LymeNet Newsletter Volume 4 Issue 14

Volume: 4
Issue: 14
Date: 14-Oct-96

Table of Contents:

I. LDF: New Jersey task Force Fund Raisers in October II. LYMENET: Steven Philips, MD., to Speak in CT III. LANCET: A new Borrelia species isolated from patients with relapsing fever in Spain IV. INFECT IMMUN: Outer surface protein C (OspC), but not P39, is a protective immunogen against a tick-transmitted Borrelia burgdorferi challenge: evidence for a conformational protective epitope in OspC V. N ENGL J MED: Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha VI. About The LymeNet Newsletter

Newsletter:

*********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * ***********************************************************************

IDX# Volume 4 - Number 14 - 10/14/96 IDX# INDEX IDX# IDX# I. LDF: New Jersey task Force Fund Raisers in October IDX# II. LYMENET: Steven Philips, MD., to Speak in CT IDX# III. LANCET: A new Borrelia species isolated from patients IDX# with relapsing fever in Spain IDX# IV. INFECT IMMUN: Outer surface protein C (OspC), but not P39, IDX# is a protective immunogen against a tick-transmitted IDX# Borrelia burgdorferi challenge: evidence for a IDX# conformational protective epitope in OspC IDX# V. N ENGL J MED: Prevention of Jarisch-Herxheimer reactions IDX# by treatment with antibodies against tumor necrosis factor IDX# alpha IDX# VI. About The LymeNet Newsletter IDX#

I. LDF: New Jersey task Force Fund Raisers in October -------------------------------------------------------- Sender: Tom Forschner <[email protected]> Date: October 8, 1996

The Lyme Disease Foundation's New Jersey Task Force will be holding its first Gold Tournament in the State of New Jersey on October 15, 1996 at Essex Fells Country Club. We need your support now!

We need golfers and reception attendees. We also need people to take out ads in the Golf program, or to advertise by buying tee or cart signs.

You don't have to be a golfer to help.

US Congressman Rodney Frelinghuysen will be joining us for the reception and Bart Oates, formerly with the New York Giants, will be golfing with us. The Giants have donated an autographed football and Rodney Hampton's autographed jersey. The New Jersey Devils have donated 4 "center ice" tickets (probably the best seats in the house) for their games with Vancouver (Dec 5) and Boston (Jan 14). Whittenhaurer has donated a very fine men's watch and Lipton will be providing beverages.

Other Lyme Disease Foundation events: Lipton Tea of Englewood Cliffs will be holding a walk/run-a-thon on October 18th for its employees to benefit the Lyme Disease Foundation.

Call me or Cheryl at the Foundation if you need more information at: 860-525-2000. You may also contact some of the Task Force Volunteers directly:

Roberta Bethencourt..............908-446-6296 Barbara Brennan..................908-879-5331 Martha Behrle....................201-403-8915 Ruth Vanderhoof..................201-334-7070

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II. LYMENET: Steven Philips, MD., to Speak in CT -------------------------------------------------- Sender: Cindy Onorato, The Lyme Disease Network of CT

The Lyme Disease Network of Connecticut Proudly Presents:

An Evening with Dr. Steven Phillips

Dr. Phillips has opened a practice in Ridgefield, CT. He is a graduate of the Yale University School of Medicine residency program at Greenwich Hospital and has been performing research in Lyme disease for the past 6 years.

Dr. Phillips will be talking about Lyme disease, its chronic manifestations, testing and therapy. The talk will focus on the microbiology and immune system interactions inherent to Lyme disease, and the therapeutic strategies designed specifically in light of recent advances in the understanding of how Lyme disease works.

DATE: Wednesday, October 16th at the Ridgefield Public Library in Ridgefield, CT, at 8pm. The Library is located on Main Street.

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III. LANCET: A new Borrelia species isolated from patients with relapsing fever in Spain ----------------------------------------------------------- AUTHORS: Anda P, Sanchez-Yebra W, del Mar Vitutia M, Perez Pastrana E, Rodriguez I, Miller NS, Backenson PB, Benach JL ORGANIZATION: Centro Nacional de Microbiologia, Virologia e Inmunologia Sanitarias, Instituto de Salud Carlos III, Madrid, Spain. REFERENCE: Lancet 1996 Jul 20;348(9021):162-5 ABSTRACT:

BACKGROUND: Lyme disease and tick-borne relapsing fever are worldwide systemic borrelioses caused by several Borrelia species transmitted by hard ticks (family Ixodidae) and soft ticks (family Argasidae), respectively. A previous seroepidemiological study of Lyme borreliosis showed several serologically reactive patients with clinically atypical presentations, and this discovery led to the hypothesis that some of the cases of Lyme borreliosis had been caused by another borrelia organism.

