Ketone Monoester Plus Carbohydrate Supplementation Does Not Alter Exogenous and Plasma Glucose Oxidation or Metabolic Clearance Rate During Exercise in Men Compared with Carbohydrate Alone

BACKGROUND

Increasing β-hydroxybutyrate (βHB) availability through ketone monoester plus carbohydrate (KE+CHO) supplementation is suggested to enhance physical performance by sparing glucose use during exercise. However, no studies have examined the effect of ketone supplementation on glucose kinetics during exercise.

OBJECTIVES

This exploratory study primarily aimed to determine the effect of KE+CHO supplementation on glucose oxidation and physical performance during steady-state exercise compared with carbohydrate.

METHODS

Using a randomly assigned, crossover design (clinicaltrials.gov, NCT04737694), 12 men consumed KE+CHO (573 mg ketone monoester/kg body mass, 110 g glucose) or carbohydrate (110 g glucose) before and during 90 min of steady-state treadmill exercise [54 ± 3% peak oxygen uptake (V̇˙O_2peak)] wearing a weighted vest (30% body mass; 25 ± 3 kg). Glucose oxidation and turnover were determined using indirect calorimetry and stable isotopes. Participants performed an unweighted time to exhaustion (TTE; 85% V̇˙O_2peak) after steady-state exercise and a weighted (25 ± 3 kg) 6.4 km time trial (TT) the next day after consuming a bolus of KE+CHO or carbohydrate. Data were analyzed by paired t-tests and mixed model ANOVA.

RESULTS

βHB concentrations were higher (P < 0.05) after exercise [2.1 mM (95% CI: 1.6, .6)] and the TT [2.6 mM (2.1, 3.1)] in KE+CHO compared with carbohydrate. TTE was lower [-104 s (-201, -8)], and TT performance was slower [141 s (19,262)] in KE+CHO than in carbohydrate (P < 0.05). Exogenous [-0.01 g/min (-0.07, 0.04)] and plasma [-0.02 g/min (-0.08, 0.04)] glucose oxidation and metabolic clearance rate {MCR [0.38 mg·kg^-1·min^-1 (-0.79, 1.54)]} were not different, and glucose rate of appearance [-0.51 mg·kg^-1·min^-1 (-0.97, -0.04)], and disappearance [-0.50 mg·kg^-1·min^-1 (-0.96, -0.04)] were lower (P < 0.05) in KE+CHO compared with carbohydrate during steady-state exercise.

CONCLUSIONS

In the current study, the rates of exogenous and plasma glucose oxidation and MCR were not different between treatments during steady-state exercise, suggesting blood glucose utilization is similar between KE+CHO and carbohydrate. KE+CHO supplementation also results in lower physical performance compared with carbohydrate. This trial was registered at www.

CLINICALTRIALS

gov as NCT04737694.

Orally Ingested Probiotics, Prebiotics, and Synbiotics as Countermeasures for Respiratory Tract Infections in Nonelderly Adults: A Systematic Review and Meta-Analysis

The impact of gut microbiota-targeted interventions on the incidence, duration, and severity of respiratory tract infections (RTIs) in nonelderly adults, and factors moderating any such effects, are unclear. This systematic review and meta-analysis aimed to determine the effects of orally ingested probiotics, prebiotics, and synbiotics compared with placebo on RTI incidence, duration, and severity in nonelderly adults, and to identify potential sources of heterogeneity. Studies were identified by searching CENTRAL, PubMed, Scopus, and Web of Science up to December 2021. English-language, peer-reviewed publications of randomized, placebo-controlled studies that tested an orally ingested probiotic, prebiotic, or synbiotic intervention of any dose for ≥1 wk in adults aged 18-65 y were included. Results were synthesized using intention-to-treat and per-protocol random-effects meta-analysis. Heterogeneity was explored by subgroup meta-analysis and meta-regression. Risk of bias was assessed using the Cochrane risk-of-bias assessment tool for randomized trials version 2 (RoB2). Forty-two manuscripts reporting effects of probiotics (n = 38), prebiotics (n = 2), synbiotics (n = 1) or multiple -biotic types (n = 1) were identified (n = 9179 subjects). Probiotics reduced the risk of experiencing ≥1 RTI (relative risk = 0.91; 95% CI: 0.84, 0.98; P = 0.01), and total days (rate ratio = 0.77; 95% CI: 0.71, 0.83; P < 0.001), duration (Hedges' g = -0.23; 95% CI: -0.39, -0.08; P = 0.004), and severity (Hedges' g = -0.16; 95% CI: -0.29, -0.03; P = 0.02) of RTIs. Effects were relatively consistent across different strain combinations, doses, and durations, although reductions in RTI duration were larger with fermented dairy as the delivery matrix, and beneficial effects of probiotics were not observed in physically active populations. Overall risk of bias was rated as "some  concerns" for most studies. In conclusion, orally ingested probiotics, relative to placebo, modestly reduce the incidence, duration, and severity of RTIs in nonelderly adults. Physical activity and delivery matrix may moderate some of these effects. Whether prebiotic and synbiotic interventions confer similar protection remains unclear due to few relevant studies. This trial was registered at https://www.crd.york.ac.uk/prospero/ as CRD42020220213.

Serum Branched-Chain Amino Acid Metabolites Increase in Males When Aerobic Exercise Is Initiated with Low Muscle Glycogen

This study used global metabolomics to identify metabolic factors that might contribute to muscle anabolic resistance, which develops when aerobic exercise is initiated with low muscle glycogen using global metabolomics. Eleven men completed this randomized, crossover study, completing two cycle ergometry glycogen depletion trials, followed by 24 h of isocaloric refeeding to elicit low (LOW; 1.5 g/kg carbohydrate, 3.0 g/kg fat) or adequate (AD; 6.0 g/kg carbohydrate 1.0 g/kg fat) glycogen. Participants then performed 80 min of cycling (64 ± 3% VO₂ peak) while ingesting 146 g carbohydrate. Serum was collected before glycogen depletion under resting and fasted conditions (BASELINE), and before (PRE) and after (POST) exercise. Changes in metabolite profiles were calculated by subtracting BASELINE from PRE and POST within LOW and AD. There were greater increases (p < 0.05, Q < 0.10) in 64% of branched-chain amino acids (BCAA) metabolites and 69% of acyl-carnitine metabolites in LOW compared to AD. Urea and 3-methylhistidine had greater increases (p < 0.05, Q < 0.10) in LOW compared to AD. Changes in metabolomics profiles indicate a greater reliance on BCAA catabolism for substrate oxidation when exercise is initiated with low glycogen stores. These findings provide a mechanistic explanation for anabolic resistance associated with low muscle glycogen, and suggest that exogenous BCAA requirements to optimize muscle recovery are likely greater than current recommendations.

Body composition changes in physically active individuals consuming ketogenic diets: a systematic review

Background

To achieve ideal strength/power to mass ratio, athletes may attempt to lower body mass through reductions in fat mass (FM), while maintaining or increasing fat-free mass (FFM) by manipulating their training regimens and diets. Emerging evidence suggests that consumption of high-fat, ketogenic diets (KD) may be advantageous for reducing body mass and FM, while retaining FFM.

