Dr. Ying Zhang: - Standar antibiotic treatment for Lyme disease does not kill persistent Borrelia bacteria.
08/03/2015 kl.15 41 in Ticks 2 comments
Photo: NorVect / Geir Dokken
What has tuberculosis and Borrelia burgdorferi in common? In the late stage of the disease occurs persistent (tolerant) bacteria, which essentially means that the bacteria lasts and lasts and lasts. They protect themselves against antibiotics and are difficult to treat.
- Both Borrelia burgdorferi and tuberculosis is relatively easy to cure in the early stages, even with the use of one antibiotic. In the late stage it is impossible to cure the disease with the same type of treatment in the acute phase, said Dr. Ying Zhang when he visited the year NorVect conference.
Dr. Ying Zhang is a professor at the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. His research interests deal with bacterial persistence, antibiotic resistance and pathogenicity (the study of how a disease progresses), and to use research results to increase understanding of the disease and treating it.
- I work with bacteria, mainly tuberculosis, but started four or five years ago to work with Lyme borreliosis.
25-50% of borreliosis ill in Europe have persistent or recurrent pain after 2-4 weeks of antibiotic treatment. There is a larger proportion than in the US. Patients diagnosed PTLDS, "Post-Lyme Disease tretament Syndrome". The reason is uncertain. Are there late effects? Autoimmunity? Co-infections? Or persistent (tolerant) bacteria that are not killed by the current standard treatment?
- I relate to the past. Studies have demonstrated Borrelia burgdorferi in patients after completion of the standard treatment.
Today there is no approved treatment for PTLDS.
What does it mean when a bacterium referred to as persistent?
Essentially it persists. Even with antibiotic treatment, it will not die. Borrelia burgdorferi is one such bacterium. It changes shape under stress. What rush it? Including antibiotics.
The screw-like borreliaspiroketen curls up into a gem and ends up being persistent Borrelia in cyst form, also called "round body". In the treatment of Lyme disease in the late phase, which therefore combination therapy to be able to kill both spirochete and cyst form.
The phenomenon of "persistence" was first described in 1942 by Gladys Hobby having discovered that penicillin did not kill the bacteria that were in stationary phase. That is in a phase where it grew, but were hibernation / standby. When penicillin was removed, altered the stationary bacterium form and began to multiply / grow again. In growing phase was the equally sensitive to the same type of penicillin.
The bacterium is thus resistant to penicillin / antibiotics in stationary phase, which must not be misunderstood with genetic resistance.
How can it be solved?
- Largely focuses on the spirochete, but it is not the main form of the disease process or treatment of Lyme borreliosis. It is the persistent bacteria that is the problem.
Dr. Zhang used in his lecture a metaphor which he called dandelion phenomenon.
- The current standard treatment for Lyme disease, which is used regardless of what stage the disease is in, can be compared with a mower only cuts off the visible part of the dandelion. The root is still there, even though it is not easy to see. When you remove the mower, growing dandelions back. It has fine, but causes disease relapse. What you need is an antibiotic similar to the shovel, which also digs up roots.
Dr. Zhang's research team identified recently a number of FDA-approved drugs that works very well against persistent Borrelia burgdorferibakterier. This discovery has aroused great interest and opened new possibilities for a more effective treatment of persistent Lyme borreliosis.
- I can tell if a medication used to treat tuberculosis, called Pyrazinamide, a remarkable "Persistence" -medikament. It plays an essential role in the treatment of tuberculosis and has shortened treatment by six months. It is an interesting drug because it only kills the persistent bacteria that other antibiotics fail to take.
One of the solutions may be to use drugs against persistent Borrelia bacteria, as is done in tuberculosis treatment. Studies so far have shown very positive results.
To learn more about which drugs work best against persistent Borrelia burgdorferi and why, see Dr. Ying Zhang's speech in its entirety on NorVects sites. Here you will also get an overview of both old and new research, as he's starting point in concerning their own research. He also has many exciting plans ahead which he tells more about here.
IDSA or ILADS?
- I often get questions about which camp I belong. IDSA (2-4 weeks of treatment) or ILADS (longer combination therapy). I belong to both camps. I do not belong to either camp. I am the green pad in Yin and Yang, in between, he smiles.
- I have friends in IDSA and I have friends in ILADS. I work with both. For me it is not important where I am. Important it is to work together to find a more effective treatment of Lyme borreliosis.
Two days after NorVect conference, published Dr. Ying Zhang's latest research Identification of new compounds with high activity against stationary phase Borrelia burgdorferi from the NCI compound collection.
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