884. Immune Profiling of Early Lyme Disease
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Background: Lyme disease, caused by the spirochete Borrelia burgdorferi, is the most commonly reported vector-borne infectious disease in North America. While proper diagnosis and treatment of Lyme disease often leads to a complete resolution of symptoms and a return to health, a percentage of individuals develop Post-Treatment Lyme Disease Syndrome at 6 months post-treatment. In addition, a number of individuals never seroconvert. These observations led us to hypothesize that heterogeneity in the host immune response following B. burgdorferi infection is a key factor in determining the various pathophysiological outcomes.

Methods: 67 patients with clinically diagnosed, early-untreated Lyme disease were enrolled in a prospective cohort study. Patients are treated with 3 weeks of doxycycline and followed for 6 months. 15 age, sex, and comorbidity matched controls are also followed at the same intervals over 6 months. At each visit a physical exam, health interview and laboratory evaluation are performed. We applied polychromatic flow cytometric approaches to catalogue the immune cell subsets found in the blood of Lyme patients versus matched controls as a first step to characterize the host response to B. burgdorferi infection in our cohort.

Results: Lyme patients, while heterogeneous, have significant changes in the ratio of CD45RO+ central and effector memory CD4+ (mean% = 2.78, p < .0004) and CD8+ T-cells (mean% = 0.54, p < .0007) when compared to controls (mean% = 8.22 and 1.52 respectively. Also, during acute infection, there is a clear bias toward Th2 (CD4+ mean% = 2.31 vs. 1.2, p < .015) and unexpectedly Tc2 (CD8+ mean% = 3.89 vs. 1.33, p <.001) effector cells. This bias disappears following antibiotic treatment.

Conclusion: These results demonstrate that polychromatic flow cytometry can be a useful approach to understand the complexity of the host immune response to infection with B. burgdorferi.  The finding of a bias toward a Th2/Tc2 effector T cell response may provide mechanistic insights into the failure of some Lyme patients to seroconvert and may play a determining role in the range of pathophysiological outcomes to infection.  The finding that CD8+ effector cells are increased in patients with acute Lyme was unexpected and may underscore novel features of the response to B. burgdorferi infection in the human host.

Mark Soloski, PhD1, Manish Kumar, PhD1, George Wu, BS2, Hongkai Ji, PhD2, Kathleen Kortte, PhD, ABPP-CN/RP3, Lauren Crowder, MPH4 and John Aucott, MD4,5, (1)Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, (2)Biostatistics, Johns Hopkins University School of Public Health, Baltimore, MD, (3)Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, (4)Lyme Disease Research Foundation, Lutherville, MD, (5)Internal Medicine, The Johns Hopkins University School of Medicine, Lutherville, MD

Disclosures:

M. Soloski, None

M. Kumar, None

G. Wu, None

H. Ji, None

K. Kortte, None

L. Crowder, None

J. Aucott, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.