Methods

A systematic review of the literature was conducted using PubMed and Cochrane Library databases to compare the effects of KD versus control diets (CON) on body mass and composition in physically active populations. Randomized and non-randomized studies were included if participants were healthy (free of chronic disease), physically active men or women age ≥ 18 years consuming KD (< 50 g carbohydrate/d or serum or whole blood β-hydroxybutyrate (βhb) > 0.5 mmol/L) for ≥14 days.

Results

Thirteen studies (9 parallel and 4 crossover/longitudinal) that met the inclusion criteria were identified. Aggregated results from the 13 identified studies show body mass decreased 2.7 kg in KD and increased 0.3 kg in CON. FM decreased by 2.3 kg in KD and 0.3 kg in CON. FFM decreased by 0.3 kg in KD and increased 0.7 kg in CON. Estimated energy balance based on changes in body composition was − 339 kcal/d in KD and 5 kcal/d in CON. Risk of bias identified some concern of bias primarily due to studies which allowed participants to self-select diet intervention groups, as well as inability to blind participants to the study intervention, and/or longitudinal study design.

Conclusion

KD can promote mobilization of fat stores to reduce FM while retaining FFM. However, there is variance in results of FFM across studies and some risk-of-bias in the current literature that is discussed in this systematic review.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12970-021-00440-6.

Metabolomic profiles are reflective of hypoxia-induced insulin resistance during exercise in healthy young adult males

Hypoxia-induced insulin resistance appears to suppress exogenous glucose oxidation during metabolically matched aerobic exercise during acute (<8 h) high-altitude (HA) exposure. However, a better understanding of this metabolic dysregulation is needed to identify interventions to mitigate these effects. The objective of this study was to determine if differences in metabolomic profiles during exercise at sea level (SL) and HA are reflective of hypoxia-induced insulin resistance. Native lowlanders (n = 8 males) consumed 145 g (1.8 g/min) of glucose while performing 80-min of metabolically matched treadmill exercise at SL (757 mmHg) and HA (460 mmHg) after 5-h exposure. Exogenous glucose oxidation and glucose turnover were determined using indirect calorimetry and dual tracer technique ([¹³C]glucose and [6,6-²H₂]glucose). Metabolite profiles were analyzed in serum as change (Δ), calculated by subtracting postprandial/exercised state SL (ΔSL) and HA (ΔHA) from fasted, rested conditions at SL. Compared with SL, exogenous glucose oxidation, glucose rate of disappearance, and glucose metabolic clearance rate (MCR) were lower (P < 0.05) during exercise at HA. One hundred and eighteen metabolites differed between ΔSL and ΔHA (P < 0.05, Q < 0.10). Differences in metabolites indicated increased glycolysis, tricarboxylic acid cycle, amino acid catabolism, oxidative stress, and fatty acid storage, and decreased fatty acid mobilization for ΔHA. Branched-chain amino acids and oxidative stress metabolites, Δ3-methyl-2-oxobutyrate (r = -0.738) and Δγ-glutamylalanine (r = -0.810), were inversely associated (P < 0.05) with Δexogenous glucose oxidation. Δ3-Hydroxyisobutyrate (r = -0.762) and Δ2-hydroxybutyrate/2-hydroxyisobutyrate (r = -0.738) were inversely associated (P < 0.05) with glucose MCR. Coupling global metabolomics and glucose kinetic data suggest that the underlying cause for diminished exogenous glucose oxidative capacity during aerobic exercise is acute hypoxia-mediated peripheral insulin resistance.

Borrelia burgdorferi and other bacterial products induce expression and release of the urokinase receptor (CD87)

The urokinase-type plasminogen activator receptor (uPAR, CD87) is a highly glycosylated 55- to 60-kDa protein anchored to the cell membrane through a glycosylphosphatidylinositol moiety that promotes the acquisition of plasmin on the surface of cells and subsequent cell movement and migration by binding urokinase-type plasminogen activator. uPAR also occurs in a soluble form in body fluids and tumor extracts, and both membrane and soluble uPAR are overexpressed in patients with tumors. uPAR may be a factor in inflammatory disorders as well. We investigated whether Borrelia burgdorferi could stimulate up-regulation of cell membrane uPAR in vitro. B. burgdorferi, purified native outer surface protein A, and a synthetic outer surface protein A hexalipopeptide stimulated human monocytes to up-regulate membrane uPAR as measured by immunofluorescence/FACS and Western blot. The presence of soluble uPAR in culture supernatants, measured by Ag capture ELISA, was also observed. LPS from Salmonella typhimurium and lipotechoic acid from Streptococcus pyogenes also induced the up-regulation of both membrane and soluble uPAR protein by monocytes. Up-regulation of uPAR was induced by conditioned medium from B. burgdorferi/monocyte cocultures. The up-regulation of uPAR by B. burgdorferi was concomitant with an increase in uPAR mRNA, indicating that synthesis was de novo. The expression and release of uPAR in response to B. burgdorferi and other bacterial components suggests a role in the pathogenesis of Lyme disease as well as in other bacterial infections.

Borrelia spirochetes upregulate release and activation of matrix metalloproteinase gelatinase B (MMP-9) and collagenase 1 (MMP-1) in human cells

Borrelia burgdorferi, the spirochetal agent of Lyme disease, stimulated human peripheral blood monocytes to release pro-matrix metalloproteinase-9 (gelatinase B; pro-MMP-9) and active matrix metalloproteinase-1 (collagenase-1; MMP-1). Human neutrophils also released pro-MMP-9 and a 130-kDa protein with gelatinolytic activity in response to live B. burgdorferi. In addition, U937 cells and human keratinocyte cells were also stimulated to release pro-MMP-9 under the same conditions. However, human umbilical vein endothelial cells (HUVECs) released pro-MMP-9 and pro-MMP-2 in a constitutive manner and were not influenced by live spirochetes. MMPs produced by human monocytes also enhanced the penetration of B. burgdorferi through extracellular matrix component barriers in vitro. Plasmin stabilized on the surface of the Lyme disease spirochete was shown to activate pro-MMP-9 to its active form. This active form was also observed in the plasma of mice infected with a relapsing fever borrelia. These results suggest that borreliae can upregulate MMPs and possibly mediate an activation cascade initiated by plasmin bound to the microbial surface. MMPs may play a role in dissemination of the Lyme disease spirochete and in the pathogenesis of Borrelia infection.

The generation of enzymatically active plasmin on the surface of spirochetes

The spirochete Borrelia burgdorferi, the etiologic agent of Lyme disease, is transmitted to the host by a feeding Ixodid tick. The spirochete subsequently disseminates through the skin, enters the bloodstream, and becomes systemic. A potential mechanism for this invasiveness was identified with the discovery that B. burgdorferi can bind components of the plasminogen activation system (PAS). The methodology for analyzing the generation of enzymatically active plasmin on the surface of this organism is given, and applied to measure spirochete viability, strain differences, and breakdown of extracellular matrix (ECM) macromolecules. Plasmin acquisition by B. burgdorferi was measured photometrically by a specific chromogenic substrate. The growth of B. burgdorferi in culture was not affected by the presence of active plasmin on the spirochete surface. Plasmin-coated B. burgdorferi degraded the purified (ECM) components fibronectin, laminin, and vitronectin, but not collagen. The addition of B. burgdorferi with surface plasmin to a radiolabeled, native ECM resulted in degradation of noncollagenous protein, as measured by release of solubilized radioactivity. Breakdown of purified ECM components or native ECM did not occur after exposure to untreated spirochetes or spirochetes treated with uPA or PLG alone. These results provide in vitro evidence that enzymatically active plasmin on the surface of B. burgdorferi may be partially responsible for its invasiveness.

