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==Overview==
==Overview==
Future and investigational therapies of Lyme disease are directed towards decreasing the pro inflammatory immune process and decreasing Th1 upregulation. Studies have also been conducted to test the role of neurohormones in neuropsychiatric complications of Lyme disease.  
Future and investigational therapies of [[Lyme disease]] are directed towards decreasing the pro-inflammatory [[immune]] process and decreasing Th1 [[upregulation]]. Studies have also been conducted to test the role of [[Neurohormone|neurohormones]] in [[neuropsychiatric]] complications of [[Lyme disease]]. Other therapies including [[hyperbaric oxygen therapy]], [[Antifungal medication|antifungal medications]] and use of bee venom are also under investigation.
 
==Future or Investigational Therapies==
==Future or Investigational Therapies==
====Inflammation====
====Psycho-neuroimmunological therapies====
* Evidences of a distinct pro inflammatory immune process has been observed in both acute and antibiotic refractory Lyme disease. 
* A developing hypothesis is that the [[chronic]] secretion of [[Stress (medicine)|stress]] [[hormones]] (specifically [[glucocorticoids]] and [[catecholamines]]) as a result of ''[[Borrelia afzelii|Borrelia]]'' infection may reduce the effect of [[neurotransmitters]], or other receptors in the brain by cell-mediated pro-inflammatory pathways, thereby leading to the dysregulation of neurohormones.<ref>{{cite journal |author=Elenkov IJ, Iezzoni DG, Daly A, Harris AG, Chrousos GP |title=Cytokine dysregulation, inflammation and well-being |journal=Neuroimmunomodulation |volume=12 |issue=5 |pages=255-69 |year=2005 |pmid=16166805 |doi=10.1159/000087104}}</ref><ref>{{cite journal |author=Calcagni E, Elenkov I |title=Stress system activity, innate and T helper cytokines, and susceptibility to immune-related diseases |journal=Ann. N. Y. Acad. Sci. |volume=1069 |issue= |pages=62-76 |year=2006 |pmid=16855135 |doi=10.1196/annals.1351.006}}</ref>
* This pro-inflammatory process is a [[cell-mediated immunity]] and results in Th1 [[upregulation.]] 
* A significant decrease in output of Interleukin-10([[IL-10]] ), an up regulation of [[Interleukin-6]] ([[IL-6]]), [[Interleukin-12]] (IL-12), and Interferon-gamma and dysregulation in [[TNF-alpha]] predominantly has been observed.<ref>{{cite journal |author=Shin JJ, Glickstein LJ, Steere AC |title=High levels of inflammatory chemokines and cytokines in joint fluid and synovial tissue throughout the course of antibiotic-refractory lyme arthritis |journal=Arthritis Rheum. |volume=56 |issue=4 |pages=1325-35 |year=2007 |pmid=17393419 |doi=10.1002/art.22441}}</ref>
* Host immune response to [[infection]] results in increased levels of Interferon-gamma in serum and [[lesions]] of Lyme disease patients that correlate with a greater severity of disease.
* Interferon-gamma alters gene expression in [[endothelium|endothelia]] exposed to ''B. burgdorferi'' in a manner that promotes recruitment of [[T cells]] and suppresses that of [[neutrophils]].
* [[IL-10]] is generally regarded as an anti-inflammatory [[cytokine]] as it acts on several different cell types to suppress the production of proinflammatory mediators.
* Researchers are also beginning to identify [[microglia]] as a previously unrecognized source of inflammatory mediator production following [[infection]] with ''B. burgdorferi''.
** Such production may play an important role during the development of cognitive disorders in Lyme neuroborreliosis.
** This effect is associated with induction of [[NF-κB|nuclear factor-kappa B]] (NF-KB) by ''Borrelia''.<ref>{{cite journal |author=Rasley A, Anguita J, Marriott I |title=Borrelia burgdorferi induces inflammatory mediator production by murine microglia |journal=J. Neuroimmunol. |volume=130 |issue=1-2 |pages=22-31 |year=2002 |pmid=12225885}}</ref><ref>{{cite journal |author=Rasley A, Tranguch SL, Rati DM, Marriott I |title=Murine glia express the immunosuppressive cytokine, interleukin-10, following exposure to Borrelia burgdorferi or Neisseria meningitidis |journal=Glia |volume=53 |issue=6 |pages=583-92 |year=2006 |pmid=16419089 |doi=10.1002/glia.20314}}</ref>
* Deregulation in production of pro-inflammatory [[cytokines]] such as [[IL-6]] and [[TNF-alpha]] can lead to neuronal damage in ''Borrelia''-infected patients.<ref>{{cite journal |author=Ramesh G, Philipp MT |title=Pathogenesis of Lyme neuroborreliosis: mitogen-activated protein kinases Erk1, Erk2, and p38 in the response of astrocytes to Borrelia burgdorferi lipoproteins |journal=Neurosci. Lett. |volume=384 |issue=1-2 |pages=112-6 |year=2005 |pmid=15893422 |doi=10.1016/j.neulet.2005.04.069}}</ref>
* [[IL-6]] and [[TNF-alpha|TNF-Alpha]] [[cytokines]] produce [[fatigue]] and [[malaise]], two of the more prominent symptoms experienced by patients with post treatment Lyme disease syndrome.<ref>{{cite journal |author=Papanicolaou DA, Wilder RL, Manolagas SC, Chrousos GP |title=The pathophysiologic roles of interleukin-6 in human disease |journal=Ann. Intern. Med. |volume=128 |issue=2 |pages=127-37 |year=1998 |pmid=9441573}}</ref>
* [[IL-6]] is also significantly linked to cognitive impairment.<ref>{{cite journal |author=Wright CB, Sacco RL, Rundek TR, ''et al'' |title=Interleukin-6 is associated with cognitive function: the Northern Manhattan Study |journal= |volume=15 |issue=1 |pages=34-38 |year=2006 |pmid=16501663 |doi=10.1016/j.jstrokecerebrovasdis.2005.08.009}}</ref>
 
