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New Lyme Test Could Be a ‘Game-Changer’

Thu, 02/29/2024 - 10:03
Dr. George Dempsey of East Hampton Family Medicine accepting the Bay Area Lyme Disease Foundation's Courage Award in San Francisco in 2021.
Drew Altizer

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Through the height of the Covid pandemic, “antibody” was a buzzword.

“Antibodies are very cool,” Dr. George Dempsey, the medical director of East Hampton Family Medicine, said by phone last week. “They’re so specific, designed to find one particular thing. That’s why we use them in testing.”

With over 400 blood samples collected from Lyme-infected East Enders since 2014, Dr. Dempsey is the largest contributor to the Bay Area Lyme Foundation Lyme Disease Biobank. His samples have led to a collaboration with Drexel University’s College of Medicine’s Mary Ann Comunale, assistant professor of microbiology and immunology, and Dr. Liz Horn, the principal investigator for the biobank, to improve the test that can detect Lyme disease.

The current test catches only about 60 percent of infections, and it’s not good at catching very early illness. The new detection test, called the GlycoLyme Assay, may be faster and more sensitive, and may also help alert doctors to the end of an infection, not just the beginning.

Instead of simply testing for the presence of antibodies, the new test focuses on the process of glycosylation, which adds sugars to antibodies and modifies their response. Dr. Horn likens the process to decorating: After infection with the bacterium that causes Lyme disease, the sugars make different patterns on antibodies early in the body’s immune response. After treatment, those decorations disappear, although the antibodies do not. The presence of these patterns could distinguish between new and old infections, which is important because old and new infections are treated differently.

“It would help us know whether an infection is improving or resolving, which could be huge,” said Dr. Dempsey. According to the Centers for Disease Control, Lyme disease is the most common vector-borne disease in the United States, infecting nearly 500,000 people annually.

“We make antibodies when an infection develops, but it takes a little time,” said Dr. Dempsey, who has been practicing medicine in East Hampton for 22 years. That lag is precious, because the earlier the treatment for Lyme begins, the better the outcome. “Three to four weeks into an infection is not too late. Six months or a year after infection, that’s when it becomes a problem.” As it stands, Dr. Dempsey says doctors generally don’t wait for test results to come back if a patient is showing the classic symptoms of Lyme. They treat first and ask questions later.

The Drexel studies show that it’s possible Lyme has a way of masking the presence of antibodies, which could explain the unreliability of the current antibody test. Additionally, Dr. Horn says that the sugars that attach themselves to the antibodies “impair the immune system’s ability to work against Lyme disease,” which is why if left untreated, Lyme won’t resolve. “When they remove the sugars, they’re finding the immune system goes back to normal.”

“The researchers at Drexel are looking at molecular changes that actually affect how active the antibody is. It’s almost like they’re searching for a switch that tells them the antibody is on or off,” said Dr. Dempsey. “Not whether an antibody is present or not, but if it’s in an active state.”

Their more specific test may help explain why, even after treatment, up to 20 percent of Lyme patients still don’t feel well. The ability to understand what state the antibodies are in can give doctors and researchers a better understanding of how the infection evolves.

“If we can show two points in time together — the early detection of Lyme disease, and then resolution of the infection — it will be a game-changer. We will have a new way to look at how antibodies behave in Lyme, but also other diseases affecting the immune system,” said Dr. Dempsey.

“We haven’t had anything new in Lyme disease in a really long time,” said Dr. Horn. “The sample-collection process has allowed a lot of projects to go forward. It’s great to get new researchers into the field, and that’s one of the things the biobank enables.”

Dr. Dempsey said he’s noticed a greater awareness among his patients about Lyme disease, but also a knowledge gap between locals and vacationers. He doesn’t advocate the use of pesticides for ticks (“The environmental impact of killing everything is not healthy”), but does recommend targeted permethrin-based sprays for clothing.

In early February, the team was awarded $265,000, as one of five winners in phase two of the LymeX Diagnostics Prize Competition, which began with a field of 52. (The field was winnowed to 10 in 2022, when Dr. Dempsey’s team was awarded $100,000.) An additional $7 million in prize money, contributed by the United States Department of Health and Human Services and the Steven and Alexandra Cohen Foundation, is dedicated to future phases.

To get involved in the Lyme Disease Biobank, people experiencing symptoms of early-stage Lyme disease that has not yet been treated, or who are in the first 48 hours of taking antibiotics, are asked to donate a small sample of blood and fill out forms reporting symptoms. Participants will receive information on tick-borne diseases, advice from experienced doctors, and tick-bite prevention tips.

They should contact East Hampton Family Medicine at 200 Pantigo Road, at 631-324-9200.

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