A bactericidal monoclonal antibody elicits a change in its antigen, OspB of Borrelia burgdorferi, that can be detected by limited proteolysis

mAb CB2, directed against outer surface protein B (OspB), causes bacteriolysis of Borrelia burgdorferi in the absence of complement. How this happens is unknown. We examined the effect of mAb binding on OspB tertiary structure by using limited proteolysis to probe changes in protein conformation. Truncated OspB (tOspB) that lacked N-terminal lipid was cleaved by four enzymes: trypsin, endoproteinase Arg-C, endoproteinase Asp-N, and endoproteinase Glu-C. CB2 affected the cleavage by trypsin and Arg-C, but not by AspN or Glu-C. None of the enzymes cleaved CB2 under these conditions. Both trypsin and Arg-C cleaved tOspB near the N-terminus; CB2 slowed the rate of cleavage, but did not affect the identity of the sites cleaved. Irrelevant mAb had no effect, indicating that the effect was specific. CB2 was active against tOspB of strain B31, but not against tOspB of strain BEP4, to which it does not bind, suggesting that binding was required to elicit the effect on cleavage. With trypsin, CB2 showed a maximal effect at 8 mol of tOspB to 1 mol of mAb. At this ratio, not enough CB2 was present to bind all the tOspB; therefore, either CB2 shows turnover or CB2 acts by binding tOspB and effecting a change in this tOspB such that it, in turn, propagates the effect in other molecules of tOspB. Regardless of the mechanism, these data show that CB2 elicits a change in tOspB that can be measured by its reduced susceptibility to protease cleavage.

Use of the plasminogen activation system by microorganisms

The use of host-derived PAS components by invasive bacteria is an increasingly recognized mechanism for acquisition of extracellular proteolytic activity. This overview summarizes the pertinent contributions to this field and is divided into three parts: (1) the PAS, (2) the interaction of bacteria that produce their own plasminogen activators with the host's PAS, and (3) the interaction of bacteria that do not produce their own plasminogen activators but use plasminogen activators supplied by the host. The significance of these mechanisms in relation to the invasive potentials of the various organisms is discussed.

Characterization of the Sialokinin I gene encoding the salivary vasodilator of the yellow fever mosquito, Aedes aegypti

The gene encoding sialokinin I, the principal vasodilatory peptide of Aedes aegypti, has been isolated and characterized. Degenerate oligonucleotide primers based on peptide amino acid sequence were used to amplify a gene fragment from messenger RNA (mRNA) isolated from female salivary glands. The amplification product was used to probe a salivary gland complementary DNA (cDNA) library, and a number of corresponding cDNAs were isolated and their primary sequence determined. Analysis of the conceptual translation product of a 406-bp cDNA indicates that sialokinin I is expressed as a preprosialokinin and is subsequently post-translationally processed to the active peptide. Northern analysis revealed a 490-bp transcription product expressed exclusively in female salivary glands, and hybridization in situ of probes to RNA in whole tissues localized gene expression to the medial lobe of female salivary glands. Screening of an Ae. aegypti genomic library with the cDNA resulted in the isolation of a clone containing the gene, designated Sialokinin I (Sia I). Comparison of the cDNA with the genomic clone reveals two introns of 62 bp and 833 bp. Primer extension analysis showed that several transcription initiation sites are present. Southern analysis of genomic DNA shows that Sia I is most probably a single-copy gene. Similarities of the Sia I gene product with other genes are confined to the region encoding the active decapeptide.

Plasmin-coated borrelia Burgdorferi degrades soluble and insoluble components of the mammalian extracellular matrix

Borrelia burgdorferi, the spirochetal agent of Lyme disease, binds plasminogen in vitro. Exogenously provided urokinase-type plasminogen (PLG) activator (uPA) converts surface-bound PLG to enzymatically active plasmin. In this study, we investigated the capacity of a B. burgdorferi human isolate, once complexed with plasmin, to degrade purified extracellular matrix (ECM) components and an interstitial ECM. In a modified enzyme-linked immunosorbent assay using immobilized, soluble ECM components, plasmin-coated B. burgdorferi degraded fibronectin, laminin, and vitronectin but not collagen. Incubation of plasmin-coated organisms with biosynthetically radiolabeled native ECM resulted in breakdown of insoluble glycoprotein, other noncollagenous proteins, and collagen, as measured by release of solubilized radioactivity. Radioactive release did not occur with untreated spirochetes or spirochetes treated with uPA or PLG alone. Kinetic and inhibition studies suggested that the breakdown of collagen was indirect and due to prior disruption of supportive ECM proteins. B. burgdorferi is an invasive bacterial pathogen that may benefit by use of the host's plasminogen activation system. The results of this study have identified mechanisms in which the spirochete can use this borrowed proteolytic activity to enhance invasiveness.

Plasminogen is required for efficient dissemination of B. burgdorferi in ticks and for enhancement of spirochetemia in mice

The role of the host plasminogen activation system in transmission of and invasion by Borrelia burgdorferi, the tick-borne spirochetal agent of Lyme disease, was investigated using plasminogen (Plg)-knockout mice. PLG was not detected in spirochetes from unfed ticks, but binding occurred as ticks fed on the host's blood. Plasminogen activators were derived from the host blood meal. PLG was required for efficient dissemination of B. burgdorferi within the tick and for enhancement of spirochetemia in mice but was not critical for transmission and infection. These results provide evidence for a bacterium using a vertebrate protease to disseminate in an invertebrate vector and underscores the interplay among vector, pathogen, and host in promoting the life cycle and disease.

Characterization of the physiological requirements for the bactericidal effects of a monoclonal antibody to OspB of Borrelia burgdorferi by confocal microscopy

A confocal microscopy study was undertaken to characterize the bactericidal effects of the Fab fragments of CB2, an immunoglobulin G1kappa murine monoclonal antibody, to an epitope in the carboxy region of the outer surface protein B (OspB) of Borrelia burgdorferi. Simultaneous direct labeling of both fixed and live spirochetes with fluorochrome-labeled Fab-CB2 and 11G1, and an immunoglobulin Mkappa monoclonal antibody to OspA, showed that OspA and OspB seem to colocalize in dead spirochetes but do not appear to be physically associated when the organisms are alive. A polar bleb composed of a Fab-CB2-OspB complex, followed by incorporation of 11G1-OspA, precedes the formation of a spheroplast. The spheroplasts contain both OspA and OspB and are a terminal stage in the bactericidal process induced by Fab-CB2. Outer membrane destabilization by Fab-CB2, but not cell wall or cytoplasmic membrane alterations, was demonstrated experimentally by the sequential treatment of spirochetes with Fab-CB2 and monoclonal antibodies to flagellin and DnaK. The action of Fab-CB2 is epitope specific, as another monoclonal antibody to an epitope in the amino terminus of OspB was not bactericidal. The bactericidal effect of Fab-CB2 is not dependent on the induction of spirochetal proteases but is dependent on the presence of Ca2+ and Mg2+. Supplementation of Ca2(+)- and Mg2(+)-free medium with these cations restored the bactericidal effects of Fab-CB2. The mechanism by which a Fab fragment of an antibody destroys a bacterium directly may represent a novel form of antibody-organism interaction.

