosis of many cases after treatment is effective. We present an improved, direct method Lyme disease diagnosis, where the Lyme specific biomarker Outer Surface Protein A (OspA) in clinical serum samples is identified using a diagnostic platform combining surface enhanced Raman scattering (SERS) and aptamers. Employing orthogonal projections to latent structures discriminant analysis, the system accurately identified 91% of serum samples from Lyme patients, and 96% of serum samples from symptomatic controls. In addition, the OspA limit-of-detection, determined to be 1 × 10-4 ng/mL, is greater than four orders of magnitude lower than that found in serum samples from early Lyme disease patients. The application of this platform to detect this difficult-to-diagnose disease suggests its potential for detecting other diseases that present similar difficulties.
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Affiliation(s)
| | | | - Il Han
- Ionica Sciences, Ithaca, NY, USA
| | - John Lombardi
- Department of Chemistry, The City College of New York, New York, NY, USA
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Sakaguchi Y, Kinumi T, Takatsu A. A Dual Functional-Group Derivatization Liquid Chromatography–Tandem Mass Spectrometry Method: Application for Quantification of Human Insulin. Chromatographia 2022. [DOI: 10.1007/s10337-022-04136-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wojciechowska-Koszko I, Kwiatkowski P, Sienkiewicz M, Kowalczyk M, Kowalczyk E, Dołęgowska B. Cross-Reactive Results in Serological Tests for Borreliosis in Patients with Active Viral Infections. Pathogens 2022; 11:pathogens11020203. [PMID: 35215146 PMCID: PMC8879713 DOI: 10.3390/pathogens11020203] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
Currently, serological tests for Lyme disease (LD), routinely performed in laboratories following the European Concerted Action on Lyme Borreliosis recommendations as part of two-stage diagnostics, are often difficult to interpret. This concerns both the generation of false positive and negative results, which frequently delay the correct diagnosis and implementation of appropriate treatment. The above problems result from both morphological and antigenic variability characteristics for the life strategy of the spirochete Borrelia burgdorferi sensu lato, a complicated immune response, and imperfections in diagnostic methods. The study aimed to check the reactivity of sera from 69 patients with confirmed infection with Epstein–Barr virus (EBV), cytomegalovirus (CMV) and BK virus (BKV) with Borrelia antigens used in serological tests: indirect immunofluorescence (IIFT), enzyme-linked immunosorbent (ELISA) and immunoblot (IB). In the group of patients infected with EBV, the highest percentage of positive/borderline anti-Borrelia IgM and IgG results was obtained in the following tests: IIFT (51.9% for IgM, 63.0% for IgG), ELISA (22.2% for IgM, 29.6% for IgG) and IB (11.1% for IgM, 7.4% for IgG). In the group of CMV-infected patients, the highest percentage of positive/borderline anti-Borrelia IgM results were obtained in the following tests: IB (23.1%), IIFT (15.4%) and ELISA (7.7%), while in the IgG class in the IIFT (15.4%), IB (11.5%) and ELISA (3.9%) tests. In the group of patients infected with BKV, the highest percentage of positive/borderline anti-Borrelia IgM results was obtained in the following tests: IIFT (25.0%), IB (25.0%) and ELISA (3.9%), and in the IgG class in the tests: IB (50.0%), IIFT (6.2%) and ELISA (6.2%). The native flagellin (p41) and OspC proteins were the most frequently detected Borrelia antigens in all studied groups of patients in both classes of antibodies. Similar to other authors, the study confirmed the fact that serological tests used in the diagnosis of LD have a high potential to generate false positive results in patients with active viral infections, which may be related to cross-reacting antibodies appearing during the most common polyclonal activation of T/B lymphocytes, activated by viral superantigens.
