Mollie W. Jewett, PhD, Associate Professor, Division Head of Immunity and Pathogenesis, Burnett School of Biomedical Sciences at UCF College of Medicine talks about Lyme disease and how it is treated.
Interview conducted by Ivanhoe Broadcast News in February 2019.
For viewers who are not familiar, maybe they’ve heard of Lyme disease but don’t really know what’s going on; can you explain what it is and what it’s doing to the body?
MOLLIE JEWETT: Lyme disease is a bacterial infection. It’s a disease that’s transmitted to people by the bite of a tick called an Ixodes scapularis or a black-legged tick. A percentage of those ticks are carrying a bacteria called Borrelia burgdorferi which is a mouthful. But those bacteria are what moves throughout the body after the tick bite. Early on in the disease, the symptoms are flu like symptoms as well as in some patients there’s what’s called a bull’s eye rash. It looks like a bull’s eye right at that tick bite site with a red bull’s eye and a spreading redness, which is indicative of that infection and then, as the infection persists longer and longer over time, those bacteria can move from a tick bite site to different places in the body. And Lyme disease characteristics are arthritis and other complications to do with the heart, complications to do with the nervous system. And that’s all about the body responding to the bacteria getting to those different places.
How long would the disease have to be at work, the bacteria would have to be at work for this to really become more serious?
MOLLIE JEWETT: We sort of think about Lyme disease in three stages. The first early stage is that that bite site and that that bull’s eye rash that’s in about the first week. Later on, as you go into weeks to months, would be what we would call disseminated stage where those bacteria have moved to other sites in the body and start to have other symptoms. A really prolonged third stage of disease would be even more accentuated issues that the patients are having, such as accentuated arthritis and neurological outcomes.
When a patient develops the arthritis, heart condition or neurological outcomes, are those reversible?
MOLLIE JEWETT: This is an interesting question and really a lot of what dictates the reversibility is how early the bacterial infection is detected. So if diagnosis happens early in those early weeks to early months, then the body hasn’t undergone a long period of damage. So, by taking the appropriate antibiotics there’s good research showing that the bacterial infection is cleared, and even at later stages those Stage 3 infection antibiotics have shown to be fairly good at treating the infection. However, the damage that’s been done to these other places in the body can lead to some long persistent symptoms for some patients.
So the antibiotics are pretty good way to treat this.
MOLLIE JEWETT: Right.
But not a cure for everybody in terms of these symptoms that continue because of the damage. I mean, you can imagine if your car gets damaged, you can fix some parts of it because the mechanic knows how to fix it. But there may be some aspects that the mechanic doesn’t know to fix. And even though what caused the damage is gone, the damage remains.
Tell me about your lab what you specifically are studying.
MOLLIE JEWETT: My lab has two focuses. One is focusing on really trying to work hard to improve that early diagnosis. And we think that that really can be a game changer for patients given what I was saying about how the early definitive diagnosis really is the key for treating the infection and preventing those longer term symptoms from occurring. So that’s one of our major focuses. The other major focus is that we’re really interested in understanding how the Borrelia burgdorferi bacteria is able to move from that initial bite site to actually overcome the body’s normal protection mechanisms and move from that bite site to get to those other sites in the body where those debilitating symptoms actually occur.
I want to talk about the early diagnosis first. Why is it so difficult to get an early diagnosis with this disease now?
MOLLIE JEWETT: There are a couple of challenges. In the world of microbiology and infectious disease the golden ticket for diagnosis is being able to actually find that pathogen that infectious microbe in the patient. Borrelia burgdorferi doesn’t require a high number of individual bacteria to cause an infection, it is also only in the bloodstream for a very short time. The bacteria get deposited by the tick right at that bite site and then there’s a very transient blood stage to get to those other sites. Sampling and having the right moment in time when those bacteria can be detected in the blood is very challenging and uniquely challenging to this infection. So, a lot of the diagnostics are based on detecting the body’s reaction to the presence of the bacteria. It takes time for the body to produce those molecules. I call it the blind period in Lyme disease diagnosis during the time when the infection is very difficult to detect. There isn’t a sensitive way to detect the organism itself. But during this period it’s also too soon to detect the antibodies. So, one of the questions would be can we improve early sensitivity of detection. The other question that we’re working on is what the right antibodies to be looking for are. We have to be sure that those are specific for this infection because you want to know that this is Lyme disease, a Borrelia burgdorferi infection, that’s being detected and not something else. So, sensitivity and specificity are really the keys to having both a very good test as well as a very sensitive test.
Can you describe for me what you and your colleagues are doing in the lab right now that will help with early diagnosis?
