
Lyme disease bacteria eradicated by new drug in early tests - dempedempe
https://scopeblog.stanford.edu/2020/03/30/lyme-disease-bacteria-eradicated-by-new-drug-in-early-tests/
======
PragmaticPulp
Note that they're carefully dancing around the elephant in the room: As far as
I know, no one has ever demonstrated that Lyme spirochetes survive a course of
standard antibiotics (Emphasis mine):

> Standard treatment of Lyme disease is oral antibiotics, typically
> doxycycline, in the early stages of the disease; but for reasons that are
> unclear, the antibiotics don't work for up to 20% of people with the tick-
> borne illness. _One possibility is that drug-tolerant bacteria cause the
> lingering symptoms._

Many people experience lingering symptoms after contracting Lyme disease.
Officially, this is known as "Post-Treatment Lyme Disease Syndrome". The CDC
page for the PTLDS has more information:
[https://www.cdc.gov/lyme/postlds/index.html](https://www.cdc.gov/lyme/postlds/index.html)

These PTLDS symptoms are definitely real, but the idea that persistent lyme
infection is the cause of the lingering problems is more of a hypothesis at
this point.

It will be interesting to see if this new antibiotic produces different
outcomes in PTLDS patients, but it's misleading to claim that this is the only
antibiotic known to act on the Lyme disease spirochetes. The original study
specifically explored the action of Azlocillin on Doxycycline-resistant
spirochetes. From the study:

> Our results also demonstrate that azlocillin and cefotaxime can effectively
> kill in vitro doxycycline-tolerant B. burgdorferi.

The authors point to indirect evidence suggesting that spirochetes might still
be present in PTLDS patients, but acknowledge that no one has yet been able to
culture a viable spirochete from PTLDS patients:

> A recent study in humans demonstrated that B. burgdorferi DNA was identified
> in PTDLS patient by xenodiagnosis but unable to culture viable spirochete17.
> In about 85% of Lyme arthritis patients, B. burgdorferi DNA was detected in
> synovial fluid by polymerase chain reaction (PCR) testing

It would be great if this antibiotic could produce positive outcomes for PTLDS
patients, but I wouldn't get too excited until we see some human studies.
PTLDS (aka "chronic lyme") has a long history of promising treatments failing
to produce results in patients.

~~~
hinkley
Lyme disease talk just makes me think of Nicholas Zakas and then I get bummed
out.

I know there's a guy, or maybe he represents a group of researchers, who
thinks that Chronic Fatigue Syndrome is caused by inflammation in the brain,
either due to some undetectable infection, or just a misfiring that is a
lingering effect of some other insult (sounds to me like a histamine response
aka allergy).

If your body thought you had the flu but you didn't, you'd be knocked on your
ass not unlike many people with CFS or Lyme. And if it _never stopped_ you'd
be in pretty bad shape a year in.

So. Are we treating microbes that don't culture in a petri dish, or are we
solving an autoimmune response gone whacky? You could really ask the same
question about Crohn's or IBS.

I recall years ago reading a long story about a consultant who was called in
to figure out why this black soot was all over a neighborhood around a
brewery. The brewery said it was diesel exhaust. But why only this
neighborhood? He heard of a similar problem is some town in the UK. But Petri
dish after Petri dish cultured nothing that could explain the black soot.
Ergo, it's not microbial.

Our intrepid consultant pours a small amount of distilled spirits onto a
sample dish, and gets a bunch of black shit. The 'soot' was feeding off the
Angel's Share (evaporative losses from the brewery), and would barely grow
without it. Vigorous growth in vivo, negligible growth in vitro.

We've come up with a cure or treatment for so many microbes that we can
detect, but how do we know we're detecting them all? People die of cancer not
because cancer is getting worse (well, pollution notwithstanding) but because
Cancer is patient. There's a lot of space in the middle for new vectors to
slip in.

~~~
HeadsUpHigh
Smart talking aside it's possible and relatively easy to identify microbes
without growing them. When an immuno-suppresive is effective at reducing
symptoms you know it's an autoimmune disorder. You can even find specific
anti-bodies in some cases.

>You could really ask the same question about Crohn's or IBS.

No you couldn't. They are clearly auto-immune disorders.