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Affiliation(s)
- Iwona Wojciechowska-Koszko
- Department of Diagnostic Immunology, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich Av. 72, 70-111 Szczecin, Poland;
- Correspondence: ; Tel.: +48-91-466-12-59
| | - Paweł Kwiatkowski
- Department of Diagnostic Immunology, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich Av. 72, 70-111 Szczecin, Poland;
| | - Monika Sienkiewicz
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Muszynskiego St. 1, 90-151 Lodz, Poland;
| | - Mateusz Kowalczyk
- Babinski Memorial Hospital, Aleksandrowska St. 159, 91-229 Lodz, Poland;
| | - Edward Kowalczyk
- Department of Pharmacology and Toxicology, Medical University of Lodz, Zeligowskiego St. 7/9, 90-752 Lodz, Poland;
| | - Barbara Dołęgowska
- Department of Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich Av. 72, 70-111 Szczecin, Poland;
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Wojciechowska-Koszko I, Mnichowska-Polanowska M, Kwiatkowski P, Roszkowska P, Sienkiewicz M, Dołęgowska B. Immunoreactivity of Polish Lyme Disease Patient Sera to Specific Borrelia Antigens-Part 1. Diagnostics (Basel) 2021; 11:diagnostics11112157. [PMID: 34829504 PMCID: PMC8625222 DOI: 10.3390/diagnostics11112157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/22/2022] Open
Abstract
The diverse clinical picture and the non-specificity of symptoms in Lyme disease (LD) require the implementation of effective diagnostics, which should take into account the heterogeneity of Borrelia antigens. According to available guidelines, laboratories should use a two-tier serological diagnosis based on the enzyme-linked immunosorbent (ELISA) screening test and confirmation of the immunoblot (IB). The aim of the study was to investigate the immunoreactivity of LD patient sera to Borrelia antigens and to attempt to identify the genospecies responsible for LD using an ELISA–IB assay combination. Eighty patients with suspected LD and 22 healthy people participated in the study. All samples were tested with ELISA and IB assays in both IgM and IgG antibodies. In the case of the ELISA assay, more positive results were obtained in the IgM class than in the IgG class. In the case of the IB assay, positive results dominated in the IgG class. Positive results obtained in the IB assay most often showed IgM antibodies against the OspC and flagellin antigens, whereas the IgG antibodies were against VlsE, BmpA, OspC, p41, and p83 antigens. The IB assay is an important part of LD serodiagnosis and should be mandatory in diagnostic laboratories.
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Affiliation(s)
- Iwona Wojciechowska-Koszko
- Department of Diagnostic Immunology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (P.K.); (P.R.)
- Correspondence: ; Tel.: +48-91-466-12-59
| | - Magdalena Mnichowska-Polanowska
- Department of Medical Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Paweł Kwiatkowski
- Department of Diagnostic Immunology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (P.K.); (P.R.)
| | - Paulina Roszkowska
- Department of Diagnostic Immunology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (P.K.); (P.R.)
| | - Monika Sienkiewicz
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Muszynskiego St. 1, 90-151 Lodz, Poland;
| | - Barbara Dołęgowska
- Department of Laboratory Medicine, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland;
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Chou E, Minor A, Cady NC. Quantitative multiplexed strategies for human Lyme disease serological testing. Exp Biol Med (Maywood) 2021; 246:1388-1399. [PMID: 33794698 PMCID: PMC8243215 DOI: 10.1177/15353702211003496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lyme disease, which is primarily caused by infection with the bacterium Borrelia burgdorferi in the United States or other Borrelia species internationally, presents an ongoing challenge for diagnostics. Serological testing is the primary means of diagnosis but testing approaches differ widely, with varying degrees of sensitivity and specificity. Moreover, there is currently no reliable test to determine disease resolution following treatment. A distinct challenge in Lyme disease diagnostics is the variable patterns of human immune response to a plurality of antigens presented by Borrelia spp. during the infection. Thus, multiplexed testing approaches that capture these patterns and detect serological response against multiple antigens may be the key to prompt, accurate Lyme disease diagnosis. In this review, current state-of-the-art multiplexed diagnostic approaches are presented and compared with respect to their diagnostic accuracy and their potential for monitoring response to treatment.
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Affiliation(s)
- Eunice Chou
- Nanobioscience Constellation, College of Nanoscale Science &
Engineering, State University of New York Polytechnic Institute, Albany, NY
12203, USA
- College of Medicine, State University of New York, Downstate
Medical Center, Brooklyn, NY 11203, USA
| | - Armond Minor
- Nanobioscience Constellation, College of Nanoscale Science &
Engineering, State University of New York Polytechnic Institute, Albany, NY
12203, USA
| | - Nathaniel C Cady
- Nanobioscience Constellation, College of Nanoscale Science &
Engineering, State University of New York Polytechnic Institute, Albany, NY
12203, USA
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Abstract
Lyme borreliosis is caused by a growing list of related, yet distinct, spirochetes with complex biology and sophisticated immune evasion mechanisms. It may result in a range of clinical manifestations involving different organ systems, and can lead to persistent sequelae in a subset of cases. The pathogenesis of Lyme borreliosis is incompletely understood, and laboratory diagnosis, the focus of this review, requires considerable understanding to interpret the results correctly. Direct detection of the infectious agent is usually not possible or practical, necessitating a continued reliance on serologic testing. Still, some important advances have been made in the area of diagnostics, and there are many promising ideas for future assay development. This review summarizes the state of the art in laboratory diagnostics for Lyme borreliosis, provides guidance in test selection and interpretation, and highlights future directions.