====Neuroendocrine====
* A developing hypothesis is that the [[chronic]] secretion of [[Stress (medicine)|stress]] [[hormones]] as a result of ''Borrelia'' infection may reduce the effect of [[neurotransmitters]], or other receptors in the brain by cell-mediated pro-inflammatory pathways, thereby leading to the dysregulation of neurohormones, specifically [[glucocorticoids]] and [[catecholamines]], the major stress hormones.<ref>{{cite journal |author=Elenkov IJ, Iezzoni DG, Daly A, Harris AG, Chrousos GP |title=Cytokine dysregulation, inflammation and well-being |journal=Neuroimmunomodulation |volume=12 |issue=5 |pages=255-69 |year=2005 |pmid=16166805 |doi=10.1159/000087104}}</ref><ref>{{cite journal |author=Calcagni E, Elenkov I |title=Stress system activity, innate and T helper cytokines, and susceptibility to immune-related diseases |journal=Ann. N. Y. Acad. Sci. |volume=1069 |issue= |pages=62-76 |year=2006 |pmid=16855135 |doi=10.1196/annals.1351.006}}</ref>
* This process is mediated via the [[hypothalamic-pituitary-adrenal axis]].  
* This process is mediated via the [[hypothalamic-pituitary-adrenal axis]].  
* Additionally, [[tryptophan]], a precursor to [[serotonin]], appears to be reduced within the [[CNS]] in a number of infectious diseases that affect the brain, including Lyme disease.<ref>{{cite journal |author=Gasse T, Murr C, Meyersbach P, ''et al'' |title=Neopterin production and tryptophan degradation in acute Lyme neuroborreliosis versus late Lyme encephalopathy |journal=European journal of clinical chemistry and clinical biochemistry : journal of the Forum of European Clinical Chemistry Societies |volume=32 |issue=9 |pages=685-9 |year=1994 |pmid=7865624}}</ref>
* Additionally, [[tryptophan]], a precursor to [[serotonin]], appears to be reduced within the [[CNS]] in a number of patients with [[Lyme disease]].<ref>{{cite journal |author=Gasse T, Murr C, Meyersbach P, ''et al'' |title=Neopterin production and tryptophan degradation in acute Lyme neuroborreliosis versus late Lyme encephalopathy |journal=European journal of clinical chemistry and clinical biochemistry : journal of the Forum of European Clinical Chemistry Societies |volume=32 |issue=9 |pages=685-9 |year=1994 |pmid=7865624}}</ref>  
* Researchers are investigating if this neurohormone secretion is the cause of neuro-psychiatric disorders that develop in some patients with borreliosis.<ref>{{cite journal |author=Zajkowska J, Grygorczuk S, Kondrusik M, Pancewicz S, Hermanowska-Szpakowicz T |title=New aspects of pathogenesis of Lyme borreliosis |language=Polish |journal=Przegla̧d epidemiologiczny |volume=60 Suppl 1 |issue= |pages=167-70 |year=2006 |pmid=16909797}}</ref>
* [[Antidepressants]] have been shown to be immunomodulatory and anti-inflammatory against pro-inflammatory [[cytokine]] processes, specifically on the regulation of Interferon gamma and [[IL-10]], as well as [[TNF-alpha]] and [[IL-6]] through a [[Psychoneuroimmunology|psycho-neuroimmunological]] process.<ref>{{cite journal |author=Kubera M, Lin AH, Kenis G, Bosmans E, van Bockstaele D, Maes M |title=Anti-Inflammatory effects of antidepressants through suppression of the interferon-gamma/interleukin-10 production ratio |journal=Journal of clinical psychopharmacology |volume=21 |issue=2 |pages=199-206 |year=2001 |pmid=11270917}}</ref>
* [[Antidepressants]] acting on [[serotonin]], [[norepinephrine]], and [[dopamine]] receptors have been shown to be immunomodulatory and anti-inflammatory against pro-inflammatory [[cytokine]] processes, specifically on the regulation of IFN-gamma and [[IL-10]], as well as [[TNF-alpha]] and [[IL-6]] through a [[Psychoneuroimmunology|psycho-neuroimmunological]] process.<ref>{{cite journal |author=Kubera M, Lin AH, Kenis G, Bosmans E, van Bockstaele D, Maes M |title=Anti-Inflammatory effects of antidepressants through suppression of the interferon-gamma/interleukin-10 production ratio |journal=Journal of clinical psychopharmacology |volume=21 |issue=2 |pages=199-206 |year=2001 |pmid=11270917}}</ref>
* Antidepressants have also been shown to suppress Th1 upregulation.<ref>{{cite journal |author=Diamond M, Kelly JP, Connor TJ |title=Antidepressants suppress production of the Th1 [[cytokine]] interferon-gamma, independent of monoamine transporter blockade |journal=European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology |volume=16 |issue=7 |pages=481-90 |year=2006 |pmid=16388933 |doi=10.1016/j.euroneuro.2005.11.011}}</ref>
* Antidepressants have also been shown to suppress Th1 upregulation.<ref>{{cite journal |author=Diamond M, Kelly JP, Connor TJ |title=Antidepressants suppress production of the Th1 [[cytokine]] interferon-gamma, independent of monoamine transporter blockade |journal=European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology |volume=16 |issue=7 |pages=481-90 |year=2006 |pmid=16388933 |doi=10.1016/j.euroneuro.2005.11.011}}</ref>
* These studies warrant investigation of antidepressants for use in a psycho-neuroimmunological approach for optimal [[pharmacotherapy]] of antibiotic refractory Lyme patients.
* These studies warrant investigation of antidepressants for use in a psycho-neuroimmunological approach for optimal [[pharmacotherapy]] of antibiotic refractory Lyme patients.
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==== Antifungal medications ====
==== Antifungal medications ====
* Anecdotal clinical research has shown potential for the antifungal [[azole]] medications such as [[fluconazole]] for the treatment of Lyme disease, but this has yet to be repeated in a controlled study or postulated a developed hypothetical model for its use.<ref>{{cite journal|author=Schardt FW|title=Clinical effects of fluconazole in patients with neuroborreliosis|journal=Eur. J. Med. Res.|volume=9|issue=7|pages=334-6|year=2004|pmid=15337633}}</ref>
* Some clinical research has shown potential for the antifungal [[azole]] medications such as [[fluconazole]] for the treatment of Lyme disease, but this has yet to be repeated in a controlled study or postulated a developed hypothetical model for its use.<ref>{{cite journal|author=Schardt FW|title=Clinical effects of fluconazole in patients with neuroborreliosis|journal=Eur. J. Med. Res.|volume=9|issue=7|pages=334-6|year=2004|pmid=15337633}}</ref>


