Archive for April, 2019

The Functional & Molecular Effects of Doxycycline Treatment on Borrelia Burgdorferi Phenotype

https://www.frontiersin.org/articles/10.3389/fmicb.2019.00690/full?

ORIGINAL RESEARCH ARTICLE

Front. Microbiol., 18 April 2019 | https://doi.org/10.3389/fmicb.2019.00690

The Functional and Molecular Effects of Doxycycline Treatment on Borrelia burgdorferi Phenotype

John R. Caskey1,2†, Nicole R. Hasenkampf1, Dale S. Martin1, Vladimir N. Chouljenko2, Ramesh Subramanian2, Mercedes A. Cheslock1 and Monica E. Embers1*

Recent studies have shown that Borrelia burgdorferi can form antibiotic-tolerant persisters in the presence of microbiostatic drugs such as doxycycline. Precisely how this occurs is yet unknown. Our goal was to examine gene transcription by B. burgdorferi following doxycycline treatment in an effort to identify both persister-associated genes and possible targets for antimicrobial intervention. To do so, we performed next-generation RNA sequencing on doxycycline-treated spirochetes and treated spirochetes following regrowth, comparing them to untreated B. burgdorferi. A number of genes were perturbed and most of those which were statistically significant were down-regulated in the treated versus the untreated or treated/re-grown. Genes upregulated in the treated B. burgdorferi included a number of Erp genes and rplU, a 50S ribosomal protein. Among those genes associated with post-treatment regrowth were bba74 (Oms28), bba03, several peptide ABC transporters, ospA, ospB, ospC, dbpA and bba62. Studies are underway to determine if these same genes are perturbed in B. burgdorferi treated with doxycycline in a host environment.

Introduction

The efficacy of antibiotic treatment for Lyme disease has been a contentious issue among physicians and researchers (DeLong et al., 2012; Halperin, 2015). In particular, the ability of commonly used and recommended therapy regimens to cure disease has been called into question (Cameron et al., 2014). Evidence to indicate that infection is not eradicated by conventional antibiotics such as doxycycline and ceftriaxone has been provided by studies in mice (Hodzic et al., 2008, 2014; Barthold et al., 2010), dogs (Straubinger et al., 1997) and in our own studies of non-human primates (Embers et al., 2012, 2017; Crossland et al., 2018). In actuality, eradication of the spirochetes following antibiotic treatment of a disseminated infection has not been achieved in any animal model tested (Straubinger et al., 1997; Bockenstedt et al., 2002, 2012; Hodzic et al., 2008, 2014; Barthold et al., 2010; Embers et al., 2012). Despite these findings, the mechanisms of post-treatment disease are not well understood (Aucott, 2015). The symptoms which a significant portion of patients experience could result from autoimmunity (Weinstein and Britchkov, 2002), immune responses to residual, dead spirochetes (Bockenstedt et al., 2002, 2012), or a remaining infection. Each of these plausible explanations may also be acting in concert.

Studies on the development of antibiotic-tolerant Borrelia burgdorferi persisters have been conducted using in vitro experimentation, and research on the development of drug tolerance in general is expanding (Meylan et al., 2018). B. burgdorferi has been shown to develop persisters in the presence of doxycycline (Caskey and Embers, 2015), amoxicillin, and ceftriaxone (Sharma et al., 2015). The mechanism by which B. burgdorferi persists is driven by stochastically determined slowed growth (Caskey and Embers, 2015) and gene expression is altered (Feng et al., 2015). The ability of this spirochete to enter a slow-growing, dormant phase likely results from the evolution of its zoonotic cycle (Stewart and Rosa, 2018). Within the tick, the spirochetes encounter a nutrient-poor environment which lasts several months. Population growth increases after the blood meal (Piesman et al., 1990), but quickly subsides and becomes stagnant.

Commonly prescribed antibiotics for Lyme disease, including doxycycline and amoxicillin, are also microbiostatic. The mechanism of interfering with protein translation operates upon actively dividing cells, so may be less effective in slow-growing populations. Such antibiotics are able to stop the growth of the bacteria such that the immune system can target and clear the infection. However, B. burgdorferi persists in an immune host environment, and the multiple modes of immune evasion (Embers et al., 2004; Hastey et al., 2012) may also reduce the effectiveness of microbiostatic antibiotics.

In the set of experiments described in this report, two keys aspects of doxycycline-treated B. burgdorferi phenotype were evaluated. First, the functionality of antibiotic-treated spirochetes was assessed by testing infectivity in immune-deficient and immune-competent murine hosts. Second, the molecular adaptation to doxycycline treatment was comprehensively investigated with next-generation sequencing to obtain transcriptional profiles of spirochetes that were treated and those that were treated and re-grew. These studies allow us to better understand both functional and molecular phenotypes to drug-tolerant B. burgdorferipersisters and to identify potential targets for treatment.

Materials and Methods

Ethics Statement

Practices in the housing and care of mice conformed to the regulations and standards of the Public Health Service Policy on Humane Care and Use of Laboratory Animals, and the Guide for the Care and Use of Laboratory Animals. The Tulane National Primate Research Center (TNPRC) is fully accredited by the Association for the Assessment and Accreditation of Laboratory Animal Care-International. The Tulane University Institutional Animal Care and Use Committee approved all animal-related protocols, including the infection and sample collection from mice.

Borrelia Culture and Antibiotic Treatment Regimen

Low passage (p4 or p5) Borrelia burgdorferi sensu stricto strain B31 clonal isolate 5A19 (Purser and Norris, 2000) was grown at 34°C in BSK-II media (Zuckert, 2007), as described previously (Barbour, 1984). Because the spirochetes are microaerophilic and gene expression is affected by oxygen levels (Seshu et al., 2004) they were grown in a tri-gas incubator set at 5% CO2, 3% O2, and the remainder N2. For the infectivity assay in mice, three sets of 50 ml B. burgdorferi cultures were inoculated from frozen stocks and grown to 5 × 107 cells/mL. In a previous study, we determined the density-independent minimum inhibitory concentration (MIC) for this strain in a 5 day treatment protocol to be 2.5 μg/ml and the minimum bactericidal dose to be 50 μg/mL (Caskey and Embers, 2015). Thus, the B. burgdorferi cultures to be used for the bioassay were either not treated (0 μg/mL), treated with a concentration (10 μg/mL doxycycline) higher than the MIC but not greater than the minimum bactericidal concentration (MBC), or treated with the MBC. In all cases, BSK-II media was determined to be the optimal growth media for the experimental conditions after comparing growth rates of B. burgdorferi in BSK-II and BSK-H (data not shown). At day 5, the cultures were checked for motility by dark field microscopy (Johnson, 1989) (for RNA seq experiments) and for viability by BacLight staining (for bioassay in mice, as shown in the Supplementary Material).

