Borrelia burgdorferi- The Cause of Lyme Disease

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Introduction

Borrelia burgdorferi is an ancient spirochete-shaped bacteria that is responsible for Lyme disease [1]. These bacteria symbiotically live within the bodies of ticks, benefitting from this relationship, whereas the ticks do not. Borrelia burgdorferi is a part of the Spircochete phylum, which is distinctive for bacteria that have a spirally shaped body and flagella that are found in the periplasmic space between the inner and outer membranes [1]. Borrelia burgdorferi are excellent swimmers, and are able to navigate their way from ticks to new, vertebrate hosts such as small mammals, birds, and lizards [1]. Oftentimes, ticks in their larval feeding phase pick up Borrelia burgdorferi from rodents infected with the bacteria [1]. As the ticks grow into their adult phase, they eventually target only large mammals, infecting them with Borrelia burgdorferi as they feed. Interestingly, Borrelia burgdorferi are almost never transferred transovarially [1]. Humans typically obtain Borrelia burgdorferi and Lyme disease as a result from nymphal ticks, because they are smaller and more difficult to spot than adult ticks, allowing the nymphs to feed for longer periods of time [1]. Lyme disease can cause an array of symptoms in patients, the most infamous being the distinctive bullseye pattern rash that appears on the skin, called erythra migrans [1]. Because Borrelia burgdorferi is transmitted via ticks, Lyme disease is most prevalent in rural areas, where ticks can be more commonly found [1]. In the United States, Lyme disease can most commonly be found in New England, mid-Atlantic states, upper north-central states, and in some areas of California in the northwest [2]. Furthermore, this infection is seasonal, when ticks are the most active and most likely to come into contact with humans. Research on Lyme disease has been heavily prioritized, with more than $3.5 million per year granted by the CDC to fund new research [2]. In order to better understand Lyme disease and its impacts, it is important to recognize the unique characteristics of Borrelia burgdorferi through its genome, metabolism, morphology, motility, and chemotaxis.

Lyme Disease

Lyme disease is the prevailing arthropod-borne illness in the United States, and was first characterized as an infectious illness in 1977 [1], [3]. It is estimated that 476,000 people living in the United States are diagnosed and treated for Lyme disease each year [4]. Lyme disease is transferred from blacklegged ticks (Ixodes scapularis and Ixodes pacificus) to humans. For Borrelia burgdorferi to transmit from tick to host, 36 hours of feeding by the tick are required [2]. The process by which Borrelia burgdorferi is transmitted from tick to host is widely speculated. Some researchers believe that transmission occurs through infectious saliva while the tick feeds on the blood of the host organism. On the other hand, some scientists are convinced that transmission may only occur during the regurgitation of fluids from the gut that occurs during the feeding of these ticks [5]. No matter which way the bacteria is transferred, the consequences of this pathogen remain quite uncomfortable. Symptoms of this infection include: rash, fever, headache, and fatigue. The rash, Erythema migrans leaves bullseye patterns on the skin of infected individuals, and often serves as a clear indicator of Lyme disease [6]. This disease can progress through three stages: early localized infection, disseminated infection, and late disseminated infection. In the first stage symptoms include Erythema migrans, fever, fatigue, headache, malaise, artralgias, and myalgias. In the second stage, which takes place anywhere from days to weeks after the first stage, is the presence of musculoskeletal, neurologic, and cardiovascular symptoms, with legions of Erythema migrans. The final stage includes symptoms of pain and swelling of joints and neurologic manifestations such as encephalopathy and neuropathy [2]. Standard treatment for this infection involves a course of antibiotics, typically doxycycline, amoxicillin, cefuroxime axetil, or erythromycin. Additionally, more severe cases utilize ceftriaxone or penicillin G, intravenously [2]. Diagnosis for Lyme Disease is fairly straightforward. Within a month of the onset of symptoms, blood is drawn from patients suspected for the illness, usually patients displaying Erythema mirgans along with other symptoms. Blood samples are then tested for immunoglobulin G antibodies and immunoglobulin M antibodies via the Western blot technique. However, patients who have had the illness for longer than one month have their blood drawn and tested for only immunoglobulin G antibodies, via Western blot [7].