==== Alternative medicine ====
==== Alternative medicine ====
* One approach in the field of [[alternative medicine]] is the use of bee venom to treat Lyme disease because it contains the peptide [[melittin]], which has been shown to exert inhibitory effects on Lyme bacteria [[in vitro]]; however, no clinical trials of this treatment have been carried out.<ref>{{cite journal|author=Lubke LL, Garon CF|title=The antimicrobial agent melittin exhibits powerful in vitro inhibitory effects on the Lyme disease spirochete|journal=Clin. Infect. Dis.|volume=25 Suppl 1|issue=|pages=S48-51|year=1997|pmid=9233664}}</ref>
* One approach in the field of [[alternative medicine]] is the use of bee venom to treat Lyme disease because it contains the peptide [[melittin]], which has been shown to exert inhibitory effects on Lyme bacteria [[in vitro]]; however, no clinical trials of this treatment have been carried out.<ref>{{cite journal|author=Lubke LL, Garon CF|title=The antimicrobial agent melittin exhibits powerful in vitro inhibitory effects on the Lyme disease spirochete|journal=Clin. Infect. Dis.|volume=25 Suppl 1|issue=|pages=S48-51|year=1997|pmid=9233664}}</ref>
====New Developments====
* New research has also found that [[chronic]] Lyme patients have higher amounts of ''Borrelia''-specific [[FoxP3|forkhead box P3]] (FoxP3) than healthy controls, indicating that [[regulatory T cell]]s might also play a role, by [[immunosuppression]], in the development of [[chronic]] Lyme disease.
* FoxP3 are a specific marker of regulatory [[T cells]].<ref>{{cite journal |author=Jarefors S, Janefjord CK, Forsberg P, Jenmalm MC, Ekerfelt C |title=Decreased up-regulation of the interleukin-12Rbeta2-chain and interferon-gamma secretion and increased number of forkhead box P3-expressing cells in patients with a history of chronic Lyme borreliosis compared with asymptomatic Borrelia-exposed individuals |journal=Clin. Exp. Immunol. |volume=147 |issue=1 |pages=18-27 |year=2007 |pmid=17177959 |doi=10.1111/j.1365-2249.2006.03245.x}}</ref>
* The signaling pathway [[P38 mitogen-activated protein kinases]] (p38 MAP kinase) has also been identified as promoting expression of pro-inflammatory [[cytokines]] from ''Borrelia''.<ref>{{cite journal |author=Ramesh G, Philipp MT |title=Pathogenesis of Lyme neuroborreliosis: mitogen-activated protein kinases Erk1, Erk2, and p38 in the response of astrocytes to Borrelia burgdorferi lipoproteins |journal=Neurosci. Lett. |volume=384 |issue=1-2 |pages=112-6 |year=2005 |pmid=15893422 |doi=10.1016/j.neulet.2005.04.069}}</ref>
* The culmination of these new and ongoing immunological studies suggest this cell-mediated immune disruption in Lyme patients amplifies the inflammatory process, often rendering it [[chronic]] and self-perpetuating, regardless of whether the ''Borrelia'' bacterium is still present in the host, or in the absence of the inciting pathogen in an [[autoimmune]] pattern.<ref>{{cite journal |author=Singh SK, Girschick HJ |title=Toll-like receptors in Borrelia burgdorferi-induced inflammation |journal=Clin. Microbiol. Infect. |volume=12 |issue=8 |pages=705-17 |year=2006 |pmid=16842565 |doi=10.1111/j.1469-0691.2006.01440.x}}</ref>
* Researchers hope that this new developing understanding of the [[biomolecular]] basis and [[pathology]] of cell-mediated signaling events caused by ''B. burgdorferi'' [[infection]] will lead to a greater understanding of immune response and [[inflammation]] caused by Lyme disease and, hopefully, new treatment strategies for [[chronic]], antibiotic-resistant disease.
