The Lyme Times

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8 The Lyme Times
CDC & NIHWebinar
Persistence of Borrelia burgdorferi tops agenda
On May 22, 2014, the Centers for
Disease Control and Prevention (CDC)
joined the National Institutes of Health
(NIH) to sponsor a login/call-in program
of speakers highlighting the state of the
science surrounding the question of per-
sistence of the Borrelia burgdorferi (Bb)
infection. They proposed that a “better
understanding of this topic should lead
to improved diagnostics, safer and more
durable therapeutics, and improved pre-
vention options.”
The webinar session, convened by Ben
Beard, CDC, and moderated by Joseph
Breen, NIH, featured a panel of im-
pressive speakers:
• Dr. Stephen Barthold, U.C. Davis. The
Comparative Biology of Bb Persistence
• Dr. Linda Bockenstedt, Yale Sºchool of
Medicine. Design of Animal Studies
to Assess Bb Persistence
• Dr. Monica Embers, Tulane
University. Studies of Bb Persistence
in the Nonhuman Primate
• Dr. Adriana Marques, NIH. Searching
for Persistence of Infection in Lyme
disease
• Dr. Linden Hu, Tufts University.
Bb Persistence: Consensus and
Controversy
Questions remain, however. Are re-
sidual Bb spirochetes capable of causing
disease following antibiotic treatment?
What are the mechanisms of persistence?
Does persistent infection require live spi-
rochetes or just their DNA? How do we
explain the inability to culture Bb after
antibiotic therapy? Does duration of in-
fection prior to treatment matter? Are
there differences in the ability of different
strains to persist? Can xenodiagnosis
provide a way to study mechanisms of
Lyme disease? Among the speakers, Dr.
Barthold noted that as Bb evolved to
survive in the wild without destroying
the host, he suspects it can sequester in
spaces to evade antibiotics.
View weinar slides at
Read the transcript at
osignature” in the blood — reflections of
disease — that can distinguish recovered
Lyme patients from those who have per-
sistent symptoms. Such a biosignature
might help clarify the pathophysiology of
recovery vs chronicity, thereby enabling
more effective treatment interventions.
Biorepository
Much of our work has been made
possible through our biorepository of well-
characterized samples from patients with
both early and later stages of Lyme. As is
now well recognized nationally, such a re-
pository is essential for progress. In addition
to the importance of samples from patients
with early Lyme, one of the key pressing
national needs is for samples from patients
with well-established chronic symptoms as
well. While the CDC does have a limited
supply of samples from patients with Lyme
arthritis, there is no central resource for
samples from patients with later-dissem-
inated disease. These are hard to gather and
require patience, time, and commitment.
We are grateful to the Center for providing
the resources to allow such an effort.
Education
On the educational front, with the help
of generous donors and the contribution
of teaching time by experts in Lyme
and TBD, we have recently established a
joint Fellowship between the Division of
Family Medicine at the Columbia Medical
Center and the Department of Psychiatry.
This 2-year fellowshi p trains a family
medicine doctor to become an expert in
Lyme and TBD — to think critically, to
thoroughly understand the literature on
these diseases, to participate in new re-
search studies, to lecture at conferences,
and to return to the community as a highly
trained professional in the evaluation and
treatment of patients with these complex
diseases. We continue educating medical
students in summer training.
Annual conference
The national Lyme conference that we or-
ganize with the Lyme Disease Association
(LDA) continues to be a great pleasure for
me personally and a tremendous learning
opportunity for all who attend. Over the
years our speakers have been luminaries
not only in TBD but also in related areas of
medicine. Our mission has been not only
to teach about what is known but to invite
those whose outstanding work in other
related areas might have application to
TBD. Not only does this conference educate
doctors and other healthcare providers but
it also provides an opportunity for critical
conversation among researchers to allow
for new collaborations.
Federal funding
Perhaps most frustrating to me early
in the Center’s years was the lack of in-
terest by national funding agencies in the
problem of chronic Lyme. The tide has
turned, however. As a result of outstanding
animal research at U.C. Davis, Cornell,
Tulane, and other institutions in Europe, it
is widely recognized that the Bb organism
can persist despite antibiotic therapy. That
such persisters may be contributing to per-
sistent symptoms is a leading area of in-
vestigation. The identification of new or-
ganisms, particularly Borrelia miyamotoi,
raises questions about whether these may
be contributing to symptom chronicity or
“seronegative” antibiotic responsive Lyme.
A new attitude of collegiality and
openness has emerged in the last several
years, along with a new interest in private
philanthropy to support scientific research.
I am hopeful that much will be accom-
plished in the next five years as a result of
major changes in how we view chronicity
and TBD.
Brian Fallon, MD, MPH, is the director of
the Lyme and Tick-borne Diseases Research
Center at Columbia University in New York
City and Professor of Clinical Psychiatry at
the College of Physicians and Surgeons. His
research has focused on neuropsychiatry, the
discipline that studies the behavioral and
mood effects of diseases that affect the brain.
He may be reached at
Columbia, from page 7