A hot topic in the world of medicine today is whether or not chronic Lyme disease exists. In fact, leading infectious diseases and neurological academic societies do not acknowledge chronic Lyme disease as a true clinical being. This is disputed by other professional organizations that have been fighting for the acceptance of chronic Lyme disease, by focusing on diagnosis via symtomology rather than by diagnosis that is purely serological [8]. It has been documented that many patients diagnosed and treated for Lyme disease have ongoing symptoms despite treatment [8]. The list of symptoms for chronic Lyme disease is extensive, including: fatigue, night sweats, arthalgia, myalgia, arrhythmias, nausea, diarrhea, abdominal pain, trouble sleeping, cognitive dysfunction, headache, backpain, and depression [8]. Because many groups do not recognize chronic Lyme disease, patients who seek help do not receive much attention or care. For physicians who do recognize chronic Lyme disease based on symtomology or unvalid testing methods, the treatment plan is incredibly variable. Some patients may be treatment with several of rounds of different antibiotics for up to several years [8]. This treatment can be quite harmful to both the patient, and towards its potential contribution to generating bacteria that are resistant to antibiotics. A study on primary care physicians in Connecticut found ~2% recognize and diagnose chronic Lyme disease, whereas the rest reported that they did not believe or were hesistant of the existence of the chronic illness [8]. There is a large need for more research to be conducted on this topic so that patients may receive the care and attention that they need, in addition to the avoidance of unnecessary treatment options through the use of antibiotics that are harmful in many different aspects.

Genome and Metabolism

Borrelia burgdorferi has a unique genome from other different types of bacteria. First, these bacteria have linear chromosomes, containing 911 kb. Furthermore, Borrelia burgdorferi have 21 circular plasmids that span 9 to 58 kb. Overall, these bacteria have a genome of a little less than 1,250 kb [9]. Borrelia burgdorferi protects its linear chromosomes from DNA-degrading enzymes through the use of covalently closed hairpin ends. In order to protect the genome, these hairpin ends lock in both the 5’ and 3’ ends of the chromosome [9]. Interestingly, out of the 853 genes that the chromosomes of Borrelia burgdorferi hold, not a single one codes for biosynethtic reactions for these bacteria [9]. It is commonly believed that this seemingly harmful absence of metabolic capacities could be owed to the loss of genes via convergent evolution [10]. Because of this these bacteria have minimal metabolic capabilities, forcing them to rely on the metabolic pathways and nutrients of their host in order to survive [11]. Interestingly, over 6% of the chromosonal genes within Borrelia burgdorferi play a role in chemotaxis and motility [1]. Furthermore, gene expression is altered depending on the environment that the bacteria is residing in, allowing them to adapt to different conditions [1]. This is useful to Borrelia burgdorferi as these bacteria constantly transfer from tick to new host, which oftentimes vary in both temperature and pH [1].

As with all bacteria, Borrelia burgdorferi must adapt to its everchanging environment. Because these bacteria inhabit the midgut of ticks, they must be able to withstand blood flowing in from the prey of the ticks into the gut. In response to this, these bacteria will synthesize outer surface protein C, which directs Borrelia burgdorferi to the salivary glands of the ticks. This is a great example of alteration of protein expression. Furthermore, Borrelia burgdorferi downregulates the synthesis of the protein that anchors the bacterium to the midgut, outer surface protein A [12] ,[13]. These changes in protein synthesis allow Borrelia burgdorferi to disconnect from the midgut and enter the salivary glands, allowing the bacteria to navigate towards the tick host, so that it may transfer from the tick to a new home [13]. Once Borrelia burgdorferi enters its new host, certain parts of its genome may ensure greater survival. For example, it has been found that Borrelia burgdorferi that lacks its 24.7-27.5 plasmids and 9kb have a lesser degree of infectivity than their counterparts that do have these parts of its genome intact [14]. It has been speculated that this part of the genome of Borrelia burgdorferi may encode for genes that are resistant to the antibodies of the host [14].