===Lyme Funding and Treatment Controversy===
* Many of the scientists involved in formulating what have become controversial Lyme diagnostic tests and treatment guidelines have been heavily involved in both bioweapons research and commercial vaccine and diagnostic test development, which the Lyme patient community views  as a conflict of interest. <ref>Conflicts of Interest in Lyme Disease: Treatment, Laboratory Testing, and Vaccination, Lyme Disease Association Inc., 2001</ref>
* In response to these and other concerns expressed by the expanding national community of patients, Richard Blumenthal, the Attorney General of Connecticut, has launched an investigation exploring possible corruption.
* To date, federal research aimed at developing treatments for [[chronic]] Lyme disease is roughly $30 million, as contrasted to a $22 billion budget for military biodefense. 
* Scientists setting Lyme treatment and diagnostic testing policy in the United States have a well publicized history in the biodefense field, and many have recently received lucrative biodefense grants for BSL-3 and BSL-4 labs where, critics contend, Lyme treatment research lacks transparency, accountability, and  focus on treatment research.<ref>Biocontainment lab planned at Primate Center,
PONTCHARTRAIN NEWSPAPERS COVINGTON, St.Tammany News, www.newsbanner.com Dec. 13, 2004</ref><ref>"Lyme Disease is  Biowarfare Issue" by Elena Cooke, published/discussed by Dave Emory, WFMU Talk Show Host, 2007 http://ftrsupplemental.blogspot.com/2007/02/history-of-lyme-disease-as-bioweapon.html</ref>
* In 2003, Lyme researcher Dr. Mark Klempner was appointed head of the new $1.6 billion biodefense top-security facility at [[Boston University]].<ref>[http://www.washingtonpost.com/wp-dyn/articles/A27646-2005Jan21.html Washington Post January 22, 2005]</ref>
* In 2004, Lyme researcher Dr. Jorge Benach was reportedly chosen as a recipient for a $3 million biodefense research grant, and in 2005, Lyme researcher Dr. Alan Barbour was reportedly placed in charge of a new, $40 million biodefense complex based at UC Irvine.<ref>[http://www.nystar.state.ny.us/nl/archives2004/longislandA08-04.htm NYStar News Publication of the New York State Office of Science, Technology and Academic Research, August 2004]</ref><ref>[http://www.ucihealth.com/News/Releases/06-05BiodefenseResearch.htm UCI Medical Centre, June 1, 2005]</ref>
* Former NIH [[Lyme disease]] program officer Edward McSweegan has published numerous articles and letters to editor pages relating to biowarfare topics ranging from anthrax to plague.
* Curiously, Mr. McSweegan's novel, ''Deliberate Release'', is a biowarfare thriller that describes the deliberate release of a germ weapon.<ref>McSweegan, Edward , "Deliberate Release", published September 20, 2002 by 1st Books Library, ISBN-10: 1403343535.</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 22:35, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Future and investigational therapies of Lyme disease are directed towards decreasing the pro-inflammatory immune process and decreasing Th1 upregulation. Studies have also been conducted to test the role of neurohormones in neuropsychiatric complications of Lyme disease. Other therapies including hyperbaric oxygen therapy, antifungal medications and use of bee venom are also under investigation.

