title: Association of antibiotic treatment-resistant Lyme arthritis with T cell responses to dominant epitopes of outer surface protein A of Borrelia burgdorferi.
abstract: OBJECTIVE
  To explore further the association of antibiotic treatment-resistant Lyme arthritis and T cell reactivity with outer surface protein A (OspA) of Borrelia burgdorferi, including the identification of T cell epitopes associated with this treatment-resistant course.
  
  
  METHODS
  The responses of peripheral blood and, if available, synovial fluid lymphocytes to B burgdorferi proteins, fragments, and synthetic peptides, as determined by proliferation assay and interferon-gamma production, were compared in 16 patients with treatment-responsive and 16 with treatment-resistant Lyme arthritis.
  
  
  RESULTS
  The maximum severity of joint swelling correlated directly with the response to OspA. Moreover, the only significant difference between patients with treatment-resistant and treatment-responsive arthritis was in reactivity with N-terminal and C-terminal fragments of OspA, OspA1 (amino acids [aa] 16-106), and OspA3 (aa 168-273). Epitope mapping showed that 14 of the 16 patients with treatment-resistant arthritis had responses to OspA peptides (usually 4 or 5 epitopes), whereas only 5 of the 16 patients with treatment-responsive arthritis had reactivity with these peptides (usually 1 or 2 epitopes) (P = 0.003). Patients with HLA-DRB1 alleles associated with treatment-resistant arthritis were more likely to react with peptide 15 (aa 154-173) and, to a lesser degree, with peptide 21 (aa 214-233) than patients with other alleles, whereas the responses to other epitopes were similar in both groups.
  
  
  CONCLUSIONS
  The maximum severity of joint swelling and the duration of Lyme arthritis after antibiotic treatment are associated with T cell responses to specific epitopes of OspA.
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts, USA.
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: J A
authors.initials: JA
authors.lastname: Field
authors.forename: L
authors.initials: L
authors.lastname: Glickstein
authors.forename: P J
authors.initials: PJ
authors.lastname: Molloy
authors.forename: B T
authors.initials: BT
authors.lastname: Huber
authors.forename: A C
authors.initials: AC
authors.lastname: Steere
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000917:Antibody Formation; D000954:Antigens, Surface / Q000276:immunology*; D001425:Bacterial Outer Membrane Proteins / Q000276:immunology*; D001428:Bacterial Vaccines / Q000276:immunology; D015748:Borrelia burgdorferi Group; D002648:Child; D004318:Doxycycline / Q000627:therapeutic use; D004352:Drug Resistance, Microbial / Q000276:immunology*; D018604:Epitope Mapping; D018984:Epitopes, T-Lymphocyte / Q000187:drug effects; D005260:Female; D006680:HLA Antigens / Q000235:genetics; D006801:Humans; D016056:Immunodominant Epitopes / Q000276:immunology; D008074:Lipoproteins; D008193:Lyme Disease / Q000188:drug therapy* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013601:T-Lymphocytes / Q000276:immunology; D013753:Tetracycline Resistance / Q000276:immunology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000954:Antigens, Surface; D001425:Bacterial Outer Membrane Proteins; D001428:Bacterial Vaccines; D018984:Epitopes, T-Lymphocyte; D006680:HLA Antigens; D016056:Immunodominant Epitopes; D008074:Lipoproteins; C072045:OspA protein; D004318:Doxycycline