METHODS: Blood from patients in southern Spain who had suspected Lyme disease or relapsing-fever borreliosis was cultured before treatment began. Isolates of Borrelia spp were inoculated into several strains of mice of different ages. The 16S rRNA and flagellin in genes of Borrelia spp were sequenced by PCR and assessed by phylogenetic analyses.

FINDINGS: We isolated a species of Borrelia from three patients with relapsing fever and from Ornithodorus spp ticks in southern Spain. This organism (refractory to in-vitro cultivation) caused a relapsing spirochaetaemia with multiple organ involvement in laboratory mice that recreated the human disease. Phylogenetic analysis showed that this organism is a previously unrecognised species.

INTERPRETATION: We have discovered a new borrelia pathogen that is closely related to the other tick-borne agents of relapsing fever in Europe and Africa, and which causes a relapsing systemic disease with serological similarities to Lyme borreliosis.

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IV. INFECT IMMUN: Outer surface protein C (OspC), but not P39, is a protective immunogen against a tick-transmitted Borrelia burgdorferi challenge: evidence for a conformational protective epitope in OspC ------------------------------------------------------------------- AUTHORS: Gilmore RD Jr, Kappel KJ, Dolan MC, Burkot TR, Johnson BJ ORGANIZATION: Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado. REFERENCE: Infect Immun 1996 Jun;64(6):2234-9 ABSTRACT:

Outbred mice were immunized with the soluble fraction of a crude Escherichia coli lysate containing either recombinant outer surface protein C (OspC or P39 of Borrelia burgdorferi B31 (low passage). Following seroconversion, the mice were challenged with an infectious dose of B. burgdorferi B31 via the natural transmission mode of tick bite. Three mice immunized with P39 were not protected; however, all 12 of the recombinant OspC-immunized mice were protected from infection as assayed by culture and serology. Although OspC has been shown to be a protective immunogen against challenge with in vitro-cultured borrelia administered by needle, this study is the first to demonstrate OspC effectiveness against tick-borne spirochetes.

Following feeding, all ticks still harbored B. burgdorferi, suggesting that the mechanism of protection is not linked to destruction of the infectious spirochete within the tick. In a separate experiment, groups of four mice were immunized with protein fractions from B. burgdorferi B31 purified by preparative gel electrophoresis in an attempt to identify potential protective antigens. Many of these mice developed high-titer-antibody responses against OspC, but curiously the mice were susceptible to B. burgdorferi infection via tick bite. These results suggest that the protective epitope(s) on OspC is heat sensitive/conformational, a finding which has implications in vaccine development.

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V. N ENGL J MED: Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha ------------------------------------------------------------------- AUTHORS: Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, Coxon RE Warrell DA ORGANIZATION: Department of Internal Medicine, Black Lion Hospital, Addis Ababa, Ethiopia. REFERENCE: N Engl J Med 1996 Aug 1;335(5):311-5 ABSTRACT:

BACKGROUND: In patients with louse-borne relapsing fever (Borrelia recurrentis infection), antimicrobial treatment is often followed by sudden fever, rigors, and persistent hypotension (Jarisch-Herxheimer reactions) that are associated with increases in plasma concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin-6, and interleukin-8. We attempted to determine whether sheep polyclonal Fab antibody fragments against TNF-alpha (anti-TNF-alpha Fab) could suppress the Jarisch-Herxheimer reaction.

METHODS: We conducted a randomized, double-blind, placebo-controlled trial in 49 patients with proven louse-borne relapsing fever. Immediately before the intramuscular injection of penicillin, the patients received an intravenous infusion of either anti-TNF-alpha Fab or a control solution.

RESULTS: Ten of the 20 patients given anti-TNF-alpha Fab had Jarisch-Herxheimer reactions with rigors, as compared with 26 of the 29 control patients (P = 0.006). The controls had significantly greater mean maximal increases in temperature (1.5 vs. 0.8 degrees C, P < 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), and systolic blood pressure (25 vs. 15 mm Hg, P < 0.003), as well as higher mean peak plasma concentrations of interleukin-6 (50 vs. 17 micrograms per liter) and interleukin-8 (2000 vs 205 ng per liter) (P < 0.001 for both comparisons). Levels of TNF-alpha were undetectable after treatment with anti-TNF-alpha Fab.

CONCLUSIONS: Pretreatment with sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer reactions that occur after penicillin treatment for louse-borne relapsing fever, reduces the associated increases in plasma concentrations of interleukin-6 and interleukin-8, and may be useful in other forms of sepsis.

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VI. ABOUT THE LYMENET NEWSLETTER ---------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please refer to the LymeNet Home Page at: http://www.lymenet.org ----------------------------------------------------------------------- To unsubscribe from the LymeNet newsletter, send a message to: [email protected] On the first line of the message, write: unsub lymenet-l ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX (for contributions ONLY): 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]> Advisors: Carol-Jane Stolow, Director <[email protected]>
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