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Talagrand-Reboul E, Raffetin A, Zachary P, Jaulhac B, Eldin C. Immunoserological Diagnosis of Human Borrelioses: Current Knowledge and Perspectives. Front Cell Infect Microbiol 2020; 10:241. [PMID: 32509603 PMCID: PMC7248299 DOI: 10.3389/fcimb.2020.00241] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/27/2020] [Indexed: 01/11/2023] Open
Abstract
Spirochetes of the genus Borrelia are divided into relapsing fever borreliae and Lyme disease borreliae. Immunoserological assays have been poorly developed for relapsing fever borreliae, where direct detection methods are more adapted to the pathophysiology of these infections presenting with massive bacteraemia. However, emergence of the novel agent of relapsing fever B. miyamotoi has renewed interest in serology in this context. In Lyme disease, because direct detection methods show low sensitivity, serology plays a central role in the diagnostic strategy. This diagnostic strategy is based on a two-tier methodology involving a first test (ELISA) with high sensitivity and acceptable specificity and a second, more specific test (western blot) for diagnostic confirmation. The most frequent limitations and pitfalls of serology are cross reactions, false IgM positivity, a seronegative window period at the early time of the infection, and serologic scars with a suspicion of reinfection. International guidelines have thus been proposed to avoid these difficulties with interpretation. Finally, unconventional diagnostic tests have been developed recently in the context of a highly publicized disease, with widely varying results, some of which have no available evidence-based data. New two-tier testing strategies using two ELISA tests (C6 and WCS for example) to replace immunoblot are currently proposed by some authors and guidelines, and promising new tests such as CXCL-13 in CSF are promising tools for the improvement of the diagnosis of Lyme borreliosis.
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Affiliation(s)
- Emilie Talagrand-Reboul
- UR 7290 Virulence Bactérienne Précoce, Université de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Fédération de Médecine Translationnelle, Groupe Borréliose de Strasbourg, Strasbourg, France.,National Reference Center for Borrelia, CHRU Strasbourg, Strasbourg, France
| | - Alice Raffetin
- Department of Infectious Diseases, Centre Hospitalier Lucie-et-Raymond-Aubrac, Villeneuve-Saint-Georges, France
| | - Pierre Zachary
- UR 7290 Virulence Bactérienne Précoce, Université de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Fédération de Médecine Translationnelle, Groupe Borréliose de Strasbourg, Strasbourg, France.,National Reference Center for Borrelia, CHRU Strasbourg, Strasbourg, France
| | - Benoît Jaulhac
- UR 7290 Virulence Bactérienne Précoce, Université de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Fédération de Médecine Translationnelle, Groupe Borréliose de Strasbourg, Strasbourg, France.,National Reference Center for Borrelia, CHRU Strasbourg, Strasbourg, France
| | - Carole Eldin
- Aix Marseille Univ, IRD, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
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Zhou Y, Qin S, Sun M, Tang L, Yan X, Kim TK, Caballero J, Glusman G, Brunkow ME, Soloski MJ, Rebman AW, Scavarda C, Cooper D, Omenn GS, Moritz RL, Wormser GP, Price ND, Aucott JN, Hood L. Measurement of Organ-Specific and Acute-Phase Blood Protein Levels in Early Lyme Disease. J Proteome Res 2020; 19:346-359. [PMID: 31618575 PMCID: PMC7981273 DOI: 10.1021/acs.jproteome.9b00569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lyme disease results from infection of humans with the spirochete Borrelia burgdorferi. The first and most common clinical manifestation is the circular, inflamed skin lesion referred to as erythema migrans; later manifestations result from infections of other body sites. Laboratory diagnosis of Lyme disease can be challenging in patients with erythema migrans because of the time delay in the development of specific diagnostic antibodies against Borrelia. Reliable blood biomarkers for the early diagnosis of Lyme disease in patients with erythema migrans are needed. Here, we performed selected reaction monitoring, a targeted mass spectrometry-based approach, to measure selected proteins that (1) are known to be predominantly expressed in one organ (i.e., organ-specific blood proteins) and whose blood concentrations may change as a result of Lyme disease, or (2) are involved in acute immune responses. In a longitudinal cohort of 40 Lyme disease patients and 20 healthy controls, we identified 10 proteins with significantly altered serum levels in patients at the time of diagnosis, and we also developed a 10-protein panel identified through multivariate analysis. In an independent cohort of patients with erythema migrans, six of these proteins, APOA4, C9, CRP, CST6, PGLYRP2, and S100A9, were confirmed to show significantly altered serum levels in patients at time of presentation. Nine of the 10 proteins from the multivariate panel were also verified in the second cohort. These proteins, primarily innate immune response proteins or proteins specific to liver, skin, or white blood cells, may serve as candidate blood biomarkers requiring further validation to aid in the laboratory diagnosis of early Lyme disease.