For RNA sequencing, duplicate in vitro experiments to determine gene expression under antibiotic-treated, and antibiotic-withdrawn conditions were conducted with three groups and two biological replicates of each group performed separately. The spirochetes were grown to 5 × 107 cells/mL as described (Caskey and Embers, 2015). Group 1, (untreated) consisted of RNA from an untreated B. burgdorferi control. Group 2 (treated), consisted of RNA from B. burgdorferi treated with 50 μg/mL doxycycline for 5 days. Group 3 (treated/re-grown), consisted of RNA from B. burgdorferi treated with 50 μg/mL doxycycline for 5 days, then allowed to regrow until the population reached the initial pre-treatment concentration of 5 × 107 cells/ml; this re-growth occurred between 10 and 12 days after the end of the treatment period.

Bioassay in Mice

A sample of 2 × 105 B. burgdorferi derived from one of the three treatment groups was needle-inoculated into severe combined immune-deficient CB-17. SCID mice and C3H/HeN mice (Charles River Labs). Ear punch biopsies (2 mm) were taken on day 14 for all mice. On day 21, the mice were euthanized, and tissues including ear skin, heart, bladder, spleen and tibiotarsal joints were harvested. Tissues were used for culture in 5 mL of BSK-II and preserved in RNALaterTM to perform RT-PCR for both flaB and ospC genes. This was not performed in one experimental set of mice. The culture tubes were incubated in a tri-gas incubator as described above, and checked 2–3 times weekly, for up to 45 days, for signs of motility. The experiment was repeated three times, with a total of five control group SCID mice and C3H mice, a total of three 10 μg/mL doxycycline-treated-group SCID mice and C3H mice, and a total of seven 50 μg/mL-doxycycline-treated-group SCID mice and C3H mice. A summary of the experimental design is shown in Figure 1.

BacLight Staining for Viability

To determine the proportion of live and dead B. burgdorferi following doxycycline treatment, Live/Dead BacLight® (Molecular Probes) staining was performed on untreated and 50 μg/mL-treated B. burgdorferi per the manufacturer’s instructions. Briefly, 1.0 μL of 1.67 mM SYTO-9, a green nucleic acid stain, and 1.0 μL of 1.67 mM propidium iodide, which will only stain cells with damaged cell membranes red, were thawed and mixed in equal proportions. A volume of 1.5 μL of the stain mixture was then added to 500 μL of B. burgdorferisuspended in phosphate buffered saline, pH 7.4 (Gibco), incubated in the dark for 15 min, then applied to a slide and coverslip for viewing and counting. The samples were viewed and counted in live/dead ratios using a fluorescent microscope. The excitation/emission maxima for SYTO-9 is 480/500 nm, and 490/635 nm for propidium iodide. Images captured were obtained using a Nuance FX®36 fluorescence microscope (Leica) and software, with an optimal emission filter range of 500–560 nm for SYTO-9, and 600–650 nm for propidium iodide. Results were calculated as percent viability, and reported as mean ± SD per group.

RT-PCR

Mouse tissues collected from the assessment of infectivity by antibiotic-treated spirochetes were subjected to RT-PCR on the flaB and ospC genes as described (Embers et al., 2012). B. burgdorferi in these tissues was detected by a nested RT-PCR program utilizing 5S and 23S-targeted primers (Postic et al., 1994). This included external forward and reverse primers (CTGCGAGTTCGCGGGAGA-3′fwd; 5′-TCCTAGGCATTCACCATA-3′rev) and internal forward and reverse primers (5′-GAGTAGGTTATTGCCAGGGTTTTATT-3′fwd; 5′-TATTTTTATCTTCCATCTCTATTTTGCC-3′rev) targeting the 5S-23S intergenic sequence. Several genes identified as differentially expressed post-antibiotic treatment were subjected to standard RT-PCR to confirm the trend in gene expression. RNA was extracted from in vitro-cultured B. burgdorferi from each condition (untreated, treated and treated/re-grown) using the RNeasy kit.

A total of 10 ng RNA was added as template for the Qiagen® One-step RT-PCR kit. Briefly, 0.4 nM of forward primer and 0.8 nM of the reverse primer were added to each reaction. The recommended cycling steps were used with annealing temperature up to 5°C below the melting temperature of each primer. Primers for amplification included: BB0778 = 5′TGTATGCACTGGTAGAAATA-3′(fwd) and 5′-TTTAACCTCTCCGTCTTTAT-3′(rev); BBA66 = 5′-GTTACAACCGTACCCGGAAATA-3′(fwd) and 5′-GCTGTCTTGGTTGACTAAAG-3′(rev); BBL39 = 5′-GGTGCTTGCAAGATTCATACTTC-3′(fwd) and 5′-CTCCTAAGTCTGCCCAGTTATT-3′(rev); BBN39 = 5′AGGAATCAGAAGACGAAGGATTAG-3′(fwd) and 5′-AACTTAGGCTCTTCGTAACCAG-3′(rev); BBJ09 = 5′-CAAGCTAAAGAGGCCGTAGAA-3′(fwd) and 5′-GCAAGCTTTGTATTGTTCGTAGT-3′(rev). Reactions were performed in a volume of 25 μl and 12 μl of each reaction was loaded onto the gel.

Preparation of RNA for Sequencing

Borrelia burgdorferi cultures were grown to 5 × 107 cells/mL for the control, treated, and treated/regrown groups in 50 mL conical tubes in BSK-II media. For the control group, total RNA was extracted, while the treated and treated/regrown groups were treated with 50 μg/mL doxycycline for 5 days. On day 5, total RNA from the treated B. burgdorferi culture was extracted, while the treated/regrown B. burgdorferi culture was resuspended in doxycycline-free media, and monitored for regrowth. When the culture regrew to the initial concentration, total RNA was extracted. RNA extraction was done according to the Qiagen® RNEasy® Mini Kit manufacturer’s instructions. In all cases, RNA was kept in a –80° freezer when not being processed, and freeze-thaw cycles were kept to a minimum. After RNA extraction, the total RNA was assessed for concentration and purity with a ThermoFisher Scientific® NanoDropTM 2000 spectrophotometer. Samples with a total RNA concentration less than 300 ng/μL were not used in downstream steps. Next, for all groups, ribosomal RNA was depleted from the samples using Invitrogen Ribominus® kits that followed the manufacturer’s instructions. Finally, the RNA for all groups was then processed according to the Life Technologies Ion Total RNA-Seq kit v2 sample preparation instructions. RNA integrity was verified using a BioAnalyzer (Applied Biosystems) prior to RNASeq.

Analysis of RNASeq Data

The B. burgdorferi genome FASTA and gene annotation GTF files were downloaded from PATRIC1 and the NCBI2 databases. After sequencing, the reference FASTA and annotation files were created from the B. burgdorferi chromosome and plasmids using a bash script and the sequenced samples were aligned using Bowtie2 (Langmead and Salzberg, 2012). Read counts were calculated for each gene using Htseq, and the software package DESeq2 was used to calculate differential gene expression between conditions (Anders et al., 2015). A cutoff of p < 0.05 using a Bonferroni False Discovery Rate (FDR) test, included in the DESeq2 package, was used to assess statistical significance between experimental conditions.