Future or Investigational Therapies

Psycho-neuroimmunological therapies

Hyperbaric oxygen therapy

  • The use of hyperbaric oxygen therapy (which is used conventionally to treat a number of other conditions), as an adjunct to antibiotics for Lyme has been discussed.[6]
  • Though there are no published data from clinical trials to support its use, preliminary results using a mouse model suggest its effectiveness against B. burgdorferi both in vitro and in vivo.[7]

Antifungal medications

  • Some clinical research has shown potential for the antifungal azole medications such as fluconazole for the treatment of Lyme disease, but this has yet to be repeated in a controlled study or postulated a developed hypothetical model for its use.[8]

Alternative medicine

  • One approach in the field of alternative medicine is the use of bee venom to treat Lyme disease because it contains the peptide melittin, which has been shown to exert inhibitory effects on Lyme bacteria in vitro; however, no clinical trials of this treatment have been carried out.[9]

References

  1. ↑ Elenkov IJ, Iezzoni DG, Daly A, Harris AG, Chrousos GP (2005). "Cytokine dysregulation, inflammation and well-being". Neuroimmunomodulation. 12 (5): 255–69. doi:10.1159/000087104. PMID 16166805.
  2. ↑ Calcagni E, Elenkov I (2006). "Stress system activity, innate and T helper cytokines, and susceptibility to immune-related diseases". Ann. N. Y. Acad. Sci. 1069: 62–76. doi:10.1196/annals.1351.006. PMID 16855135.
  3. ↑ Gasse T, Murr C, Meyersbach P; et al. (1994). "Neopterin production and tryptophan degradation in acute Lyme neuroborreliosis versus late Lyme encephalopathy". European journal of clinical chemistry and clinical biochemistry : journal of the Forum of European Clinical Chemistry Societies. 32 (9): 685–9. PMID 7865624.
  4. ↑ Kubera M, Lin AH, Kenis G, Bosmans E, van Bockstaele D, Maes M (2001). "Anti-Inflammatory effects of antidepressants through suppression of the interferon-gamma/interleukin-10 production ratio". Journal of clinical psychopharmacology. 21 (2): 199–206. PMID 11270917.
  5. ↑ Diamond M, Kelly JP, Connor TJ (2006). "Antidepressants suppress production of the Th1 cytokine interferon-gamma, independent of monoamine transporter blockade". European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology. 16 (7): 481–90. doi:10.1016/j.euroneuro.2005.11.011. PMID 16388933.
  6. ↑ Taylor R, Simpson I (2005). "Review of treatment options for Lyme borreliosis". J Chemother. 17 Suppl 2: 3–16. PMID 16315580.
  7. ↑ Pavia C (2003). "Current and novel therapies for Lyme disease". Expert Opin Investig Drugs. 12 (6): 1003–16. PMID 12783604.
  8. ↑ Schardt FW (2004). "Clinical effects of fluconazole in patients with neuroborreliosis". Eur. J. Med. Res. 9 (7): 334–6. PMID 15337633.
  9. ↑ Lubke LL, Garon CF (1997). "The antimicrobial agent melittin exhibits powerful in vitro inhibitory effects on the Lyme disease spirochete". Clin. Infect. Dis. 25 Suppl 1: S48–51. PMID 9233664.


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