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Affiliation(s)
- Yong Zhou
- Institute for Systems Biology, Seattle, Washington, USA
| | - Shizhen Qin
- Institute for Systems Biology, Seattle, Washington, USA
| | - Mingjuan Sun
- Institute for Systems Biology, Seattle, Washington, USA
- Second Military Medical University, Shanghai, China
| | - Li Tang
- Institute for Systems Biology, Seattle, Washington, USA
| | - Xiaowei Yan
- Institute for Systems Biology, Seattle, Washington, USA
| | - Taek-Kyun Kim
- Institute for Systems Biology, Seattle, Washington, USA
| | - Juan Caballero
- Molecular and Developmental Complexity Lab, Langebio-Cinvestav, Irapuato, Guanajuato, Mexico
| | | | | | - Mark J. Soloski
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alison W. Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carol Scavarda
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY
| | - Denise Cooper
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY
| | - Gilbert S. Omenn
- Institute for Systems Biology, Seattle, Washington, USA
- Center for Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | | | - Gary P. Wormser
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY
| | | | - John N. Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leroy Hood
- Institute for Systems Biology, Seattle, Washington, USA
- Providence St. Joseph Health, Seattle, Washington, USA
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13
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Bamm VV, Ko JT, Mainprize IL, Sanderson VP, Wills MKB. Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums. Pathogens 2019; 8:E299. [PMID: 31888245 PMCID: PMC6963551 DOI: 10.3390/pathogens8040299] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022] Open
Abstract
Lyme disease is a complex tick-borne zoonosis that poses an escalating public health threat in several parts of the world, despite sophisticated healthcare infrastructure and decades of effort to address the problem. Concepts like the true burden of the illness, from incidence rates to longstanding consequences of infection, and optimal case management, also remain shrouded in controversy. At the heart of this multidisciplinary issue are the causative spirochetal pathogens belonging to the Borrelia Lyme complex. Their unusual physiology and versatile lifestyle have challenged microbiologists, and may also hold the key to unlocking mysteries of the disease. The goal of this review is therefore to integrate established and emerging concepts of Borrelia biology and pathogenesis, and position them in the broader context of biomedical research and clinical practice. We begin by considering the conventions around diagnosing and characterizing Lyme disease that have served as a conceptual framework for the discipline. We then explore virulence from the perspective of both host (genetic and environmental predispositions) and pathogen (serotypes, dissemination, and immune modulation), as well as considering antimicrobial strategies (lab methodology, resistance, persistence, and clinical application), and borrelial adaptations of hypothesized medical significance (phenotypic plasticity or pleomorphy).
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Affiliation(s)
| | | | | | | | - Melanie K. B. Wills
- G. Magnotta Lyme Disease Research Lab, Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada; (V.V.B.); (J.T.K.); (I.L.M.); (V.P.S.)