Construction of the http://borreliarna.tech Database

The database was constructed using a typical Drupal 7.x installation. A node was created for each gene, and using the pages module, html tables were created to display information for entire plasmids and the chromosome. Drupal indexed information for each node (webpage), which allowed the genes to be searchable using a search field. The data from the RNASeq experiment was also uploaded to the nodes, and designed to be searchable. The raw data are also available on the SRA (NCBI) database (accession # SUB5253665).

Results

Doxycycline Levels That Prevent Re-growth of B. burgdorferi in Culture Do Not Uniformly Prevent Infectivity of the Spirochetes in Mice

Three conditions of B. burgdorferi were tested for infectivity in mice (Figure 1) including untreated, 10 μg/mL doxycycline-treated, and 50 μg/mL doxycycline-treated. The doxycycline concentration of 10 μg/mL was utilized to serve as a treatment that is higher than the MIC but below the MBC, and the doxycycline concentration of 50 μg/mL was utilized based on previous work that determined it as the MBC for doxycycline (Caskey and Embers, 2015).

  • untreated control had 100% motile B. burgdorferi in the culture
  • culture treated with 10 μg/mL doxycycline had approx. 20% motile B. burgdorferi
  • culture treated with 50 μg/mL had 0% motile B. burgdorferi

We hypothesized that doxycycline treatment would inhibit growth of the spirochetes, but not kill them. Thus, we surmised, they should grow in the scid mice, but not in the immunocompetent (C3H) mice because dormant or slow-growing spirochetes may not be able to evade the immune response of the host. As shown in Table 1, fewer mice were colonized (as indicated by organ culture) by the antibiotic-treated B. burgdorferi, but positive organ cultures were apparent from both C3H and scid mice. One single positive culture was used to score them as positive. In the initial experiment, the untreated B. burgdorferi were grown for 5 days after reaching a density of 5 × 107 and had reached stationary phase prior to inoculation of mice. Thus, control mice (injected with 0 μg/mL-treated spirochetes) were not uniformly positive. For mice inoculated with 10 μg/mL-treated B. burgdorferi versus 0 μg/mL-treated B. burgdorferi, no significant differences in colonization were observed. The only somewhat significant difference was the number of scid mice infected with 50 μg/mL-treated B. burgdorferi versus 0 μg/mL-treated B. burgdorferi (Fisher’s exact test, 2-tailed p = 0.0885).

With respect to the molecular detection, mouse tissues were tested by RT-PCR for viability. Using several different targets, mice treated with 0 or 10 μg/mL were reliably positive, which correlated well with culture results. For those treated with 50 μg/mL of doxycycline, only one mouse was positive by RT-PCR and this result was found in the joint tissue by a nested set of primers. Amplification of B. burgdorferi genes from ear and heart tissue of mice inoculated with antibiotic-treated spirochetes is shown in Supplementary Figure 1.

Genes That Are Upregulated Following Doxycycline Treatment May Reflect Entry Into Dormancy

To investigate the gene expression of B. burgdorferi during treatment with doxycycline and regrowth, three sample groups of B. burgdorferi were grown in BSK-II as untreated (G1), treated (G2), and treated/regrown (G3), where untreated was an untreated control, treated were spirochetes treated with the MBC of doxycycline, and regrown were spirochetes treated with the MBC of doxycycline then monitored for regrowth (see Figure 1, “Experimental Design”). Figure 2 shows a “volcano” plot comparing the significantly affected genes in doxycycline-treated versus untreated B. burgdorferi. Using the log2 fold change above 2, the number of significantly up-regulated genes was 20 and the number of down-regulated genes was 40. A heat map comparing the groups is shown in Figure 3. During treatment, the bb0778 gene, which encodes the ribosomal protein L21, was significantly upregulated (p < 0.05; Ojaimi et al., 2003). This upregulation suggests that the doxycycline bound only to the 30S subunit, and not to other lower-affinity binding sites in the 50S ribosome, as has been proposed as a mechanism of action (Schnappinger and Hillen, 1996; Korobeinikova et al., 2012). Also, upregulated in the treatment versus control group were three Erp proteins (ErpA, ErpN, and ErpQ). The paralogous gene products of bbP38 (ErpA) and bbL39 (ErpN) were also subjected to RT-PCR to confirm the differential regulation (Figure 4). Operon-associated Erp proteins were also affected, but did not make the log fold change and significance cut-off in all cases. In order of upregulation in the treatment group were Erps A, N, P, G, B, and O. A compilation of the data showing relative fold changes and p-values can be found at the borreliarna.tech website. The expression of one gene, bba66, was increased in both the treated and the treated/regrown, whereas the others were also expressed, albeit at a lower level, in the untreated samples. The majority (50%) of the genes that were significantly differently expressed (p < 0.05) after treatment with doxycycline were found on lp54 (designated as BBA.._), most of which were down-regulated (Table 2). This includes outer surface protein-encoding genes associated with entry into the mammalian host (e.g., osm28, p35, ospD, ospC, cspA, and dbpA). The down-regulation of ospA was also observed; this may reflect a global down-regulation in gene expression and representative of the in vitro phenotype as ospA is down-regulated upon primary infection.

As expected, a large number of genes were down-regulated in the treated group versus the untreated group. These are associated with positive growth regulation, infection/virulence and metabolism. These included virulence factors, peptide and nucleic acid transporters, superoxide dismutase, and adenylate kinase.

Genes That Are Up-Regulated by B. burgdorferi Following Treatment and Re-growth May Be Associated With Exit From Dormancy

Many of the genes that were down-regulated upon treatment, were subsequently, and not surprisingly, up-regulated during re-growth (Table 3). Those genes that are upregulated in treated/regrown B. burgdorfericompared to those untreated may be of primary importance in establishing re-growth. In particular, bba03, bba74 (oms28), ospA, ospD, bba62, cspA and the oligopeptide permease protein genes oppF and oppD were up-regulated. Several of these gene products (outlined in the discussion) are associated with the habitation within the tick, and may therefore be indicators of dormancy, or exit from dormancy when expressed upon the blood meal (Caimano et al., 2016).

Several of these genes (bbl39/ErpN, ospA, bbn39/ErpQ) were much more abundant in the treated/re-grown compared to the untreated, indicating that they are associated with exiting dormancy rather than logarithmic growth, given that the growth phase was similar in the two groups.

Discussion

The results of the bioassay in mice demonstrate that after treatment with the MBC of doxycycline, the spirochetes were able to host adapt, and evade immune pressure to establish an infection. The number of spirochetes injected into each mouse was held constant, but viability was not assessed. Therefore, the number of actively growing B. burgdorferi was likely significantly reduced after doxycycline treatment. What is most interesting about the result is that no significant differences were observed in the spirochete infectivity when immunocompetent versus immunodeficient mice were used. This result suggests that exit from dormancy may occur very rapidly in vivo, allowing the immunoevasive phenotype to become established.

