Summary
Objective metabolite-based measurements differ between Lyme disease patients that develop persistent symptoms following antibiotic treatment (PTLD) and those that are clinically cured. These differences could be useful in better identifying, differentiating, and understanding the underlying biochemistry of patients with persistent symptoms in Lyme disease.
Why was this study done?
Following standard of care antibiotic treatment approximately 10% of Lyme disease patients experience persistent symptoms that negatively impact the functionality of their life. This condition is referred to as Post-Treatment Lyme Disease (PTLD). Objective biomarkers or specific clinical symptoms for PTLD do not exist, making it difficult to diagnosis or to measure treatment success or failure. Evaluating metabolite patterns is one method to potentially identify a metabolomic signature for PTLD. Having such an objective measure could aid in improving diagnostics and treatments for persistent Lyme disease associated illness.
How was this study done?
In this study, blood samples from two cohorts of patients were analyzed by liquid chromatography-mass spectrometry (LC-MS) to identify small molecule metabolites (SMM) and metabolic pathways that differ between PTLD and clinically cured (non-PTLD) Lyme disease patients at three timepoints (baseline, following treatment completion, and at one-year post treatment). Longitudinal metabolic responses and biosignatures were identified and compared.
What were the major findings?
This study determined that observable metabolic differences existed between PTLD
and clinically cured patients at multiple timepoints. Results were validated using a cohort of PTLD and clinically cured patients from the Johns Hopkins Medicine Lyme Disease Research Center SLICE studies and validated with a second cohort from New York Medical College. Greater differential abundance and metabolic variability was observed in PTLD patients than non-PTLD clinically cured patients. Metabolite classes including glycerophospholipids, bile acids and acylcarnitines were altered in PTLDS patients as compared to non-PTLDS patients. Small numbers of metabolites (6-40) could be used to define PTLD vs. non-PTLD patients.
What is the impact of this work?
This study provides evidence that an objective metabolite-based measurement can distinguish patients with PTLD and help understand the underlying biochemistry of patients with persistent symptoms in Lyme disease.
This research was supported by
- Steven and Alex Cohen Foundation
- RDRCC/P30 grant AR070254.
Publication Information
Fitzgerald, B. L., Graham, B., Delorey, M. J., Pegalajar-Jurado, A., Islam, M. N., Wormser, G. P., Aucott, J. N., Rebman, A. W., Soloski, M. J., Belisle, J. T., & Molins, C. R. (2020). Metabolic Response in Patients with Post-Treatment Lyme Disease Symptoms/Syndrome. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, ciaa1455. Advance online publication. https://doi.org/10.1093/cid/ciaa1455
