New Lyme diagnostic could pinpoint disease earlier

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The first signs of spring are propelling people to the outdoors. But as locals flee concerns of COVID-19, another disease lurks in the shadows: Lyme.

With the tick-borne illness making its annual resurgence in the region, researchers from Tufts University School of Medicine say they have discovered a new way to identify the disease, looking at an antibody generated in response to the infection, that can help people receive more effective treatment.

“There are real problem areas in the current tests that impact a lot of people,” said Peter Gwynne, lead author of the study and a molecular biology and microbiology researcher at Tufts University School of Medicine.

“Even if we only make a small improvement in one of those areas, it would make a difference to the way the disease is diagnosed and managed,” Gwynne continued. “There’s still a lot of work to do, but it’s very refreshing to have that pathway for how the lab work (which is basically quite boring, a lot of the time) might make a material difference.”

The research, conducted in the Tufts Department of Molecular Biology and Microbiology, with colleagues at the National Institute of Allergy and Infectious Diseases, was published in the Journal of Clinical Investigation on March 15.

Lyme disease is estimated to affect nearly 500,000 people in the United States every year, with the majority of cases occurring in the Northeast, according to US Centers for Disease Control and Prevention data.

The disease is caused by a bacteria introduced through the bite of an infected tick, prompting a telltale bull’s-eye rash around the bite and flu-like symptoms. The disease can also cause a host of long-term symptoms, including arthritis, fatigue, mental impairment, and effects on the heart and brain. While antibiotics can clear most infections, scientists said the disease can evade such treatments in 10 to 20 percent of cases.

State data from 2021 show that 2,143 people who went to emergency rooms had been diagnosed with a tick-borne disease, with children ages 5 to 14 experiencing the highest rate of tick-borne illnesses.

Current tests for Lyme disease identify the antibodies the body produces in response to Lyme infection, but those antibodies can take three to four weeks to appear after an infection, delaying diagnosis. Diagnostics used today miss half of positive cases in the first or second week after infection and identify only 85 percent of infections after a month, Gwynne said.

Antibodies can also linger in the body long after the disease has been cleared. When someone has recurrent symptoms of Lyme but had a previous infection, doctors are unable to know whether they had a persistent infection that was never cured, they were cured and then reinfected, or they have a different illness altogether.

Researchers said they discovered that the Lyme bacteria acquired fats from its surroundings and placed them on the bacteria’s surface. These fats, called phospholipids, prompt an immune response in both people and animals, researchers said.

The antibodies produced in response to these weaponized fats, called autoantibodies, are different from the antibodies that typical diagnostics find. Early data suggests that the autoantibodies show up earlier after infection.

“We know the earlier you treat, the more likely you are to treat successfully,” Gwynne said. “Somewhere between 10 to 20 percent of people continue to have symptoms after they’ve been treated. That’s less likely to happen if you are treated early. Those first few weeks are really important.”

The data also suggest that the body clears autoantibodies more quickly, helping scientists know how effective treatment has been or if someone has become reinfected in the future.

The researchers have a provisional patent pending for the technique. Gwynne is raising $1 million to continue the work and is working to determine how well the tests compare to current tests.

“Rather than replacing the current test, maybe its role is to supplement the test,” Gwynne said. “We need to find the capability of this test and how it fits into the current testing scheme.”

If future studies are successful, the researchers hope a diagnostic company could begin development of a commercially available version of their test within a couple of years.

Commentary on the research, published in the journal by researchers Gunjan Arora, Thomas Hart, and Erol Fikrig, all with the Yale University School of Medicine, said the new technique has promise in diagnosing early or repeat infections.

“The lipid autoantibodies described in the study by Gwynne and colleagues represent potentially promising biomarkers that could aid clinicians in the diagnosis of Lyme disease and meaningfully impact patient outcomes,” the researchers said.