We have previously demonstrated that the persister cell phenotype appears to be generated stochastically and driven by slowed growth (Caskey and Embers, 2015). In this study, we aimed to identify gene expression patterns associated with the survival and re-growth of B. burgdorferi in the antibiotic environment. While a similar study in which RNASeq was applied to antibiotic treatment of B. burgdorferi was conducted (Feng et al., 2015), several important distinctions between that study and ours should be made. In that report by Feng et al, in vitro-cultured Bb were treated with either doxycycline or amoxicillin (50 μg/mL) for 6 days and then subjected to RNASeq, with comparison to the untreated control. Genes that were up-regulated by 2-fold or more were ascribed significant and the pathways affected were elucidated. In our study, we treated a slightly denser culture (5 × 107 versus 1 × 107) with doxycycline at the same dose (50 μg/ml) for 5 days. An aliquot of the treated cells was allowed to re-grow, such that we had 3 treatment groups. In addition, we performed RNASeq on duplicate samples and ascribed significance using both fold-change and p-values to account for variation between samples. Both studies shed light on the mechanisms that Bb may use to establish persistence and re-grow. The Feng study identified a large number of genes as upregulated following treatment, whereas we found that the vast majority of genes were down-regulated, likely owing to a global decline in transcription. In the Feng study, the ClpPprotease was indicated as the most highly up-regulated gene in treated B. burgdorferi. It was up-regulated in our screen as well (0.43-fold), but not determined to be significant. The genes found to be significantly increased in treated versus control encoded several Erp proteins and a 50S ribosomal protein (bb0778). This was verified by standard RT-PCR, as shown in Figure 4. The results in Figure 4 are derived from amplifying transcript from an equal quantity of input RNA. We did not have a good constitutively transcribed gene that is consistently expressed in all groups equally to be used as a housekeeping gene control, based on the RNASeq data. Thus, these results are not fully quantitative but only meant for validation of the RNASeq results.

We fully expected that genes categorized by involvement in the stress response (Bugrysheva et al., 2003; Drecktrah et al., 2015; Cabello et al., 2017) and DNA repair mechanisms (Fisher et al., 2017) would be significantly up-regulated with antibiotic treatment. However, this did not appear to be the case with either the Feng study or our own. The mechanisms governing the development of persister cells are not easily discerned by these RNASeq analyses, perhaps because the spirochetes stochastically enter dormancy (Caskey and Embers, 2015) and regrowth is determined by non-heritable traits. One supposition may be that instead, post-transcriptional, or even post-translational events such as lysine acetylation (Fisher et al., 2017; Bontemps-Gallo et al., 2018) govern the entry and exit from dormancy in the antibiotic environment. For example, in the toxin-mediated growth reduction within S. typhimurium, the toxins (TacT) add a post-translational modification (acetylation) to tRNA, which is reversed by a peptidyl tRNA hydrolase (Cheverton et al., 2016). A toxin-antitoxin system for Borrelia persister development has not been identified, but enzymatic modification of translational components could be involved in formation of persister cells and their re-growth. Nonetheless, we have identified a number of surface proteins which may be antigenic and serve as targets for novel immunotherapeutic strategies.

BBA62 is a 169 aa outer membrane protein located on plasmid lp54 that is annotated for North American and European strains of B. burgdorferi. It was found to be the most highly upregulated outer membrane protein in the treated/regrown group. BBA74 (Oms28), originally thought to be a porin (Skare et al., 1996), is an outer surface protein of 257 amino acids. The bba74 gene is also located on plasmid lp54 it is thought to be expressed only in the tick and during blood-feeding, as it is induced by temperature shift within the tick, but not with host adaptation in the mammal (Mulay et al., 2007, 2009). That we are seeing it induced after doxycycline treatment is of interest and may parallel what we see with OspA (below). OspD is an outer membrane protein, located on plasmid lp38, which is known to be antigenic (Li et al., 2013) and expressed more highly in ticks than in the mammalian host (Li et al., 2007). BBA62 was described in 1997 as a 6.6 kD lipoprotein that did not appear to induce antibodies by animals needle-inoculated with B. burgdorferi (Lahdenne et al., 1997). The authors postulated that high-level expression of lp6.6 is associated with the arthropod phase of the spirochetal life cycle and that expression of the gene is downregulated during mammalian infection. OspA is known to be expressed in ticks and was the target of the only Lyme vaccine, which was shown to block transmission of B. burgdorferi (de Silva et al., 1996).

Analyses of bba74 expression by primer extension of wild-type B. burgdorferi grown in vitro, along with in vivo-cultivated wild-type and rpoS mutant spirochetes, revealed that, like ospA, bba74 is transcribed by sigma (70) and is subject to RpoS-mediated repression within the mammalian host. Meanwhile, ospA, ospB, and ospD appear to be regulated by the stress-response regulator bosR (Wang et al., 2013). These gene products are possible markers of dormancy, given their expression in ticks and in late Lyme arthritis (Li et al., 2013). In our study, bosR was shown to be up-regulated 0.325-fold following treatment and rpoS was up 0.386-fold; however, the p-values indicate that these were not significant perturbations. Interestingly, nine Erp proteins were found to be up-regulated by BosR (Ouyang et al., 2009), so perhaps even the slight increase in expression of this gene in response to doxycycline can have significant effects on gene regulation.

The use of RNASeq to study adaptation (Drecktrah et al., 2015; Arnold et al., 2016, 2018) has led to significant understanding of the changes in gene expression associated with growth phase and illumination of regulatory pathways. In this report, we add to this understanding through the analysis of the response to antibiotic, and elucidate possible antigenic targets (Oms28, OspA and several Erp proteins) for improved therapeutic intervention. The extension of these studies should be aimed at a better understanding of molecular adaptation to antimicrobial treatment in vivo.

Ethics Statement

Practices in the housing and care of animals conformed to the regulations and standards of the PHS Policy on Humane Care and Use of Laboratory Animals, and the Guide for the Care and Use of Laboratory Animals. The Tulane National Primate Research Center is fully accredited by the Association for the Assessment and Accreditation of Laboratory Animal Care-International. The Institutional Animal Care and Use Committee of the Tulane National Primate Research Center approved all animal-related protocols, including the infection, treatment, and sample collection from mice.

Author Contributions

JC performed research experiments and data analysis, and contributed significantly to writing. ME conceived the experiments, participated in analyses, and contributed significantly to writing. NH, DM, and MC performed the experiments and proofed the manuscript. VC contributed to the experiments and data analysis. RS contributed to the data analysis.

Funding

The research was funded by 2P20-RR020159-08 for The Louisiana Center of Biomedical Research Excellence (CoBRE) in Experimental Infectious Disease Research, COBRE Grant No. 5 P30 GM110760 (LSU), Global Lyme Alliance, and the Steven and Alexandra Cohen Foundation.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank Dr. Konstantin “Gus” Kousoulas, at the Louisiana State University GeneLab for research support with RNA sequencing. We also thank Mary Jacobs for critical review of the manuscript.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmicb.2019.00690/full#supplementary-material

Footnotes

  1. ^https://www.patricbrc.org/
  2. ^https://www.ncbi.nlm.nih.gov/genbank/

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Keywords: Lyme disease, antibiotic, Borrelia (Borreliella) burgdorferi, RNASeq analysis, mice

Citation: Caskey JR, Hasenkampf NR, Martin DS, Chouljenko VN, Subramanian R, Cheslock MA and Embers ME (2019) The Functional and Molecular Effects of Doxycycline Treatment on Borrelia burgdorferi Phenotype. Front. Microbiol. 10:690. doi: 10.3389/fmicb.2019.00690

Received: 30 November 2018; Accepted: 19 March 2019;
Published: 18 April 2019.

