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PhageTesting forLymeDisease:IsThistheFuture?
LouisTEULIERESMDPhD LeicesterUniversity &Phelix Charity chronicinfectionsandbacteriophages research [email protected]+33(0)60714944
LymeDiseaseUKConferenceMay272021
LymeDiseaseUKConferenceMay27
2021
Part 1 : Use of phages as a diagnostictool
2
Howphageslooklike?
3
PhageLifeCycle
5
PhelixPhageBorreliaTest
From Campbell (2003)
Phelix Charity and Leicester University developed a Borrelia SL,RF and a specific B. miyamotoi Phage PCR tests already validatedin early and late stage patients and healthy volunteers, showing>90% sensitivity and 100% specificity due to confirmatorysequencing.
Phages are specific viruses.Inserting their genetic materialin their host, they can eitherproduce numerous copies thatfurther destroy the bacteria, orstay in a dormant lysogenicstage and be expressed underspecific circumstances.
1.Phagetyping
(Merwe,etal.,2014)
Useofphages asadiagnostictool
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Oneassayexploitsphages withbroadhostrangesthatcaninfecttworelatedbutdifferentbacterialspecies.
AtestonthisprincipleusedphagesthatinfectbothMycobacteriumtuberculosis andM.smegmatis.
2.Phageamplificationassay
(SchmelcherandLoessner,2014)
Useofphages asadiagnostictool
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3.QuantitativePCR(qPCR)todetectamplifiedphageDNA
Useofphages asadiagnostictool
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4.Engineeredphagetoexpressreportergenes,leadingtotheproductionofdetectableoutputs
(Timothyetal.,2013)
Useofphages asadiagnostictool
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1)RebeccaJaneMarthaCLOKIE,JinyuSHAN,LouisCharlesTEULIERESPATENT:WO2018083491A1:Phage-baseddetecNonofborreliosisandmeanstherefore.
2)ELENASEVERINA,1†MARIORAMIREZ,1,2ANDALEXANDERTOMASZ1*TheRockefellerUniversity,NewYork,JOURNALOFCLINICALMICROBIOLOGY,Oct.1999,p.3308–3315Vol.37, No. 10 0095-1137/99/$04.00�0Prophage Carriage as a Molecular EpidemiologicalMarkerinStreptococcuspneumoniae
3) : Svetlana Alexeeva*, Jesús Adrián GuerraMarhnez,Maciej Spus and Eddy J. Smid*BMC Microbiology (2018) 18:120 hlps://doi.org/10.1186/s12866-018-1229-1SpontaneouslyinducedprophagesareabundantinanaturallyevolvedbacterialstartercultureanddelivercompeNNveadvantagetothehost
4) Arun M. Nanda,a Kai Thormann,b Julia Frunzkea , Forschungszentrum Jülich, Jülich,Germanya; InsNtut für Mikrobiologie und Molekularbiologie, Justus- Liebig-UniversitätGießen,Gießen,Germanyb ImpactofSpontaneousProphage InducNonontheFitnessofBacterialPopulaNonsandHost-MicrobeInteracNons
5)BhaskarChandraMohanRamisely*andPavithraAnantharamanSudhakariBacterial‘Grounded’ Prophages:Hotspots forGeneNcRenovaNonand InnovaNon Laboratory ofMolecularBiologyandEvoluNon,SchoolofChemicalandBiotechnology,SASTRADeemedUniversity,Thanjavur,IndiaFroniersinGeneNcsFebruary2019
Useofphages asadiagnostictoolBIBLIOGRAPHY
LymeDiseaseUKConferenceMay27
2021
Part 2 : Phelix Phage Borrelia detection methodPatent WO2018083491A1Publication : Shan et al., Frontiers in Microbiology 2021
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QuantitativePCR(qPCR)todetectprophageDNAforthedetectionofbacterialinfections
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Phelix Phage Borrelia Test
Phages are specific viruses. Inserting theirgenetic material in their host, they caneither produce numerous copies thatfurther destroy the bacteria, or stay in adormant lysogenic stage and be expressedunder specific circumstances.
Phelix Charity and Leicester Universitydeveloped a Borrelia burgorferi SL, RF and aspecific B. miyamotoi Phage PCR testsalready validated in early and late stagepatients and healthy volunteers, showing>90% sensitivity and 100% specificity due toconfirmatory sequencing.
