LNB in patient treated with TNF-alpha inhibitor

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RitaA
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LNB in patient treated with TNF-alpha inhibitor

Post by RitaA » Sat 2 May 2015 3:41

Infection. 2015 Apr 29. [Epub ahead of print]

Lyme neuroborreliosis in a patient treated with TNF-alpha inhibitor.

Merkac MI1, Tomazic J, Strle F.

Author information

1 General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia.

Abstract

A 57-year-old woman, receiving TNF-alpha inhibitor adalimumab for psoriasis, presented with early Lyme neuroborreliosis (Bannwarth's syndrome). Discontinuation of adalimumab and 14-day therapy with ceftriaxone resulted in a smooth course and favorable outcome of Lyme borreliosis. This is the first report on Lyme neuroborreliosis in a patient treated with TNF-alpha inhibitor.

PMID: 25922085 [PubMed - as supplied by publisher]

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ChronicLyme19
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by ChronicLyme19 » Sun 3 May 2015 2:56

I wonder what would happen if you took a late stage NB patient and then added the TNF inhibiotor, similar to the culture the one study did on the entire mouse and then found it recultivable.
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velvetmagnetta
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by velvetmagnetta » Sun 3 May 2015 11:29

CL19 - I remember you talking about this a while back. Can you refresh my memory - does this study fit in with the theory you were developing about the TNF inhibitor? What was it? It had something to do with making the spirochetes viable again like you indicated above - but also I remember something about it dampening the Herxheimer reaction? Or am I totally off?

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ChronicLyme19
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by ChronicLyme19 » Sun 3 May 2015 14:21

VM, sure. I was refering to the study that dlf posted on the thread discussing the other study on the entire mouse culture, here:

http://www.lymeneteurope.org/forum/view ... 6&start=10

dlf posted:
http://jid.oxfordjournals.org/content/1 ... 9.full.pdf

• JID 2007:195 (15 May) • Yrja¨na¨inen et al.

Anti–Tumor Necrosis Factor–a Treatment
Activates Borrelia burgdorferi Spirochetes 4
Weeks after Ceftriaxone Treatment in C3H/He Mice


Background. The effect of anti–tumor necrosis factor (TNF)–a treatment in Borrelia burgdorferi–infected and
ceftriaxone-treated C3H/He mice was evaluated.
Methods. Mice were infected with B. garinii A˚ 218 or B. burgdorferi sensu stricto N40. At 2 weeks of infection,
one group was treated simultaneously with ceftriaxone and anti–TNF-a, whereas another received ceftriaxone at
2 weeks and anti–TNF-a 4 weeks later. One group received ceftriaxone treatment only. Infected and noninfected
control groups were sham treated.
Results. At 14 weeks of infection, B. burgdorferi could not be detected by cultivation or by polymerase chain
reaction in tissue samples of any mouse treated with ceftriaxone only. However, spirochetes grew from the tissue
samples of one-third of the mice treated with anti–TNF-a simultaneously or 4 weeks after ceftriaxone. These
activated spirochetes showed ceftriaxone sensitivity rates, plasmid profiles, and virulence rates similar to those of
bacteria used to infect the mice. All infected control mice and mice given anti–TNF-a only were culture positive.
Conclusions. This report shows that, after ceftriaxone treatment for 5 days, a portion of B. burgdorferi–infected
mice still have live spirochetes in their body, which are activated by anti–TNF-a treatment.



The link above is to the full study article and it is an interesting read. This makes me wonder whether the level of TNF-a gradually drops after the antibiotic treatment and after about 12 months (at least in the murine model) it is sufficiently low that the spirochetes are able to resurge.
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RitaA
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by RitaA » Tue 5 May 2015 14:41

http://rel-risk.blogspot.com/2015/05/ld ... sy-to.html
Monday, May 4, 2015

LD and Immunocompromised: still easy to treat

Notes from:
Merkac MI, Tomazic J, Strle F. Lyme neuroborreliosis in a patient treated with TNF-alpha inhibitor. Infection. 2015 Apr 29


A 57-year-old woman, receiving TNF-alpha inhibitor adalimumab for psoriasis, presented with early Lyme neuroborreliosis (Bannwarth’s syndrome). Discontinuation of adalimumab and 14-day therapy with ceftriaxone resulted in a smooth course and favorable outcome of Lyme borreliosis.

Adalimumab is a TNF-alpha inhibitor enabling down-regulation of the inflammatory reactions associated with autoimmune diseases.