Edited by:

Alessandra Polissi, University of Milan, Italy

Reviewed by:

Peter Kraiczy, Goethe-Universität Frankfurt am Main, Germany
Sébastien Bontemps-Gallo, Institut Pasteur de Lille, France

Copyright © 2019 Caskey, Hasenkampf, Martin, Chouljenko, Subramanian, Cheslock and Embers. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Monica E. Embers, members@tulane.edu

Present address: John R. Caskey, Wisconsin National Primate Research Center, Madison, WI, United States

 

 

 

Sun Prairie Woman Warns of Lyme Disease’s Lingering Effects

Woman warns of Lyme disease’s lingering effects

SUN PRAIRIE, Wis. – As Wisconsin enters peak tick season, a Sun Prairie woman is sharing her story battling Lyme disease, saying there’s more to it than you might think.

“First of all, I am a plant freak. I love them,” Alicia Cashman said. “I used to be outdoors all the time.”

Now, Cashman brings the outdoors indoors.

“Now I look at the outdoors like you were a soldier in Vietnam and there’s landmines,” she said. “Where’s the landmine? I don’t know.”

Cashman’s landmines are a bit smaller. She’s always on the lookout for ticks after she and her husband began having symptom after unexplained symptom about 12 years ago.

“Red, hot to the touch, I developed a fever. I started seeing flashing lights,” she said. “All of a sudden your life just goes to pot, and you can’t figure out why.”

Her husband developed anxiety and severe insomnia. In both cases, Cashman said it all came back to Lyme disease.

“Lyme is not what you think it is,” she said. “It’s way more complicated and complex.”

“We do know if people aren’t treated early, sometimes they go on to have lifelong symptoms,” said Susan Paskewtiz, a professor and chair of the University of Wisconsin Madison’s entomology department.

Paskewtiz said the initial infection of Lyme disease can change people’s bodies.

Perhaps you’re forever altered as a result,” she said, adding that it can include heart issues, neurological symptoms and migrating joint pain, all things Cashman experienced. But early treatment can stop that, and that starts with early detection.

According to Paskewtiz, Wisconsin ranks among the top states for diseases transmitted by ticks.

“We have a lot of deer ticks here,” she said. “We have some places here where we’ve collected more ticks than recorded in the country, that’s very focal, a couple locations like that, but we’re high.”

Officials are already warning of ticks this year, and the city of Madison has seen the number of deer ticks rise significantly this month, according to a recent release.

Paskewitz said not everyone gets the characteristic bulls-eye type mark indicating Lyme disease, so flu-like symptoms including muscle aches and a fever can be other signs.

She said while there are usually about 3,000 to 4,000 reports of Lyme disease in the state a year, cases are likely under-reported, and she estimates the real number to be 10 times that.

Paskewtiz said there are two important things Wisconsin residents should know this year. Ticks can be as small as a freckle and found in places you might not expect.

“Usually, we recommend to people lawns are a pretty safe place,” she said, “but we’re finding them in those locations, as well.”

Cashman can still visit her plants outdoors, it just takes a bit more work. She gears up, wearing light-colored, protective clothing, and chemically treats both her clothes and yard.

“I’m doing great, but it’s taken 4 1/2 years of treatment, and I literally went from, ‘I want to die,’ to ‘I have my brain back,’” she said. “Where before, I didn’t think about it, now it never leaves my mind.”

She hopes others will keep the disease in the back of theirs.

“You can’t afford to be lazy,” she said.

Cashman now leads the Madison Area Lyme Support Group, which is presenting a free viewing of the documentary “Under Our Skin” Saturday at the East Madison Police Station May 4. She recommends those diagnosed with the disease check out the nonprofit organization the Wisconsin Lyme Network.

The Centers for Disease Control and Prevention describes patients with symptoms after the treatment of Lyme disease as having post-treatment Lyme disease syndrome, and the organization writes its cause isn’t known.

The CDC said alternative treatments for Lyme disease have been associated with complications, and its best to use care and consult a physician.

________________

**Comment**

So thankful Dr. Paskewtiz filled in many of the points I wasn’t able to make. Although I shared how all my initial symptoms were gynecological and that I believe Lyme to be a STD as well as spread congenitally, they opted to leave that intel out.  https://madisonarealymesupportgroup.com/2017/02/24/pcos-lyme-my-story/

https://madisonarealymesupportgroup.com/2018/06/19/33-years-of-documentation-of-maternal-child-transmission-of-lyme-disease-and-congenital-lyme-borreliosis-a-review/

Unfortunately, the statement that a tick’s gut is a literal garbage can full of pathogens of which Lyme is only one of many, also was omitted.  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

We are slowly pushing this thing up the hill.  Just a few short years ago, nothing would have been said about the “lingering symptoms,” so that’s a huge improvement, but of course there’s much, much more to be done.  https://madisonarealymesupportgroup.com/2019/02/25/medical-stalemate-what-causes-continuing-symptoms-after-lyme-treatment/  BTW: Ahern states it’s 60% that have lingering symptoms – so it’s a significant subset of patients.

Regarding PTLDS: https://madisonarealymesupportgroup.com/2019/04/05/post-treatment-lyme-disease-syndrome-a-review-of-its-origin-its-consequences-in-the-socio-economic-sphere/  Excerpt: 

It is demonstrated that the chronic symptoms of Lyme disease are a reality, referred to as: Chronic Lyme disease (CLD); or Syndrome- Post-treatment of Lyme disease (PTLDS).

As we said at the beginning, the CDC does not recognize the term Chronic Lyme Disease (CLD) because it is confusing[1].

With respect to this, we conclude that the CDC is wrong because data demonstrated that months or years after adequate treatments with antibiotics, patients can have the same or worse symptoms, which gives truth to the term: chronic Lyme disease (CLD).

I told the reporter that had I followed the advice of the CDC I’d be dead by now. The tiny but overriding statement at the end of the article about “alternative treatments for Lyme disease have been associated with complications,” is a complete “Catch-22,” because anything but essentially 21 days of doxycycline is considered alternative to the CDC and that’s a huge problem.  And by “consulting a physician,” that’s also setting people up for failure as there are only a handful of doctors in the entire state of Wisconsin who are properly trained and treat this monster appropriately. The same can be said of other states as well.

Sigh……well, there’s always next year!

 

 

Is the Sky Truly Going to Fall For Patients With the ‘Untreatable’ Form of Lyme Disease?

Is the Sky Truly Going to Fall For Patients With the ‘Untreatable’ Form of Lyme Disease?