From Campbell (2003)
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LD DiagnosticMethodsComparison
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Phelix Phage Borrelia Test
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ManualDNAPhenol/Chloroformextraction
3differentreal--mePCRs,eachsamplein4replicatespertarget
Confirmatorysequencingforpositive-likesamples
QCsExtractioncontrolPCRqualityofextractedDNA
IACcontrolPCRabsenceofPCRinhibitors
ResultsofthePhageBorreliaTestsDoneonLatestagepatients
• )MethodsBorreliaburgd sl andaspecific B.miyamotoi andRelapsing fever PhagesPCRTestswere performed onover2200samples (alllate stage)fromvarious European countriesandfrom USA.Allresults were verified bysequencing
Results:
34%ofthetested samples were negative,66%positiveamong which64%Borreliamiyamotoi;25%RF
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Case 1. Male age 70. Lives in Mexico. Tick bites in USA 2015 Non typical rashSince 2017 : Fatigue, loss of sight, Fever ( mild)muscular pains and legsstrength loss; Urinary problems; Brain fog
PhagePCROctober2019
BacterialqPCRUSAandMexico
OTHERTests
B.miyamotoi:Positive
Borrelia burgd SLNegative
Borrelianegative ElisaandWBIgMnegativeIgMnegativeElisaIgGdoubt
BorreliaRFNegative Babesianegative BARTONELLANEG
Treatment : since September 2019 Ceftriaxone IM/IV 2g + doxycyclin200mg+EO Pause 3 w ; Ceftriaxone IM/IV 2g + Azythromycine 500mgMetronidazol every other day: 14 days cures. Improvements : brain fog andfever stopped. Muscle and legs pains reduced. Urinary and fatigue remain (tillnow). APPROPRIATE DIAGNOSIS
PerformanceofthePhageTestinclinicalcases- 1
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Case2maleage38.TickbiteinJune2016;NoEM.Symptoms=fatigue+diffusemusclepains+Depression.ElisaWBnegative.PCRPHAGETEST(blood)positive:treatment
PhagePCRresultsSeptember2019 Othertests
B.miyamotoi positiveElisaWBresults2016negative
Serotonine DopamineZnCortisolDHEAlow
Antibiotics (+metabolic )treatment.2x10days sequences:cefuroxime +doxycycline ,(3weeks pause),azithromycin every otherday +doxycylin . Quickpositiveoutcome.Appropriate (good)usageofdrugs
PerformanceofthePhageTestinclinicalcases- 2
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Case 3. Female age 46. Lives in Europe. No tick bites memories; No EM. Since2010 : Stiff Man Syndrome (back), muscular and neurological pains left armand legs strength loss. No fever but chills.
PhagePCRAugust2019
BacterialqPCR(vetlab)
OTHERTests
B.miyamotoi:Positive AntiGADantibodiespositiveEMGnegative2018
Borrelia burgd.SLNegative Borrelianegative ElisaIgMnegativeIgGpositiveWBnegative2016
BorreliaRFNegative
Babesianegative
Yesrsinia enterolytica positive(July2019)
Treatment : Benzodiazepin baclofen since June 2018. September 2019Antibiotics (same as case 1) improvements : able to stand & some steps;stiffness remains; arms spasms stoppedTREATMENT MONITORING
PerformanceofthePhageTestinclinicalcases- 3
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Case4.Femaleage10.Tickbitein2018;EM.ELISAandWBpositive.Treated3weeksamox.NosymptomsuntilAugust2019:flulikesymptomsandjoint(anckles)pains
PhagePCRresultsSeptember2019
Othertests
Borreliaburgd SL,RF&B.miyamotoi Negative
ASLOASD;Mycoplasma&Chlamydiapneumoniaenegative
EBVPositive
Noantibiotics treatment.Appropriate (good)useofdrugs
PerformanceofthePhageTestinclinicalcases- 4
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Case5.maleage8.TickbiteinJune2020;NoEM.TickanalysisPCRPHAGEPositive.Nosymptoms.PCRPHAGETEST(Urine)Negative:Notreatment
PhagePCRresultsJune2020 PhagePCRresultsJuly2020
TICK:B.miyamotoi positive PATIENT(urine)Negative
Noantibiotics treatment.Appropriate (good)useofdrugs
PerformanceofthePhageTestinclinicalcases- 5
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LymeDiseaseUKConferenceMay
272021
Part 3 : DISCUSSION
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Ø B. miyamotoi resistance to antibiotics,
Ø HEAT AND CLIMATE FACTORS and
Ø Predominant information exchange viaplasmids may explain the greater prevalence ofmiyamotoi type in long term persisters.
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Discussionpoints
GENERALCONCLUSIONS
1) Phages being an evidence of bacterial activity, this technology is an in-vivo amplification system for active infections.Clinicians can evaluate their treatments and discriminate the activedisease from the post-lyme syndrome.
2) This is the first large scale report on prevalence of B. miyamotoi inlate stages of borreliosis in Europe. Obtaining such results were possiblethatnks to the high sensitivity of Phages PCR tests.
3) Borrelia phage-based PCR experience is now used to developp similarPhage-based Bartonella spp., Rickettsia spp and other « co-infections »testing.
LymeDiseaseUKConferenceMay
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ACKNOWLEDGEMENTS:Our gratitude towards:
Leicester University microbiology dept
R.E.D. Laboratories Belgium
Lyme Disease UK : www.lymediseaseuk.com
The patients associations
LymeDiseaseUKConferenceMay
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