Glycolytic enzyme operon of Borrelia burgdorferi: characterization and evolutionary implications

The genes encoding three enzymes of the glycolytic pathway have been identified and sequenced completely in Borrelia burgdorferi sensu stricto and partially in B. hermsii. They are clustered on the chromosome into an operon with a single putative promoter and are arranged downstream of this promoter in the following order: gapdh (glyceraldehyde-3-phosphate dehydrogenase), pgk (phosphoglycerate kinase), and tpi (triosephosphate isomerase). gapdh and pgk are separated by 19 bp of intergenic sequence and pgk and tpi are separated by only 1 bp. Each of the three genes contains a putative RBS 6-7 bp upstream of each respective translational (ATG) start codon. The deduced protein encoded by gapdh consists of 335 amino acids (aa) with a predicted MW of 36,400, that of pgk is 393 aa (MW of 42,156) and that of tpi is 290 aa (MW of 27,683). The aa sequences of each of the three enzymes share 58.4% (GAPDH), 52.8% (PGK) and 46.1% (TPI) identity with respective enzymes from other prokaryotic organisms. Phylogenetic analyses based on these universal and conserved proteins support the hypothesis that spirochetes are an ancient and distinct eubacterial phylum.

A glyceraldehyde-3-phosphate dehydrogenase homolog in Borrelia burgdorferi and Borrelia hermsii

A polyreactive monoclonal antibody recognized a 38.5-kDa polypeptide with amino-terminal sequence identity to conserved regions of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in Borrelia burgdorferi, the Lyme disease agent, and Borrelia hermsii, an agent of American relapsing fever. This monoclonal antibody also recognized GAPDH from other pathogenic spirochetes and other prokaryotes and eukaryotes as well. GAPDH activity was detected in sonicates of both B. burgdorferi and B. hermsii but not in live, intact organisms, indicating the possibility of a subsurface localization for the Borrelia GAPDH activity. Degenerate primers constructed from highly conserved regions of gapdh of other prokaryotes successfully amplified this gene homolog in both B. burgdorferi and B. hermsii. Nuclei acid and deduced amino acid sequence analysis of the 838-bp probes for each borrelia indicated 93.9% identity between B. burgdorferi and B. hermsii at the amino acid level. Amino acid identities of B. burgdorferi and B. hermsii with Bacillus stearothermophilus were 59.2% and 58.8% respectively. Southern hybridization studies indicated that the gene encoding GAPDH is located on the chromosome of each borrella. In other bacterial species, GAPDH has other functions in addition to its traditional enzymatic role in the glycolytic pathway. GAPDH may play a similar role in borrelias.

Borrelia burgdorferi shows specificity of binding to glycosphingolipids

Live but not fixed or heat-killed Borrelia burgdorferi bound to galactocerebroside, lactosylceramide, and ceramide trihexoside. In addition, this organism bound to the disialoganglioside GD1a and the trisialoganglioside GT1b but not to gangliosides GM1, GD1b, GM2, and GM3 and not to asialo GM1. This adhesion pattern confirmed earlier findings of binding to galactocerebroside and places this organism within a prokaryotic group which binds to lactosylceramide. The binding to GD1a and GT1b, both of which carry terminal as well as multiple sialic acids, indicates that B. burgdorferi can show specificity of binding within a group of acidic gangliosides. Adhesion could not be inhibited by several concentrations of sugars and sialic acid, indicating more complex binding requirements than for terminal carbohydrates alone. Low-passage strains adhered to the four substrates in greater numbers than strains in culture for long periods of time. OspB mutants in general bound better or at least equally well to several of the glycosphingolipids, and preincubation of substrates with soluble recombinant and affinity-purified Osp did not inhibitor or weakly inhibited the binding of the organisms. These findings suggest that outer surface lipoproteins A and B are not directly involved in adhesion to glycosphingolipids.

Borrelia burgdorferi binds plasminogen, resulting in enhanced penetration of endothelial monolayers

Several strains of Borrelia burgdorferi and Borrelia hermsii can bind human Lys-plasminogen specifically. Affinity blots using 125I-labeled plasminogen showed that numerous polypeptides of all the strains and species tested could bind via lysine residues to the plasminogen molecule since binding could be completely inhibited by the lysine analog epsilon-aminocaproic acid. Binding analysis using 125I-labeled plasminogen on live intact organisms showed that the organisms possess two binding sites for plasminogen: a high-affinity site with a Kd of 24 +/- 12 pM and 106 +/- 14 binding sites per spirochete and a low-affinity site with a Kd of 20 +/- 4 nM and 2,683 +/- 36 binding sites per spirochete. Indirect immunofluorescence and confocal microscopy showed a generalized but punctate pattern of plasminogen binding to the spirochete surface. Exogenously provided urokinase-type plasminogen activator converted B. burgdorferi surface-bound plasminogen to enzymatically active plasmin as demonstrated by the breakdown of the chromogenic plasmin substrate S2251. Plasmin-coated organisms showed an enhanced ability to penetrate endothelial cell monolayers grown on connective tissue substrates compared to untreated controls (P < 0.001). This functional assay demonstrated that enzymatically active plasmin on the surface of spirochetes can lead to greater invasion of tissues.

Epitopes shared by unrelated antigens of Borrelia burgdorferi

An immunoglobulin M kappa-chain murine monoclonal antibody (CAB) reacted in a Western blot (immunoblot) with approximately 30 polypeptides from a whole-cell lysate of several American and European Borrelia burgdorferi strains. The reactive antigen with the highest M(r) was measured at 93 kDa (p93) and had an NH2-terminal sequence identical to the one previously reported for this antigen. The lowest reactive antigen had an M(r) of 16,000. All antigens recognized by CAB had isoelectric points within a narrow acidic range, between 5.4 and 6.2. Thus, the objective of this study was to determine whether the broad reactivity of CAB could be due to degradation of the antigen with the highest M(r), since such spontaneous degradation of p93 has already been reported, and to determine whether CAB could recognize shared epitopes in different antigens. Treatment of B. burgdorferi with protease inhibitors did not result in changes in CAB reactivity, indicating that if such degradation existed, it was most likely not due to the action of endogenous proteases. Likewise, protease treatment of intact organisms and recovery of the antigens in the insoluble fraction of a Triton X-114 partition indicated that they were internal and thus less likely to be degraded by experimental procedures. Amino-terminal sequences of other reactive polypeptides showed one approximately 72-kDa polypeptide to be identical to the DnaK homolog of B. burgdorferi. Two other antigens at approximately 49 and 47 kDa were blocked to Edman degradation. Finally, one sequenced polypeptide with a molecular mass of approximately 38.5 kDa had a strong identity with glyceraldehyde-3-phosphate dehydrogenase of other bacteria and vertebrates. Thus, while it cannot be ruled out that some of the CAB reactivity may be due to fragmentation of p93, there is strong evidence to indicate the presence of a shared epitope in at least three, possibly five, unrelated antigens of B. burgdorferi. A linear epitope within amino acid residues 357 to 371 of p93 was identified. Evidence is presented for a discontinuous epitope in the carboxy-terminal region of the DnaK homolog, which bears strong amino acid identity with the p93 epitope. The conserved amino acid sequences necessary for these shared epitopes indicate possible genetic and/or functional relatedness among these various antigens.