0dd86-theskyisfalling

By Alicia Cashman MS, Lyme patient and advocate

4/29/19

Recently an article appeared in Newsweek titled,“Untreatable Form of Lyme Disease Could Hit 2 Million Americans By 2020, Scientists Warn”(1). The title of this article is misleading at best and inaccurate at worst and will mislead many to falsely believe that Lyme disease cannot be treated properly.

If you are new to the world of Lyme, please understand there is huge polarity in the medical and research communities on nearly every single aspect of it.  Disagreements on definitions, testing, diagnosis & treatment, and even on an understanding of the very organism itself abound. Thousands, possibly millions of patients are left alone to suffer in the fray with doctors too afraid to even treat them (2).

Lyme disease, around since the beginning of time, was “discovered” over 40 years ago by William Burgdorferi, but since then research has been scant and controlled by a highly vested group of individuals with patents on everything from test kits and vaccines, to other metabolomics (3). There are currently two lawsuits against the Centers of Disease Control (CDC) for the mishandling (4,5). The CDC completely ignores credible animal and foreign studies, continues to fixate on the acute phase, only supports its own research, and is run by what many call, “The Cabal.”

On the opposite end of the pendulum from the CDC and Infectious Disease Society of America (IDSA) is the International Lyme and Associated Diseases Society (ILADS), a group that despite persecution by state medical boards abiding by the antiquated and unscientific CDC criteria, dare to treat patients appropriately. While the CDC states that 21 days of doxycycline will essentially “cure” Lyme disease at every stage, yet denying that people can be chronically/persistently infected, ILADS states this disease is far more complex and requires many nuances to treatment. Recent research supports their stance.

Just last year, Garg et al. stated in their groundbreaking paper, “Our findings recognize that microbial infections in patients suffering from TBDs (tick borne diseases) do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes” (6). This polymicrobial aspect is completely ignored by the CDC/IDSA, yet research has shown patients that are infected with numerous pathogens have more severe disease of longer duration, not to mention the need for different medications for a longer period of time due to the stealthy nature of the pathogens but also due to immune suppression (7).

Garg et al. also highlighted the fact that borrelia is pleomorphic, which simply means that it has the ability to shape-shift when it feels threatened (6). Pleomorphism is also completely denied by the CDC. There are essentially four forms borrelia can take: spirochete, cell wall, non-cell wall (cyst or dormant form), and biofilm (a protective colony). At least two studies to date demonstrate that the CDC’s mono-therapy of doxycycline may actually push borrelia into the non-cell wall/dormant form to reemerge later when conditions are opportune (8,9). This could very well cause or exacerbate brain diseases such as Alzheimer’s, dementia, ALS, Parkinson’s, and many others (10). Patients have been misdiagnosed with these diseases only to find out much later that they are in fact infected with Lyme and/or the other pathogens that come with it (11). Once they start proper antimicrobial treatment effectively dealing with all the pathogens, these symptoms disappear altogether or improve dramatically.

Drilling this home further, Pathologist Alan MacDonald found borrelia (Lyme) DNA in 7 out of 10 brain specimens in patients who died from Alzheimer’s, and Dr. Klinghardt has gone on record stating that he’s never had a single patient with Alzheimer’s, ALS, Parkinson’s, or MS who didn’t test positive for Lyme (12). 

Most of the quibbling is over patients who remain with symptoms, and despite what the CDC states, there’s a lot of them.

Recently, microbiologist Holly Ahern wrote about this issue of persistent symptoms clearly delineating that the CDC and mainstream researchers have been quoting and utilizing an inaccurate statistic about this important but neglected group (13). She states that the CDC’s usage of 10-20% of patients who remain with symptoms, whom the CDC labels Post Treatment Lyme Disease Syndrome (PTLDS), only includes patients who were diagnosed and treated quickly. It does not and should not include a much larger group who are infected for weeks to years before getting a proper diagnosis and treatment. Research shows this second group to be 30-40% of patients. Simply adding the two groups, reveals that 60% of Lyme patients end up with chronic symptoms. This higher percentage more accurately reflects what I see as a patient advocate. Simple math also shows that if the CDC estimates state that there are over 400,000 new cases of Lyme disease each year (more than double that of breast cancer), that means more than 24,000 will have continuing symptoms. This is per year – mind you.

This crucial issue has been denied by the CDC, and is important not only from the standpoint that 5.8 million Americans are living with Alzheimer’s, and dementia deaths have doubled in the last two decades (14), both of which could be caused or exacerbated by Lyme disease and/or the various coinfections that come with it, but because only certain drugs work on the various forms of borrelia as well as these coinfections. In fact, besides potentially pushing the spirochetal form into the cyst form to reemerge later, the CDC mono-therapy of doxycycline only works on two of the four forms (8). The remaining forms necessitate different drugs and potentially a longer treatment time – far longer than days. Bizzarely, my own dog with asymptomatic Lyme disease was treated for months by our veterinarian. 

The other glaring issue is that the falsely skewed low percentages do not accurately reflect the numbers of those suffering with debilitating symptoms, which will automatically place it further down the pipeline of crucial research needing to be done. It’s the proverbial “Catch-22” with sick patients left to cope.

For the Newsweek article to state that this is an “untreatable” form of Lyme is a tad bit early since the CDC doesn’t even recognize pleomorphism, the polymicrobial nature of the disease, and that borrelia can even persist. While researchers, mainly from outside the U.S., have published studies on all these factors, the U.S. sits idly by, only doing yet again more research on the acute phase with faulty study parameters, and the continued CDC stance of using a simplistic mono-therapy that potentially could very well make patients worse-off in the long run. My own experience and that of many, many others is that we wouldn’t be alive today without treatment given by experienced practitioners utilizing judiciously applied and varied long-term antimicrobials.

I must add here that this is a far more herculean issue than it appears at first blush. Due to the CDC guidelines, doctors for decades have been persecuted by State Medical Boards for utilizing anything outside these literal mandates. My own doctor had to pay fifty-thousand dollars in legal fees to keep his practice (15). He’s far from alone. This is happening all over the U.S. as well as in other countries (2), and it’s often insurance companies turning them in.

Recently, I wrote an article about experienced and successful treatment nuances after Dr. Joseph Burrascano created a video for ILADS (16). In it, he not only lays out the sordid and politically motivated details of the history surrounding Lyme disease, but explains his in house studies performed with other health professionals to determine antibiotic efficacy utilizing microscopy. Let’s just say it’s a far cry more complex than 21 days of doxycycline which for the knottiness of Lyme disease and it’s coinfections is akin to throwing sand into the ocean.

While I’m thankful journalists are writing about this very real 21st century plague that has become a true pandemic, I hope they start doing their homework and report the fact this disease has been downplayed, denied, and mishandled for decades. The author of the Newsweek article not only used yellow journalism but erroneously used a picture of an American dog tick/wood tick that while capable of transmitting numerous pathogens, to date does not even transmit Lyme disease. Few journalists are studying the contradictory science and presenting both sides. Most articles read as CDC/IDSA propaganda, and that propaganda is killing people.