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14
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Raffetin A, Saunier A, Bouiller K, Caraux-Paz P, Eldin C, Gallien S, Jouenne R, Belkacem A, Salomon J, Patey O, Talagrand-Reboul E, Jaulhac B, Grillon A. Unconventional diagnostic tests for Lyme borreliosis: a systematic review. Clin Microbiol Infect 2019; 26:51-59. [PMID: 31306793 DOI: 10.1016/j.cmi.2019.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lyme borreliosis (LB) diagnosis currently relies mainly on serological tests and sometimes PCR or culture. However, other biological assays are being developed to try to improve Borrelia-infection diagnosis and/or monitoring. OBJECTIVES To analyse available data on these unconventional LB diagnostic assays through a systematic literature review. METHODS We searched PubMed and Cochrane Library databases according to the PRISMA-DTA method and the Cochrane Handbook for Systematic Reviews of Interventions. We analysed controlled and uncontrolled studies (published 1983-2018) on biological tests for adults to diagnose LB according to the European Study Group for Lyme Borreliosis or the Infectious Diseases Society of America definitions, or identify strongly suspected LB. Two independent readers evaluated study eligibility and extracted data from relevant study reports; a third reader analysed full texts of papers to resolve disagreements. The quality of each included study was assessed with the QUADAS-2 evaluation scale. RESULTS Forty studies were included: two meta-analyses, 25 prospective controlled studies, five prospective uncontrolled studies, six retrospective controlled studies and two case reports. These biological tests assessed can be classified as: (i) proven to be effective at diagnosing LB and already in use (CXCL-13 for neuroborreliosis), but not enough to be standardized; (ii) not yet used routinely, requiring further clinical evaluation (CCL-19, OspA and interferon-α); (iii) uncertain LB diagnostic efficacy because of controversial results and/or poor methodological quality of studies evaluating them (lymphocyte transformation test, interferon-γ, ELISPOT); (iv) unacceptably low sensitivity and/or specificity (CD57+ natural killer cells and rapid diagnostic tests); and (v) possible only for research purposes (microscopy and xenodiagnoses). DISCUSSION QUADAS-2 quality assessment demonstrated high risk of bias in 25/40 studies and uncertainty regarding applicability for 32/40, showing that in addition to PCR and serology, several other LB diagnostic assays have been developed but their sensitivities and specificities are heterogeneous and/or under-evaluated or unassessed. More studies are warranted to evaluate their performance parameters. The development of active infection biomarkers would greatly advance LB diagnosis and monitoring.
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Affiliation(s)
- A Raffetin
- Department of Infectious Diseases, Centre Hospitalier Lucie-et-Raymond-Aubrac, Villeneuve-Saint-Georges, France; ESCMID Study Group for Lyme Borreliosis - ESGBOR, Switzerland
| | - A Saunier
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Perigueux, Perigueux, France
| | - K Bouiller
- Department of Infectious Diseases, Centre Hospitalier Universitaire Besançon, Besançon, France; UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - P Caraux-Paz
- Department of Infectious Diseases, Centre Hospitalier Lucie-et-Raymond-Aubrac, Villeneuve-Saint-Georges, France
| | - C Eldin
- Centre Hospitalier Universitaire Aix-Marseille, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - S Gallien
- Department of Clinical Immunology, Centre Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - R Jouenne
- Department of Internal Medicine, Centre Hospitalier Lucie-et-Raymond-Aubrac, Villeneuve-Saint-Georges, France
| | - A Belkacem
- Department of Infectious Diseases, Centre Hospitalier Lucie-et-Raymond-Aubrac, Villeneuve-Saint-Georges, France
| | - J Salomon
- Department of Infectious Diseases, Centre Hospitalier Universitaire Raymond-Poincaré, Garches, France
| | - O Patey
- Department of Infectious Diseases, Centre Hospitalier Lucie-et-Raymond-Aubrac, Villeneuve-Saint-Georges, France
| | - E Talagrand-Reboul
- EA 7290 Virulence Bactérienne Précoce, Université de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Fédération de Médecine Translationnelle, Groupe Borréliose de Strasbourg, Strasbourg, France
| | - B Jaulhac
- ESCMID Study Group for Lyme Borreliosis - ESGBOR, Switzerland; EA 7290 Virulence Bactérienne Précoce, Université de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Fédération de Médecine Translationnelle, Groupe Borréliose de Strasbourg, Strasbourg, France; Centre National de Référence des Borrelia, CHRU Strasbourg, Strasbourg, France
| | - A Grillon
- EA 7290 Virulence Bactérienne Précoce, Université de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Fédération de Médecine Translationnelle, Groupe Borréliose de Strasbourg, Strasbourg, France.