Variations in the ospB gene of Borrelia burgdorferi result in differences in monoclonal antibody reactivity and in production of escape variants

An escape variant of Borrelia burgdorferi, selected with a monoclonal antibody to OspB, expressed a truncated form of OspB, the result of point mutations in the ospB gene leading to a premature termination codon. A single amino acid position in the C terminus of OspB was critical for monoclonal antibody recognition. The variations in the ospB gene suggest a mechanism for the evasion of the immune response by these organisms and may also have implications for current diagnostic and vaccine efforts.

The prognostic significance of race and survival from laryngeal carcinoma

Surveillance, Epidemiology, and End Results (SEER) program data suggest that blacks with laryngeal carcinoma have a significantly lower 5-year survival rate than whites. Most of this difference persists despite adjustment for "crude stage." To evaluate possible factors contributing to this residual survival deficit, 190 white and 23 black patients treated at the Martinez Veterans Administration Hospital between 1968 and 1988 were studied. The independent impact of race on survival rate was analyzed with respect to various prognostic factors including treatment delay, elapsed time (diagnosis to treatment), age, stage, cancer subsites, and type of therapy. No independent prognostic significance could be attributed to race. The differences noted in SEER data probably reflect a tendency for the use of crude stage to underestimate the impact of prognostic groups within the categories of "local" and "regional" disease, the independent prognostic significance of subsites (glottic versus supraglottic), and the variable distribution of these subsites in different populations. This study suggests that when stage, subsite, and quality of care are adequately considered, survival from laryngeal cancer in blacks is comparable to that of whites.

Selection of an escape variant of Borrelia burgdorferi by use of bactericidal monoclonal antibodies to OspB

Two immunoglobulin G (IgG) monoclonal antibodies (MAbs) to outer surface protein B (CB2 and CB6), affinity purified from mouse ascitic fluid, exhibited concentration-dependent inhibitory and bactericidal properties against Borrelia burgdorferi after a 24-h incubation period in spirochete medium. Fab fragments derived from these MAbs showed the same effects, indicating that they were not caused by agglutination of the organisms by the intact MAbs. The inhibition of spirochete growth in cultures containing MAbs was also detected by spectrophotometric analysis of the media. CB2 did not inhibit the growth of Borrelia hermsii or the BEP4 strain of B. burgdorferi, neither of which is recognized by the MAb. Affinity-purified IgG from hybridoma supernatants had similar effects on B. burgdorferi as the ascitic-fluid-derived IgG did, indicating that the inhibitory and bactericidal properties were not due to nonspecific toxic contaminants. The bactericidal properties of the MAbs were not complement dependent as there was none in the serum-free system. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of B. burgdorferi organisms surviving after exposure to CB2 revealed an escape variant which failed to express OspB. The continued presence of OspA in these escape variants indicates that the lack of OspB was not due to the loss of the plasmid which contains the genes for both of these proteins.

Characterization of antigenic determinants of Borrelia burgdorferi shared by other bacteria

Three antigenic determinants of Borrelia burgdorferi that were shared with other spirochetes and gram-negative bacterial species, as measured by Western blot, ELISA, or both, were identified and characterized using monoclonal antibodies (MAbs). Two were associated with immunogenic integral membrane lipoproteins of 19- and 22-kDa, respectively, by [3H]palmitate incorporation and Triton X-114 phase partitioning. A third antigenic determinant was shown to be associated with a 72-kDa heat shock protein that was also immunogenic in human patients. MAb agglutination assays with B. burgdorferi and treatment of the spirochete with proteases indicated that none of the antigenic determinants were surface exposed. NH2-terminal sequence analysis revealed the 72-kDa protein to have 100% identity with the first 13 amino acid residues of the Escherichia coli dnaK heat shock protein. The presence of these and other shared antigenic determinants in ELISA antigen preparations could explain the high degree of serologic cross-reactivity in current diagnostic procedures.

[The characterization of a Spanish strain of Borrelia burgdorferi]

BACKGROUND

The characteristics of a Spanish strain of Borrelia burgdorferi, the spirochete which causes Lyme's disease, and which, up to the present, has not been isolated in Spain, are described.

METHODS

The organism was obtained from ticks (Ixodes ricinus) from the northern part of Spain. It was studied in culture by dark field microscopy and the internal structure observed by electron transmission. The antigenic composition was analyzed under polyacrylamide electrophoresis, immunoblot and reactivity against monoclonal antibodies. Plasmid analysis was carried out by Southern blot.

RESULTS

In culture the length of the organism is somewhat shorter than normal. It grows slowly and tends to autoagglutinate. It has 6-13 periplasmic flagella. The antigenic analysis of this microorganism through immunoblot and reactivity against different monoclonal antibodies showed differences with regards to other North American strains, with the most significant being the composition of certain proteins of the surface of the organism. These differences may have clinical repercussion. DNA analysis by Southern blot demonstrated slight differences in regard to the composition of plasmids compared to other strains analyzed.

CONCLUSIONS

Borrelia burgdorferi exists in Spain. The isolated strain shows peculiar characteristics with respect to others analyzed. The availability of an autochthonous strain may allow more reliable serological diagnosis in Spain.

Salivary gland antigens of Ixodes dammini are glycoproteins that have interspecies cross-reactivity

Serum from rabbits and rats exposed to Ixodes dammini adults and larvae, respectively, contain antibodies to a large number of antigens in salivary gland homogenates from adult ticks that cross react with the antigens of a closely related species, Ixodes scapularis, and significantly with Dermacentor variabilis antigens. The salivary gland antigens of I. dammini are glycoproteins composed of both N- and O-linked carbohydrate chains. The antigenic determinants reside in both the polypeptide and carbohydrate chains.

Identification and characterization of an endoflagellar antigen of Borrelia burgdorferi

The 41-kD antigen of Borrelia burgdorferi is an immunodominant protein that is recognized early by antibodies in sera from Lyme disease patients and known to be associated with the endoflagella. We identified the 41-kD endoflagellar antigen to be a single polypeptide with an apparent isoelectric point (pI) of 6.5 by two-dimensional (2-D) electrophoresis. This polypeptide, which we designated P41F alpha, was heavily labeled by 125I in 2-D autoradiographs of B. burgdorferi whole-cell lysates and was recognized by a murine monoclonal antibody (MCB1) and human antisera in 2-D immunoblots. NH2-terminal sequence analysis showed 80% homology between P41F alpha and the 33-kD endoflagellar protein of Treponema pallidum. Results of indirect immunofluorescence assays (IFA), Triton X-114 phase partitioning, and agglutination studies suggested a possible surface exposure of the polypeptide. Silver stained 2-D gels also revealed the presence of another 41-kD species, with an apparent pI of 6.6 (designated P41 beta), which was not radioiodinated in 2-D autoradiographs, and was not recognized by MCB1 or human antisera. NH2-terminal sequence analysis of P41 beta revealed no homology with P41F alpha, leading to the conclusion that they are not related.