With all that is coming out on the seriousness of Lyme disease, the increasingly high infection rates, and the continued suffering of so many, the CDC, NIH, IDSA, and the big-name institutions working with them blithely continue on the same short-sighted road without blinking, while patients are still unable to get a proper diagnoses and treatment (17), and are still being told, “It’s all in your head”(18,19, 20).

The sky is going to fall for those with Lyme disease if authorities continue to ignore worldwide research and fail to act on discoveries that show this plague is quite outside the box they’ve created for it. The only possible box this fits into is Pandora’s.  If you are a patient or someone with a loved one fighting this battle, there’s hope with proper treatment.

References

  1. Gander, Kashmira. “Untreatable Form of Lyme Disease Could Hit 2 Million Americans By 2020, Scientists Warn.” April 23, 2019. Newsweek. https://www.newsweek.com/untreatable-form-lyme-disease-could-hit-two-million-americans-2020-scientists-1403338.  Accessed April 24, 2019.
  2. Teotonio, Isabel. “Everything About Lyme Disease is Steeped in Controversy.  Now Some doctors Are Too Afraid to Treat Patients.” The Star. Dec.14, 2018. https://www.thestar.com/life/health_wellness/2018/12/14/everything-about-lyme-disease-is-steeped-in-controversy-now-some-doctors-are-too-afraid-to-treat-patients.html  Accessed April 26, 2019.
  3. Lyme Disease Association, Inc. “Conflicts of Interest in Lyme Disease: Laboratory Testing, Vaccination, and Treatment Guidelines.” April 2001. http://lyme.kaiserpapers.org/pdfs/Conflicts.pdf
  4. Sin Hang Lee, M.D., v. The United States. 18-686 C. U.S. Court of Federal Claims. (2018) https://www.dropbox.com/s/zem4v9sceg1v63d/Lee%20CDC%20Complaint%205-15-2018.pdf?dl=0
  5. Torrey et al. v. Infectious Disease Society of America et al. 5:17-cv-00190-RWS. U.S. States District Court For the Eastern District of Texas Texarkana Division. (2019)  https://madisonarealymesupportgroup.com/wp-content/uploads/2019/04/c8b05-torreyamendedcomplaint3-26-19.pdf
  6. Garg et al. (2018) “Evaluating Polymicrobial Immune Responses in Patients Suffering From Tick-borne Diseases.” Scientific Reports.  doi: 10.1038/s41598-018-34393-9  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206025/
  7. Krause et al. (1996) Concurrent Lyme Disease and Babesiosis: Evidence of Increased Severity and Duration of Illness. JAMA.  http://www.lymepa.org/c07%20Lyme%20disease%20and%20Babesiosis%20coinfection.pdf
  8. Sapi et al. (2011) “Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdorferi.” Dovepress. doi: https://doi.org/10.2147/IDR.S19201
  9. Caskey et al. (2019) “The Functional and Molecular Effects of Doxycycline Treatment on Borrelia Burgdorferi Phenotype.” Frontiers in Microbiology. doi: https://doi.org/10.3389/fmicb.2019.00690
  10. Neuroscience News. “Researchers Identify Virus and Two Types of Bacteria As Major Causes of Alzheimer’s.” March 9, 2016. https://neurosciencenews.com/microbes-alzheimers-neurology-3826/.  Accessed April 26, 2019.
  11. “Kris Kristofferson’s Memory Loss Caused by Lyme Disease.” Youtube, Uploaded by FoxNews, June 9, 2016.https://www.youtube.com/watch?v=oW1eFC2trJE
  12. Dr. Mercola.  “Under Our Skin: The Untold Story of Lyme Disease.” mercola.com. October 13, 2012. https://articles.mercola.com/sites/articles/archive/2012/10/13/under-our-skin-documentary.aspx  Accessed April 26, 2019.
  13. Ahern, Holly. “Medical Stalemate: What Causes Continuing Symptoms After Lyme Treatment?” Feb. 19, 2019. lymedisease.org.  https://www.lymedisease.org/lyme-stalemate-ahern/  Accessed April 26, 2019. 
  14. Dr. Mercola. “Dementia Deaths Have Doubled in Two Decades.” mercola.com. March 28, 2019. https://articles.mercola.com/sites/articles/archive/2019/03/28/alzheimers-death-rate-doubled.aspx?  Accessed April 26, 2019.
  15. Zell, Fran. “Wisconsin Lyme Doctor Gets Reprieve.” Daily KOS. Jan. 29, 2012. https://www.dailykos.com/stories/2012/01/29/1059800/-Wisconsin-Lyme-doctor-gets-reprieve. Accessed April 26, 2019.
  16. Cashman, Alicia. “Why Lyme/MSIDS Research Remains in the Dark Ages.” Feb. 22, 2019. Madison Lyme Support Group. https://madisonarealymesupportgroup.com/2019/02/22/why-mainstream-lyme-msids-research-remains-in-the-dark-ages/.  Accessed April 26, 2019.
  17. Broom, Brian. “‘It’s Just Crazy’: Why Is Lyme Disease Treatment So Difficult to Find in Mississippi?” April 19, 2019. Mississippi Clarion Ledger. https://www.clarionledger.com/story/sports/outdoors/2019/04/19/lyme-disease-mississippi-treatment-symptoms-support-group-diagnosis-doctors-hard-to-find/3246908002/  Accessed April 26, 2019. 
  18. Golan, Jacquelyn. “It’s All in Your Head – Until Finally a Lyme Diagnosis.” lymedisease.org. Sept. 21, 2017.https://www.lymedisease.org/circuitous-route-lyme-diagnosis/.  Accessed April 27, 2019. 
  19. Dennis, Lori. “Lyme is ‘All in Your Head’ – A Wake-up Call to Mental Health Professionals.” madinamerica.com. March 4, 2017. https://www.madinamerica.com/2017/03/lyme-wake-up-call/.  Accessed April 27, 2019. 
  20. Bedrinana, Jessie. “Why Are Physically Sick Children Labeled As Mentally Ill?”  lymedisease.org.  June 30, 2017. https://www.lymedisease.org/jessie-bedrinana/. Accessed April 27, 2019.

This is the Difference Between Probiotics and Prebiotics

https://www.huffpost.com/entry/difference-between-probiotic-prebiotic_

This Is The Difference Between Probiotics And Prebiotics

Plus, how to make sure you’re getting enough of each so you’re healthy.
There’s a good chance you’re familiar with probiotics (at least familiar enough where you make sure to stock up on Greek yogurt at the grocery store or pick up pills from your pharmacy).
But when it comes to your gut health, it’s actually the balance of two types of bacteria ― probiotics and prebiotics ― that helps keep everything operating as it should.
“There is a balance between [bacteria] in the gut called homeostasis,” said Ashkan Farhadi, a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California.
When this homeostasis becomes imbalanced, it’s important to restore it by providing the body with good bacteria that then help gut health, Farhadi said.
Enter probiotics and prebiotics, which you can get through diet and supplements.

But downing a cup of Chobani alone isn’t going to solve the issue. There are specific ways to balance your gut health with probiotics and prebiotics, and multiple ways to get them from what you consume.