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15
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Pflughoeft KJ, Mash M, Hasenkampf NR, Jacobs MB, Tardo AC, Magee DM, Song L, LaBaer J, Philipp MT, Embers ME, AuCoin DP. Multi-platform Approach for Microbial Biomarker Identification Using Borrelia burgdorferi as a Model. Front Cell Infect Microbiol 2019; 9:179. [PMID: 31245298 PMCID: PMC6579940 DOI: 10.3389/fcimb.2019.00179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/09/2019] [Indexed: 01/04/2023] Open
Abstract
The identification of microbial biomarkers is critical for the diagnosis of a disease early during infection. However, the identification of reliable biomarkers is often hampered by a low concentration of microbes or biomarkers within host fluids or tissues. We have outlined a multi-platform strategy to assess microbial biomarkers that can be consistently detected in host samples, using Borrelia burgdorferi, the causative agent of Lyme disease, as an example. Key aspects of the strategy include the selection of a macaque model of human disease, in vivo Microbial Antigen Discovery (InMAD), and proteomic methods that include microbial biomarker enrichment within samples to identify secreted proteins circulating during infection. Using the described strategy, we have identified 6 biomarkers from multiple samples. In addition, the temporal antibody response to select bacterial antigens was mapped. By integrating biomarkers identified from early infection with temporal patterns of expression, the described platform allows for the data driven selection of diagnostic targets.
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Affiliation(s)
- Kathryn J. Pflughoeft
- DxDiscovery, Inc., Reno, NV, United States
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Michael Mash
- DxDiscovery, Inc., Reno, NV, United States
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Nicole R. Hasenkampf
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, LA, United States
| | - Mary B. Jacobs
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, LA, United States
| | - Amanda C. Tardo
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, LA, United States
| | - D. Mitchell Magee
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Lusheng Song
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Joshua LaBaer
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Mario T. Philipp
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, LA, United States
| | - Monica E. Embers
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, LA, United States
| | - David P. AuCoin
- DxDiscovery, Inc., Reno, NV, United States
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV, United States
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16
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Abstract
Lyme disease (LD) is the most common tick-borne disease in the Northern Hemisphere. As the most prevalent vector-borne disease in the USA, LD affects 300,000 human cases each year. LD is caused by inoculation of the bacterial spirochete, Borrelia burgdorferi sensu lato, from an infected tick. If not treated quickly and completely, the bacteria disseminate from the tick's biting site into multiple organs including the joints, heart, and brain. Thus, the best outcome from medical intervention can be expected with early detection and treatment with antibiotics, prior to multi-organ dissemination. In the absence of a characteristic rash, LD is diagnosed using serological testing involving enzyme-linked immunosorbent assay (ELISA) followed by western blotting, which is collectively known as the two-tier algorithm. These assays detect host antibodies against the bacteria, but are hampered by low sensitivity, which can miss early LD cases. This review discusses the application of some current assays for diagnosing LD clinically, thus providing a foundation for exploring newer techniques being developed in the laboratory for more sensitive detection of early LD.
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Affiliation(s)
- Eunice Chou
- Vassar College in Poughkeepsie, NY SUNY Downstate Medical School and SUNY Polytechnic Institute
| | - Yi-Pin Lin
- University in Ithaca, NY and postdoctoral training from Tufts University in Boston, MA
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17
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Five-Antigen Fluorescent Bead-Based Assay for Diagnosis of Lyme Disease. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:294-303. [PMID: 26843487 DOI: 10.1128/cvi.00685-15] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/01/2016] [Indexed: 12/18/2022]
Abstract
The systematically difficult task of diagnosing Lyme disease can be simplified by sensitive and specific laboratory tests. The currently recommended two-tier test for serology is highly specific but falls short in sensitivity, especially in the early acute phase. We previously examined serially collected serum samples from Borrelia burgdorferi-infected rhesus macaques and defined a combination of antigens that could be utilized for detection of infection at all phases of disease in humans. The five B. burgdorferi antigens, consisting of OspC, OspA, DbpA, OppA2, and the C6 peptide, were combined into a fluorescent cytometric bead-based assay for the detection of B. burgdorferi antigen-specific IgG antibodies. Samples from Lyme disease patients and controls were used to determine the diagnostic value of this assay. Using this sample set, we found that our five-antigen multiplex IgG assay exhibited higher sensitivity (79.5%) than the enzyme immunoassay (EIA) (76.1%), the two-tier test (61.4%), and the C6 peptide enzyme-linked immunosorbent assay (ELISA) (77.2%) while maintaining specificity over 90%. When detection of IgM was added to the bead-based assay, the sensitivity improved to 91%, but at a cost of reduced specificity (78%). These results indicate that the rational combination of antigens in our multiplex assay may offer an improved serodiagnostic test for Lyme disease.
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