Adult Ixodes dammini on rabbits: development of acute inflammation in the skin and immune responses to salivary gland, midgut, and spirochetal components

Rabbits exposed to female Ixodes dammini (both uninfected and infected with Borrelia burgdorferi) or injected with B. burgdorferi showed an acute inflammatory response in the skin. Granulocytes and monocyte-histiocytes were the predominant infiltrating cells. Spirochetes were detected in the tick feeding cavities in the deep dermis. The inflammatory process was accompanied by polyclonal antibody responses to tick salivary gland components. Western blots showed that immune rabbit serum reacted with proteins of molecular masses of 8, 24, and 36-41 kilodaltons in both unengorged and engorged tick salivary glands. Additional reacting bands in the immunoblot of the engorged salivary gland indicated that new antigenic components of the salivary gland are synthesized during engorgement. Rabbits did not produce antibodies to tick midgut components. Murine monoclonal antibody 11G1 detected outer surface protein A of B. burgdorferi in immunoblots of midguts from unengorged ticks, faintly in engorged salivary gland, and seldomly in unengorged salivary gland, findings suggesting that the spirochete is transmitted to the host via tick saliva during the later stages of feeding.

Biological activity of Borrelia burgdorferi antigens

OSP-A (approximately 31 kDa) and flagellins (approximately 41 kDa) are prominent antigens of Borrelia burgdorferi. Both OSP-A and flagellins are immunogenic in patients and in experimentally infected mice and hamsters, but the kinetics of antibody formation to each vary considerably between the species. The role of eluted OSP-A and flagellins in the cellular immune response, chemotaxigenesis, and cytoadherence was measured. Eluted OSP-A and flagellins stimulated the proliferation of normal and infected mouse splenocytes but only the peripheral mononuclear cells of patients. Both OSP-A and flagellins induced human neutrophil chemotaxis, but at significantly reduced levels as compared to other known chemotactic peptides. Live B. burgdorferi adhere to HEp-2 cells in culture. OSP-A and the flagellins are involved in adherence; monoclonal antibodies to determinants in these proteins partially inhibited adherence. Cytoadherence was also partially inhibited by treatment of the cells with tunicamycin and sialidase.

A murine IgM monoclonal antibody binds an antigenic determinant in outer surface protein A, an immunodominant basic protein of the Lyme disease spirochete

A hybridoma cell line formed by the fusion of the P3x63-Ag8.653 myeloma cell line with splenocytes from BALB/c mice immunized with Borrelia burgdorferi produced an IgM monoclonal antibody (mAb-11G1) with kappa-light chains which detected an antigenic determinant in a major spirochetal protein of m.w. approximately 31,000, also known as outer surface protein A (OSP-A). Apparent saturation was reached in approximately 35 min with 34 ng of mAb-11G1 binding to 5 X 10(7) spirochetes giving an estimated 4.8 X 10(2) IgM molecules per spirochete and thus a minimum of 480 binding sites per organism. Enzymatic digestion studies suggest that the antigenic determinant to mAb-11G1 is contained within the peptide chain of OSP-A as binding could be eliminated by treatment of the spirochetes with proteinase K, Pronase and pepsin (100 to 200 micrograms/ml of enzyme) but not by trypsin or bromelain treatment. Periodate oxidation as well as mixed and endoglycosidase treatment of the spirochetes did not alter the binding of mAb-11G1. Two-dimensional gel electrophoresis of whole spirochetal cell lysates disclosed that OSP-A is a heterogeneously charged basic protein with an apparent isoelectric point range from 8.5 to 9.0. Amino acid analysis of OSP-A showed a 10% lysine component which could provide the basic nature to the protein. OSP-A with the intact antigenic determinant for mAb-11G1 can be found in the urine of hamsters experimentally infected with B. burgdorferi.

A murine IgM monoclonal antibody binds an antigenic determinant in outer surface protein A, an immunodominant basic protein of the Lyme disease spirochete

A hybridoma cell line formed by the fusion of the P3x63-Ag8.653 myeloma cell line with splenocytes from BALB/c mice immunized with Borrelia burgdorferi produced an IgM monoclonal antibody (mAb-11G1) with kappa-light chains which detected an antigenic determinant in a major spirochetal protein of m.w. approximately 31,000, also known as outer surface protein A (OSP-A). Apparent saturation was reached in approximately 35 min with 34 ng of mAb-11G1 binding to 5 X 10(7) spirochetes giving an estimated 4.8 X 10(2) IgM molecules per spirochete and thus a minimum of 480 binding sites per organism. Enzymatic digestion studies suggest that the antigenic determinant to mAb-11G1 is contained within the peptide chain of OSP-A as binding could be eliminated by treatment of the spirochetes with proteinase K, Pronase and pepsin (100 to 200 micrograms/ml of enzyme) but not by trypsin or bromelain treatment. Periodate oxidation as well as mixed and endoglycosidase treatment of the spirochetes did not alter the binding of mAb-11G1. Two-dimensional gel electrophoresis of whole spirochetal cell lysates disclosed that OSP-A is a heterogeneously charged basic protein with an apparent isoelectric point range from 8.5 to 9.0. Amino acid analysis of OSP-A showed a 10% lysine component which could provide the basic nature to the protein. OSP-A with the intact antigenic determinant for mAb-11G1 can be found in the urine of hamsters experimentally infected with B. burgdorferi.

Adult Ixodes dammini on rabbits: a hypothesis for the development and transmission of Borrelia burgdorferi

A histological study of unfed Ixodes dammini adults has shown that the Lyme disease spirochete can be found in the midgut diverticula of these ticks and is presumably carried over from the nymphal stage. Sequential histology of the early stages of ticks feeding on a rabbit showed that spirochetes began to divide and were located in close proximity or attached to the epithelial cells of the diverticulae. Evidence for division was obtained by the higher number of spirochetes per tick after a three-day feeding period than in the unfed females. Although the mechanism is unclear, some spirochetes become systemic by the fifth day of feeding and can be detected in low numbers in other tick organs. Spirochetes were also noted in the feeding cavities created by I. dammini in the dermis after five days of attachment. Spirochetes were not detected in salivary glands or in the feces of I. dammini during the feeding period.

Isolation of antigenic components from the Lyme disease spirochete: their role in early diagnosis

Patients with early Lyme disease produce IgM antibodies to a 41,000-dalton polypeptide of Borrelia burgdorferi. With advancing disease, IgG antibodies recognize a larger number of spirochetal polypeptides. Sodium dodecyl sulfate treatment of spirochetes at a concentration of 0.03% resulted in an outer envelope (OE) fraction in the supernatant and a protoplasmic cylinder (PC) flagellar fraction in the pellet. Shearing of the PC pellet followed by ultrafiltration and dialysis resulted in a flagellin-enriched fraction. From the OE and flagellin-rich fractions, individual polypeptides with Mr of 66,000, 41,000, and 31,000/34,000 daltons were eluted in microgram quantities after electrophoresis. The flagellin-enriched fraction as well as the eluted polypeptides were used as antigens in the ELISA. The flagellin-enriched fraction was superior to the standard ELISA antigen. The 41-kilodalton (kDa) flagellin antigen was not useful. Antigens of 66 kDa and 31/34 kDa were confirmed to be part of the late antibody response.