MOLLIE JEWETT: We have a diagnostic method that we’re developing that is using a technical tool called immuno PCR. We didn’t invent that but we are using it. My analogy is that it’s a fishing rod with very special bait. So we’re using tiny beads to connect different proteins from the bacteria onto those beads. So, our fishing rod is the bead and the specific bait is the different components of the bacteria. By using multiple components of the bacteria, we’re gaining specificity because we are using a very unique repertoire of proteins. Then, we’re taking a patient’s serum and blood which then we can separate out and we’re going fishing in that serum using this very special bait.
When the baits in there, what is the hope? What would you be looking for?
MOLLIE JEWETT: We’re looking for the presence of those antibodies and trying to enhance being able to detect very low numbers of those antibodies so that maybe we can push the window of detecting sooner. And then also that specificity issue of being sure that we’re detecting the exact right signature for Lyme disease. We’re also trying to flip that approach on its end and say can we use that fishing approach to actually fish in that blind window, can we fish for the bacteria? And again the sensitivity is really the key for being able to find those few numbers of bacteria in that early window.
What results could we see a couple of years down the road from what you and your colleagues are doing in the lab?
MOLLIE JEWETT: Some of this work has happened in collaboration with the Centers for Disease Control and we’ve published some manuscripts with a group there. Research is a long process, so we’re still at the early stages of this. We’re really excited about the prospects and the potential for this bringing a new level of sensitivity and specificity. But we’re still honing it. To think that some years down the road this would end up in your doctor’s office. We’re also working with some engineers here at the University of Central Florida to develop a small detection module that could sit in your doctor’s office by combining the technologies in terms of the scientific detection of the Lyme disease infection with a small engineered detection readout module. We’re hoping in some years down the road that we’ll be able to bring this to help patients.
Is there a timeframe? Do you have an estimate of how long it might take to go from bench to bedside?
MOLLIE JEWETT: The process of research is long. We’re hoping in the next couple of years that we might have some sort of product that could be brought to begin to work with some diagnostic companies that could have the ability to move a research entity into an actual commercial market. And then, we’ll have to think about how to work with the FDA to move things into an actual clinical environment. But it’s our hope that we can get there.
And now the second prong of what your lab is doing. What kind of work parcel with the early diagnosis?
MOLLIE JEWETT: It could inform that for sure. This is more of a basic science; understanding what the bacteria is doing. We think that might be rather than a diagnostic, if we can understand the mechanisms that the bacteria use to move, not just physically move but avoid the defense systems of the human, then that might be a treatment. We think that by preventing the bacteria from being able to get to those other sites in the body where these debilitating outcomes happen it could improve a potential outcome for a patient and allow for an improved treatment. Basically help the body fight a stronger fight.
What’s the impact of this research?
MOLLIE JEWETT: Lyme disease is an emerging disease. I grew up in the Northeast in Vermont. And we were not worried about Lyme disease when I grew up. I did not see ticks. But now my family members call me often to say they found another tick, so this is a growing problem. Lyme disease was discovered in Lyme, Connecticut and the epicenter for Lyme disease continues to be the northeast and spreading into the upper Midwest. But that range is expanding and the number of people that are being affected by this is continuing to grow. If we can understand and put our heads and the research together to help with different approaches for diagnostic and treatment, it will have a profound effect.
Do you know how many people are currently or have been affected or are infected every year in the United States?
MOLLIE JEWETT: The current numbers from the Centers for Disease Control are about 30,000 people yearly. Although, some recent reports suggest that may be an underestimate and there may be 10 times that. It’s possible that it could be up to the 300,000, which was a growing number over time.
What should you do if you think you have a tick bite?
MOLLIE JEWETT: Say you’re on vacation on the island of Nantucket and you’re having a wonderful time. But then you notice that you have this tick on you. These ticks are slow feeders. They feed on their hosts for three to five days. So that sounds like a long time and a great opportunity to find a tick. But there is a great possibility that the tick will go unnoticed. They’re very small.
In the teenage stage which is the nymphal stage, these ticks are smaller than a sesame seed, so you could miss it. But if you’re in a location where you know that Lyme disease is prevalent and you were out in the woods and you start to feel flu like symptoms, you should certainly go to your physician, describe where you’ve been and the possibility of a tick bite. That will help inform the physician of what the next steps are. If you find the tick pull it off, put it in a little jar and bring it with you. That can also help. The sooner antibiotics can be put into place for patients, the better the outcome in terms of all of these issues with Lyme disease.
Can it be fatal if you let it go?
MOLLIE JEWETT: To my knowledge there hasn’t been a direct loss of life directly from Lyme disease. There are potential for complications that could be secondary effects particularly with inflammation that occurs in the heart.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Christin Senior, PR
321-900-5624
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
