Perhaps the highest impact study thus far was published by Dr. Monica Embers (referred to as “The Embers Study”), and co-authored by Stephen W. Barthold4, Juan T. Borda2, Lisa Bowers1, Lara Doyle3, Emir Hodzic4, Mary B. Jacobs1, Nicole R. Hasenkampf1, Dale S. Martin1, Sukanya Narasimhan5, Kathrine M. Phillippi-Falkenstein3, Jeanette E. Purcell3¤, Marion S. Ratterree3, Mario T. Philipp1*
1 Divisions of Bacteriology & Parasitology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana, United States of America, 2 Comparative Pathology, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana, United States of America, 3 Veterinary Medicine, Tulane National Primate Research Center, Tulane University Health Sciences Center, Covington, Louisiana, United States of America, 4 Center for Comparative Medicine, Schools of Medicine and Veterinary Medicine, University of California Davis, Davis, California, United States of America, 5 Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
The persistence of symptoms in Lyme disease patients following antibiotic therapy, and their causes, continue to be a matter of intense controversy. The studies presented here explore antibiotic efficacy using nonhuman primates. Rhesus macaques were infected with B. burgdorferi and a portion received aggressive antibiotic therapy 4–6 months later. Multiple methods were utilized for detection of residual organisms, including the feeding of lab-reared ticks on monkeys (xenodiagnosis), culture, immunofluorescence and PCR. Antibody responses to the B. burgdorferi-specific C6 diagnostic peptide were measured longitudinally and declined in all treated animals. B. burgdorferi antigen, DNA and RNA were detected in the tissues of treated animals.
Finally, small numbers of intact spirochetes were recovered by xenodiagnosis from treated monkeys. These results demonstrate that B. burgdorferi can withstand antibiotic treatment, administered post-dissemination, in a primate host. Though B. burgdorferi is not known to possess resistance mechanisms and is susceptible to the standard antibiotics (doxycycline, ceftriaxone) in vitro, it appears to become tolerant post-dissemination in the primate host. This finding raises important questions about the pathogenicity of antibiotic-tolerant persisters and whether or not they can contribute to symptoms post-treatment.
“These results demonstrate that B. burgdorferi can withstand antibiotic treatment, administered post-dissemination, in a primate host.”
Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection.
“[Our] results challenge prevailing dogma about [the] effectiveness of antibiotics for eliminating
B. burgdorferi infection… spirochetes persisted in sites where they encountered the antibiotic.”
The Embers Study can be reviewed more thoroughly on CALDA’s new website http://lymedisease.org in a five part blog serieswritten by the CEO of lymedisease.org and is also a director and officer of ILADS.