Clinical and geographic characteristics of Lyme disease in New York

The clinical and geographic characteristics of 679 patients who met the clinical definition of Lyme disease and who had antibody titers of greater than or equal to 1: 128 to Borrelia burgdorferi for a two year period, 1983-1984, are described. Males outnumbered females 60% to 40% for the two year period and nearly half of all cases were children and young adults nineteen years old or younger. Forty percent of the patients reported single or multiple tick bites prior to the onset of illness and tick bites were clustered in the summer months. Skin lesions (ECM) were reported in 63% of all the patients. Joint involvement as the only manifestation of Lyme disease was reported in 21% and 22% of all the patients in 1983 and 1984 respectively. A 2: 1 ratio of males to females was noted on this subgroup and 63% of these were 19 years old or less. Onset of joint manifestations were most frequent in the last three months of the year. Neurological manifestations were noted in 20% of the patients with facial palsy being the most frequent. Twenty nine patients had neurological disorders as the only manifestation of Lyme disease. Cardiovascular symptoms were reported in 26 patients (4%). The secondary manifestations of Lyme disease were of summer and early fall onset. Lyme disease in New York is restricted to suburbs north of New York City in Westchester County, and in suburbs to the east of New York City in Suffolk County, Long Island. Incidence for the two year period can range from 0.01 cases per 1000 in some communities to 28 cases per 1000 in highly endemic areas.

Isolation of the outer envelope from Borrelia burgdorferi

Borrelia burgdorferi consists of an inner protoplasmic cylinder, containing the genome and cytoplasmic elements, surrounded by a number of axial filaments, all completely encased within a multiple-layered outer envelope structure (OE). In this study, a sodium dodecyl sulfate-mediated technique was used to isolate the OE from Borrelia burgdorferi in an attempt to better understand this structure in terms of its antigenic reactivity to Lyme disease patient sera. Electron microscopic evidence suggested that the OE product was relatively free of other spirochete cellular components. SDS-PAGE analysis indicated that the electrophoretic pattern of the OE was consistent with that of the remaining protoplasmic cylinder (PC) and whole spirochete controls. Antigenic determinants in the OE were recognized by sera from Lyme disease patients in Western blots. Chemical analysis of the OE revealed a composition of 45.90% protein, 50.75% lipid and 3.33% carbohydrate. The OE comprised 16.5% by lyophilized dry weight of the whole spirochete. Antigenic determinants located within or associated with this structure are likely to play a significant role in the development of immunity in the infected host.

A role for interleukin-1 in the pathogenesis of Lyme disease

Interleukin-1 (IL-1) is the major immunoregulatory molecule produced by macrophages in response to a variety of environmental insults including chemicals, phagocytosis, bacteria, and bacterial products. Macrophages stimulated by Borrelia burgdorferi produced large quantities of IL-1 when spirochetes were added to macrophages at a ratio of 10 spirochetes per macrophage. The release of IL-1 was dose dependent: a single spirochete per macrophage was sufficient to produce significant quantities of IL-1. Spirochetal lipopolysaccharide was not required for this activity in that polymyxin B in the spirochete-macrophage culture had no effect on IL-1 production. Normal murine fibroblasts cultured with this IL-1 were shown to have an increased rate of DNA synthesis and an increase in secreted collagenase. IL-1 was found in joint fluids from Lyme disease patients. When IL-1 was injected intradermally into the backs of rabbits, the injection sites became indurated, erythematous, and warm to the touch after 4 hrs and annular lesions much like those of erythema chronicum migrans were seen in some animals after 24 hrs. B. burgdorferi is a powerful inducer for IL-1 in vitro, and it is reasonable to presume that it acts similarly in Lyme disease patients. Our results suggest that IL-1 in turn, may play a role in many of the clinical manifestations of Lyme disease.

An IgE response to spirochete antigen in patients with Lyme disease

Most but not all Lyme disease patients produce specific IgE antibodies to Borrelia burgdorferi. Development of IgE antibodies paralleled that of other immunologic classes and appeared to be directed against a polypeptide with a molecular weight of 41,000. Total serum IgE levels in Lyme disease patients were usually within the normal range in all stages of the disease. However, highly elevated total serum IgE in certain patients were not correlated to any particular disease stage nor to specific antibody titers. Spirochetes and spirochetal sonicates in high concentration induced release of histamine from basophils derived from both patients and controls. At lower antigen concentrations, histamine release could be induced only from basophils derived from patients. Synovial fluids from patients with Lyme arthritis contained IgE but only negligible amounts of histamine.

Serological evidence for simultaneous occurrences of Lyme disease and babesiosis

Babesia microti and Borrelia burgdorferi, the spirochetal agent of Lyme disease, are both transmitted by the tick Ixodes dammini. Serological evidence has shown that 54% of the patients with babesiosis tested have IgG and IgM antibodies to the spirochete causing Lyme disease. Likewise, 66% of randomly selected patients with Lyme disease from geographic areas endemic for both diseases, but not from areas where babesiosis does not occur, also have IgM and IgG antibodies to B. microti. Antigenic cross-reactivity is not the reason for these findings, as laboratory animals experimentally infected with B. microti do not develop antibodies to B. burgdorferi, and laboratory animals immunized with organisms derived from pure cultures of spirochetes do not develop antibodies to B. microti. We suggest that these patients are concurrently exposed to both organisms by doubly infected tick vectors.

Chemical and biologic characterization of a lipopolysaccharide extracted from the Lyme disease spirochete (Borrelia burgdorferi)

A lipopolysaccharide (LPS) was isolated from the Lyme disease spirochete by a modification of the hot phenol-water method. The material was composed of 45% carbohydrate, 8% protein, 44% lipid A, and 1% 3-deoxy-D-mannooctulosonic acid and accounted for approximately 1.5% of the cellular dry weight. The isolated LPS possessed several biologic activities characteristic of endotoxins. The LPS was pyrogenic for rabbits, mitogenic for human mononuclear cells and murine splenocytes, capable of clotting limulus lysate, and cytotoxic for murine macrophages. LPS extracted from Borrelia burgdorferi by the petroleum-ether:chloroform:liquid-phenol procedure was also characterized. The results show that the Lyme disease spirochete contains a hitherto unknown LPS that is biologically active in vitro, and the expression of such activities in vivo may play an important role in the pathogenesis of Lyme disease. Some of the clinical manifestations of other spirochetal disease may be explained by similar endotoxins in those organisms. To our knowledge this is the first report of an LPS extracted from a spirochete that is known to be a human pathogen.

Lyme disease spirochetes induce human and murine interleukin 1 production

IL 1 is a major immunoregulatory molecule produced by macrophages, and it appears to be the molecular orchestrator of nonspecific host defense mechanisms against a variety of environmental insults. Many investigators have used artificial agents to stimulate macrophages to produce IL 1. We now report production of large quantities of IL 1 after a physiologic stimulus. The Lyme disease spirochete, recently isolated and adapted for growth in vitro, was used to stimulate P388D1 cells or human peripheral blood monocytes. Spirochetes were added to confluent macrophage cultures in serum-free RPMI at a ratio of 10:1. The release of IL 1 was dose-dependent. The 24-hr supernatant IL 1 activity was determined by using the thymocyte Con A co-mitogenesis assay. Activity was not due to an endotoxin on, or produced by, the spirochete. A polymyxin B affinity column failed to remove activity, and polymyxin B in the spirochete-macrophage culture had no effect on IL 1 production. Supernatants were collected, were concentrated, and were subjected to size exclusion HPLC. Three areas of activity were found in P388D1 cell supernatants (Mr greater than 60,000, 40,000, and 20,000), whereas two peaks (Mr 23,000 and 13,000) were found in human monocyte supernatants. The Mr 20,000 and 13,000 peaks from murine and human cell supernatants, respectively, were subjected to SDS-PAGE and were shown to be single bands (Mr 12,400 for the mouse IL 1 and Mr 13,500 for the human IL 1). Isoelectric focusing of column-purified IL 1 preparations showed two different pI in both human (pI 7.25 and 4.4 to 5) and murine (pI 7.25 and 5.55) IL 1. Fibroblasts cultured with murine or human IL 1 preparations demonstrated both an increase in secreted collagenase and increased cell proliferation. Thus, a physiologic stimulus and simple biochemical techniques produce large amounts of very pure mouse or human IL 1. That this IL 1 is produced by Lyme disease spirochete-stimulated macrophages may explain some of the clinical manifestations of Lyme disease.