Differentiating between probiotics and prebiotics

Here’s an easy way to keep probiotics and prebiotics straight when it comes to their function in the body: “Probiotics are ‘good’ bacteria that are introduced to the gut to grow and thrive,” said Erin Palinski-Wade, a registered dietitian and author of the “2-Day Diabetes Diet.” “Prebiotics are essentially ‘food’ for these good bacteria.” This means they help stimulate and fuel the growth of probiotic bacteria already present in the body, acting like a fertilizer.

“It is essential to have both prebiotics and probiotics to promote gut health,” Palinksi-Wade added.

Probiotics help keep gut bacteria balanced by limiting the growth of bad bacteria, explained Alan Schwartzstein, a family physician practicing in Oregon, Wisconsin.

“Probiotics compete with these ‘bad’ bacteria for prebiotic food and do not allow them to multiply and cause harm to us.”

When there is a balanced amount of probiotics and prebiotics in the body, your digestive health is able to hum along.

This bacteria balance is also beneficial to your overall health, Palinski-Wade said. A good amount of probiotics in the body helps with vaginal health. A healthy gut contributes to a strong immune system, as well as good heart and brain health. What’s more, research published in Medicina has linked healthy bacteria in the gut with healthy body weight, lowering inflammation and stabilizing blood sugar levels.

How to know if your gut is OK ― and how to get it there if it isn’t

There’s a pretty simple sign that indicates if your gut has enough prebiotics and probiotics.

“Those who have a gut imbalance will have symptoms like increased gut sensitivity or changes in bowel habits,” Farhadi said. This means issues like diarrhea, constipation and excess gas.

You don’t have to wait for these unpleasant symptoms to pop up to start taking a probiotic. Whether you do it through diet or supplement, prebiotics and probiotics can be used by anyone to proactively maintain gut health, Farhadi said.

For example, in his own practice Farhadi recommends a patient eat a tablespoon of Greek yogurt (which has probiotics) sprinkled with Metamucil (which contains prebiotics) on top to restore balance in the gut.

Schwartzstein added that most people can get enough probiotics through their daily diet without a supplement. This includes eating foods like yogurt (make sure the label says “live active cultures” or the full name of the bacteria), soy drinks, soft cheeses like Gouda, and miso. There’s one main exception where heavier amounts of the bacteria might be needed.

“There are circumstances that can cause fewer probiotics in our digestive system; the most common is when we take antibiotics,” Schwartzstein said. “These antibiotics kill the healthy bacteria in our gut that serve as probiotics at the same time they kill the harmful bacteria that is causing the infection.” (This is also why most doctors only prescribe antibiotics if they are positive a patient has an infection caused by bacteria as opposed to a virus, like a cold.)

In these instances, you may need to take a probiotic supplement until you finish taking antibiotics. Talk to your doctor to make sure you take the correct strain and be aware that taking a probiotic supplement can come with side effects like gas and bloating, Schwartzstein said.

For prebiotics, Palinski-Wade said that a diet high in plant-based foods and fiber is a good way to make sure you’re consuming enough. Sources of prebiotics include garlic, vegetables, fruits and legumes.

If you don’t think you’re getting enough probiotics or prebiotics through your diet you may be leaning toward taking a supplement. In the case of prebiotics, any psyllium-based product (like Metamucil) can be used, as fiber acts as a prebiotic in the body.

Probiotics are a little trickier, as there are many different strains of probiotic bacteria that may be beneficial for certain conditions.

“Our research is so limited in this field,” Farhadi said. “Currently, the recommendation is based on individual experiences.”

Many times, Farhadi said a doctor may ask a patient to start a probiotic and see if it’s helpful. If not, they can switch between different brands and bacteria strains until they find the right fit. Talk with your physician before trying anything ― they’ll make sure you’re set up on the right path.

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**Comment**

I would caution against using yogurt, kefir, and Metamucil unless they are without sugar.  A good substitute for Metamucil is just plain psyllium husk fiber.  https://fiberfacts.org/consumer_psyllium/  I found two opposing opinions on psyllium being a prebiotic, so discuss this with your practitioner. Both, however, are soluble sources of fiber. If you try this, go slowly so your body can acclimate to it.

If you detest the taste of plain yogurt products, you can always add fruit or liquid Stevia which comes in a myriad of flavors, but avoid processed sugar like the plague.

Some examples of food-sources of Prebiotics:

  • bananas
  • cold potatoes
  • milk
  • dandelion greens
  • legumes (beans)
  • chickory root
  • artichokes
  • garlic
  • onions
  • leeks
  • asparagus
  • barley
  • oats
  • apples
  • cocoa
  • burdock root
  • seaweed

All of these contain inulin which is an oligosaccharide or type of sugar molecule that is hard to break down so it can travel into your colon. Once there it becomes food for bacteria (probiotics). https://www.healthline.com/nutrition/probiotics-and-prebiotics#section5

Some examples of food-sources for Probiotics:

  • yogurt
  • kefir (daily & non-dairy)
  • Sauerkraut
  • Kimchi
  • Kombucha tea
  • Some types of pickles (non-pasteurized).
  • Other pickled vegetables (non-pasteurized).

Regarding pro and prebiotic supplements, there are many varieties and types. Get probiotics that are refrigerated as they have live cultures in them. 

Also, look for probiotic supplements that are designed to carry the bacteria all the way to your large intestine for better effects, while others probably won’t survive stomach acid.

And, the Health line article cautions that some should not take a probiotic, or who may feel worse after taking them, such as people with small intestinal bacterial overgrowth (SIBO) or people sensitive to ingredients in the supplement. For these issues, work with a practitioner to find the right strains.

My LLMD has been utilizing both in his treatment for Lyme/MSIDS patients and he reports that he has far fewer patients suffering with gut issues now – even while using antibiotics.

What Does Lyme Disease Do To Your Body?

 Approx. 5 Min.

What Does Lyme Disease Do To Your Body?

Published on Apr 23, 2019
What exactly is the connection between a tick bite and lyme disease? While we’re not sure exactly where and when the disease originated, we do know a lot about how it works, its signs, its symptoms in humans and dogs, how it’s spread and its treatment.
SICK is a new series that looks at how diseases actually work inside our body. We’ll be visiting medical centers and talking to top researchers and doctors to uncover the mysteries of viruses, bacteria, fungi and our own immune system. Come back every Tuesday for a new episode and let us know in the comments which diseases you think we should cover next.
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What this video didn’t touch upon is the very real probability that Lyme/MSIDS is spread by more than the sole perp of the deer tick:  https://madisonarealymesupportgroup.com/2019/04/02/transmission-of-lyme-disease-lida-mattman-phd/  From 2005, Dr. Lida Mattman isolated Lyme (borrelia) from:

mosquitoes, fleas, mites, semen, urine, blood, plasma and Cerebral Spinal Fluid. She discovered that this bacteria is dangerous because it can survive and spread without cell wall (L shape). Because L-forms do not possess cell wall, they are resistant to antibiotics that act upon the cell wall.

Others have found other various ways Bb is transmitted as well:

Nobody seems to want to talk about this, yet it’s important.