Although Borrelia burgdorferi has incredibly limited metabolic capabilities, it still undergoes rudimentary forms of metabolism to propel itself within the gut or bloodstream of its host. Homologs of the metabolic pathway of glycolysis have been identified through genomic analysis of Borrelia burgdorferi [15]. It is thought that carbohydrates are solely metabolized via glycolsis in these bacteria [15]. These carbohydrate sources include glucose, glycerol, chitobiose, maltose, mannose, and N-acetylglucosamine [15]. Glycolysis is commonly thought to be the only pathway in Borrelia burgdorferi that generates ATP, resulting in the slow generation time of 8.26 to 12.36 hours, depending on temperature [15], [16]. Borrelia burgdorferi has been found to increase yields of ATP through glycolysis from 2 to 3 [16]. In these bacteria, pyrophosphate is used rather than ATP to fuel the function of phosphofructo-1-kinsane, which is the enzyme that limits the rate of glycolysis [16]. Because of this, Borrelia burgdorferi saves the ATP, increasing its net of ATP by 1.

References

1. Tilly K, Rosa PA, Stewart PE. 2008 Biology of Infection with Borrelia burgdorferi. Infectious Disease Clinics of North America 22, 217–234. [1]

2. Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD. 2008 Diagnosis and Treatment of Lyme Disease. Mayo Clinic Proceedings 83, 566–571. [2]

3. In press. Electrotransformation of the Spirochete Borrelia burgdorferi | SpringerLink. [3].

4. Kugeler KJ, Schwartz AM, Delorey MJ, Mead PS, Hinckley AF. 2021 Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010–2018. Emerg. Infect. Dis. 27, 616–619 [4].

5. Burgdorfer W, Hayes SF, Corwin D. 1989 Pathophysiology of the Lyme Disease Spirochete, Borrelia burgdorferi, in Ixodid Ticks. Clinical Infectious Diseases 11, S1442–S1450. [5]

6. Dandache P, Nadelman RB. 2008 Erythema Migrans. Infectious Disease Clinics of North America 22, 235–260. [6]

7. In press. Diagnosis of Lyme Disease - American Family Physician. [7]

8. In press. Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study | BMC Primary Care | Full Text. [8]

9. Slonczewski, J.L., Foster, J.W., Zinser, E. (2020). Microbiology An Evolving Science. New York : W.W. Norton & Company.

10. Fraser CM et al. 1997 Genomic sequence of a Lyme disease spirochaete, Borrelia burgdorferi. Nature 390, 580–586. [9]

11. Kerstholt M, Netea MG, Joosten LAB. 2020 Borrelia burgdorferi hijacks cellular metabolism of immune cells: Consequences for host defense. Ticks and Tick-borne Diseases 11, 101386. [10]

12. Anguita J, Samanta S, Revilla B, Suk K, Das S, Barthold SW, Fikrig E. 2000 Borrelia burgdorferi Gene Expression In Vivo and Spirochete Pathogenicity. Infect Immun 68, 1222–1230. [11]

13. Tokarz R, Anderton JM, Katona LI, Benach JL. 2004 Combined Effects of Blood and Temperature Shift on Borrelia burgdorferi Gene Expression as Determined by Whole Genome DNA Array. Infect Immun 72, 5419–5432. [12]

14. Xu Y, Kodner C, Coleman L, Johnson RC. 1996 Correlation of plasmids with infectivityof Borrelia burgdorferi sensu stricto type strain B31. Infect Immun 64, 3870–3876. [13]

15. In press. Borrelia burgdorferi hijacks cellular metabolism of immune cells: Consequences for host defense - ScienceDirect. [14]

16. Heroldová M, Němec M, Hubálek Z. 1998 Growth parameters of Borrelia burgdorferi sensu stricto at various temperatures. Zentralblatt für Bakteriologie 288, 451–455. [15]