Lyme disease spirochetes induce human and murine interleukin 1 production

IL 1 is a major immunoregulatory molecule produced by macrophages, and it appears to be the molecular orchestrator of nonspecific host defense mechanisms against a variety of environmental insults. Many investigators have used artificial agents to stimulate macrophages to produce IL 1. We now report production of large quantities of IL 1 after a physiologic stimulus. The Lyme disease spirochete, recently isolated and adapted for growth in vitro, was used to stimulate P388D1 cells or human peripheral blood monocytes. Spirochetes were added to confluent macrophage cultures in serum-free RPMI at a ratio of 10:1. The release of IL 1 was dose-dependent. The 24-hr supernatant IL 1 activity was determined by using the thymocyte Con A co-mitogenesis assay. Activity was not due to an endotoxin on, or produced by, the spirochete. A polymyxin B affinity column failed to remove activity, and polymyxin B in the spirochete-macrophage culture had no effect on IL 1 production. Supernatants were collected, were concentrated, and were subjected to size exclusion HPLC. Three areas of activity were found in P388D1 cell supernatants (Mr greater than 60,000, 40,000, and 20,000), whereas two peaks (Mr 23,000 and 13,000) were found in human monocyte supernatants. The Mr 20,000 and 13,000 peaks from murine and human cell supernatants, respectively, were subjected to SDS-PAGE and were shown to be single bands (Mr 12,400 for the mouse IL 1 and Mr 13,500 for the human IL 1). Isoelectric focusing of column-purified IL 1 preparations showed two different pI in both human (pI 7.25 and 4.4 to 5) and murine (pI 7.25 and 5.55) IL 1. Fibroblasts cultured with murine or human IL 1 preparations demonstrated both an increase in secreted collagenase and increased cell proliferation. Thus, a physiologic stimulus and simple biochemical techniques produce large amounts of very pure mouse or human IL 1. That this IL 1 is produced by Lyme disease spirochete-stimulated macrophages may explain some of the clinical manifestations of Lyme disease.

Incidence and cumulative frequency of endemic Lyme disease in a community

We conducted an epidemiological study of the cumulative frequency and incidence of Lyme disease in a summer community on Fire Island, New York, an area endemic for the disease. Fifteen (7.5%) of 200 persons studied in the community in 1982 reported a history of Lyme disease. An indirect immunofluorescent antibody assay showed that seventeen (9.7%) of 176 persons had serological evidence of exposure to the Lyme spirochete, including six of the 15 persons with a history of Lyme disease. Seven (0.7%-1.2%) of 600-1,000 persons in the community developed clinical symptoms and serological evidence of Lyme disease during the summer season, including two (1%) of the 200 persons in the study group. Four (3.1%) of 129 persons who had sera collected before and after the summer season demonstrated fourfold or greater rises in IgG antibody titers to the Lyme spirochete, including 2 (1.6%) persons without symptoms of Lyme disease. We conclude that the incidence of Lyme disease can be appreciably higher in endemic areas than previously recognized and that subclinical or inapparent seroconversion may occur after infection.

Interactions of phagocytes with the Lyme disease spirochete: role of the Fc receptor

The phagocytic capacity of murine and human mononuclear and polymorphonuclear phagocytes (including peripheral blood monocytes and neutrophils), rabbit and murine peritoneal exudate cells, and the murine macrophage cell line P388D1 against the Lyme disease spirochete was studied. All of these cells were capable of phagocytosing the spirochete; phagocytosis was measured by the uptake of radiolabeled spirochetes, the appearance of immunofluorescent bodies in phagocytic cells, and electron microscopy. Both opsonized and nonopsonized organisms were phagocytosed. The uptake of opsonized organisms by neutrophils was blocked by a monoclonal antibody specific for the Fc receptor and by immune complexes; these findings suggested that most phagocytosis is mediated by the Fc receptor. Similarly, the uptake of opsonized organisms by human monocytes was inhibited by human monomeric IgG1 and by immune complexes. These results illustrate the role of immune phagocytosis of spirochetes in host defense against Lyme disease.

Phagocytic cell responses to in vivo and in vitro exposure to the Lyme disease spirochete

An experimental skin lesion induced in rabbits by the bite of infected adult Ixodes dammini showed dense dermal interstitial inflammatory cell infiltrates composed of mononuclear cells (histiocytes and lymphocytes) and granulocytes. The prevalence of phagocytic cells in this experimental lesion motivated a study on the interactions of macrophages and neutrophils with Lyme disease spirochetes. Interactions as measured by uptake of radiolabeled spirochetes and by indirect immunofluorescence were enhanced by opsonization of spirochetes with immune serum and not significantly decreased by heat inactivation of the same. Phagocytosis was inhibited by treatment of cells with Cytochalasin B. Adherence of opsonized spirochetes to neutrophils was decreased by blocking Fc receptors with heat-aggregated IgG, suggesting an important role for this receptor.

Prevalence of the Lyme disease spirochete in populations of white-tailed deer and white-footed mice

The prevalence of the Ixodes dammini spirochete (IDS) in white-tailed deer (Odocoileus virginianus) and white-footed mice (Peromyscus leucopus) was studied on the eastern end of Long Island, New York. Both species commonly occur in a variety of habitats, are preferred hosts of Ixodes dammini, and can harbor the spirochetes in the blood. Each animal was examined for spirochetemia, tick infestation, and IDS infection rates in the ticks that were removed from it. The results obtained suggest that in winter deer can be infected by questing adult I. dammini. Adult ticks apparently are infected through transtadial transmission of spirochetes from subadult ticks which had fed earlier in their life history on infected animals. Deer are important hosts of adult ticks and the IDS in winter and probably are a reservoir host in other seasons. The patterns of spirochete prevalence suggest that deer and mice are reservoirs of the organism and thus are fundamental to the ecology of Lyme disease on Long Island.

Epidemiologic features of Lyme disease in New York

During 1982, surveillance identified 207 cases of Lyme disease in New York State. Cases were clustered in two geographic areas, eastern Long Island and northern Westchester counties. Symptoms and signs of Lyme disease in cases were consistent with previous reports, with erythema chronicum migrans (ECM) being the most frequently (77 percent) reported sign of disease. Facial palsy was reported in a surprisingly high 18 percent of cases. Of 160 cases whose sera were submitted for Lyme spirochete specific IgG antibody testing, 112 (70 percent) had titers greater than or equal to 64, while 88 (55 percent) had titers greater than or equal to 128. Positive titers were not associated with any single sign or symptom of disease, but were significantly associated with symptom onset or tick bite occurring during the three-month period of June, July, and August. We conclude that the incidence of Lyme disease in New York is much higher than previously recognized. In addition, our data suggest that a serologic test for Lyme-spirochete IgG antibody lacks sensitivity, but can be useful in confirming the diagnosis of Lyme disease when antibody titers are high.