Clinical picture was consistent with early LNB—Bannwarth’s syndrome. The diagnosis was confirmed by demonstration of intrathecal borrelial antibody synthesis. The patient was treated with ceftriaxone 2 g i.v., o.d., for 14 days. The decision was made to temporarily discontinue immunosuppressive therapy; However, Lyme neuroborreliosis in a patient treated with TNF-alpha inhibitor the patient subsequently admitted that between the first and second lumbar puncture she injected herself one additional dose of adalimumab. After 4 days of antibiotic treatment she started to feel better and her pain diminished, no longer requiring analgesics. In the second week of antibiotic treatment, she was without pain but still had unpleasant feelings of tingling in both hands. Two months later she was completely symptom free.

The approach in our patient, who was receiving adalimumab but in contrast to previously reported case presented with LNB (disseminated LB), was different: treatment with TNF-alpha inhibitor was discontinued (we could afford this because the underlying illness was not life-threatening), and antibiotic therapy was equivalent to that used for immunocompetent patients with LNB. Also in our patient the course of LB was smooth and the outcome was favorable in spite of the fact that the duration of antibiotic treatment was only 2 weeks, i.e., much shorter than the duration of the effects of TNF-alpha inhibitor which were operational for additional several months after the drug was discontinued. Thus, the relevance of discontinuation of adalimumab for an effective treatment of LNB in our patient is doubtful.

This is the first report on Lyme neuroborreliosis in a patient treated with TNF-alpha inhibitor.

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ChronicLyme19
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by ChronicLyme19 » Tue 5 May 2015 15:01

So it certainly seemed the anti-TNF treatment near the lyme treatment didn't hurt the patient in this case, but the question is, did it help? Did the anti-TNF help keep the spirochetes in active form instead of the dormant round bodied form, so the antibiotics could work their magic, like the reactivation in the mouse study?
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lou
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by lou » Sun 17 May 2015 23:39

So how is this different from treating with steroids? Lots of different cytokines and chemokines. Who is to say which one or ones is important? I would have to wonder if this kind of treatment were tried in a lot of patients instead, what would the outcome be? How long would you have to follow the patients to know if there were any problems later?

The thing is that we know inflammation is part of the problem, especially in late chronic disease. So can anything be done about this that is not too dangerous for the patient?

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ChronicLyme19
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by ChronicLyme19 » Mon 18 May 2015 4:38

It seems grapefruit seed extract can act as an alpha-TNF inhibitor. I wonder if this is why it it said to be active against the round body/cyst form. Maybe it just encourages them to come out of dormancy and revert back to the spirochete form and then the other antibiotics can do the job?

Here's a non-related study where they were examining the effects of GSE on TNF:
http://www.ncbi.nlm.nih.gov/pubmed/21113812

Eur J Nutr. 2011 Sep;50(6):401-9. doi: 10.1007/s00394-010-0151-6. Epub 2010 Nov 28.
Grape seed extract ameliorates tumor necrosis factor-α-induced inflammatory status of human umbilical vein endothelial cells.
Chao CL1, Chang NC, Weng CS, Lee KR, Kao ST, Hsu JC, Ho FM.
Author information
1Division of Cardiology, Department of Internal Medicine, Taoyuan General Hospital, Executive Yuan, 1492 Chung-Shan Road, Taoyuan, Taiwan.
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johnholland
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by johnholland » Mon 18 May 2015 16:22

ChronicLyme19 wrote:I wonder what would happen if you took a late stage NB patient and then added the TNF inhibiotor, similar to the culture the one study did on the entire mouse and then found it recultivable.
http://en.wikipedia.org/wiki/TNF_inhibitor

"In patients with latent Mycobacterium tuberculosis infection, active tuberculosis (TB) may develop soon after the initiation of treatment with infliximab"

http://www.nejm.org/doi/full/10.1056/NEJMoa011110

So it looks like a tnf inhibitor can activate infections.

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ChronicLyme19
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Re: LNB in patient treated with TNF-alpha inhibitor

Post by ChronicLyme19 » Mon 18 May 2015 16:57

Other herbals as well:

"TNF or the effects of TNF are also inhibited by a number of natural compounds, including curcumin[24][25][26][27] (a compound present in turmeric), and catechins (in green tea). Also activation of cannabinoid CB1 or CB2 receptors by cannabis or Echinacea purpurea seem to have anti-inflammatory properties through TNF inhibition.[28]"
http://en.wikipedia.org/wiki/TNF_inhibitor

So a question on the TB, did it activate because of the immune suppression or because of the re-activation of the infection? In the mouse study it would have had to have been re-activation since it was in a culture, no?
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