Out of curiosity, do you have any formal training on medicine/physiology or is
your knowledge base self-aquired?

~~~
darkerside
> When an immuno-suppresive is effective at reducing symptoms you know it's an
> autoimmune disorder.

Aren't there diseases where someone are caused not by the microbe directly but
by the body's immune reaction to it?

> Out of curiosity, do you have any formal training on medicine/physiology or
> is your knowledge base self-aquired?

Argument from authority (or lack thereof) is pretty contrary to the HN ethos,
imo. You're not right because your degree says so, but because the facts do.

~~~
HeadsUpHigh
>Aren't there diseases where someone are caused not by the microbe directly
but by the body's immune reaction to it?

There are symptoms that can be caused by that. The characteristic of an
autoimmune disorder is that the response never ends( either chronic or with
flare ups) or takes way longer than a normal one would.

> Argument from authority (or lack thereof) is pretty contrary to the HN
> ethos, imo. You're not right because your degree says so, but because the
> facts do.

What facts did you state then? I'm asking where does your thinking process
stems from?

------
oblib
This has no bearing on the tests of this new drug, but it's worth noting that
the best prevention is getting ticks off of you quickly.

I know this because I live in a very tick infested area (Ozark Mountains) and
very few people who've grown up here in families that have lived here for
generations get lyme disease. I don't personally know anyone who has.

Since I was kid in the `60s, and long before that, parents here did "tick
checks" every evening. After calling us in mom's would strips us little kids
down naked and pick any off they found and demand the older kids do it
themselves and it becomes a habit. So does being aware. I mean, I don't ignore
it when I think I feel one on me and I'm always aware there might be.

I'm 61 now and I've been bit more times than I can count, but I still make a
point to do a tick check every evening.

Check out this video I made a couple years ago. They can get thick here...

[https://youtu.be/TFVDv8swzxQ](https://youtu.be/TFVDv8swzxQ)

~~~
dempedempe
I also live in the Ozarks. Pretty sure that the ticks that bear Lyme disease
bacteria are practically non-existent in the Ozarks. They're more relegated to
the North East.

Not to downplay the importance of tick checks and other prevention techniques.

~~~
alexhutcheson
This is correct - you can confirm from the CDC charts here:
[https://www.cdc.gov/lyme/datasurveillance/maps-
recent.html](https://www.cdc.gov/lyme/datasurveillance/maps-recent.html)

Note that cases are reported by state of residence, so even the handful of
cases in Arkansas and Missouri are probably attributable to travel to the
upper Midwest or Northeast.

However, the Ozarks do have a high incidence of Rocky Mountain Spotted Fever,
so you should still be careful about preventing tick bites and removing them
ASAP:
[https://www.cdc.gov/rmsf/stats/index.html](https://www.cdc.gov/rmsf/stats/index.html)

------
dumbneurologist
I am a neurologist.

My main comments are the same from a thread about lyme on HN 7 months ago [1].
If you follow it to it's terminal conclusion, it shows that neurologists had a
standard course of therapy for lyme. The alt-lyme community insisted that it
was too short, and you needed long term treatment (with a duration based on
their own experiences/treatment regimens). So conventional medicine studied
the longer courses of treatment, and found there was no difference when
studied in an objective way (randomized double blind comparison). Well, as
soon as that happened, the goal posts got moved back, and they alt-lyme
community said "well of course the study was negative! the treatment course
wasn't long enough! It needs to be 12 weeks, not 8 weeks" (or whatever), even
though they had consistently been saying 8 prior to the study. And _still_
conventional medicine is open minded about any evidence that can be provided.
That's how science works! But you are going to need to pay for the evidence,
lyme people, because we feel like we did our due diligence with the first
study, and don't need a repeat of the public health resources that were wasted
searching for the autism-vaccine link over and over again.

Even the other treatment outlined in this blog post (disulfuram) has an open
study that is still looking for volunteers. That tells you a little bit about
the level of need (modest, but not zero) and the disinterest of the patient
community in advancing science (you can draw your own conclusions here).

Related to this Stanford post specifically, I'm disappointed.

> We'd been bitten by unseen ticks harboring the parasites that cause Lyme
> disease and babesiosis, a malaria-like disease

It's far (far!) less like malaria than it is to syphilis. It's a bit like
saying "this is a border collie, which is similar to a Maine Coone". Ok,
well... kind of. To the extent that they are both mammals. But why are we not
comparing the border collie to a great dane or a poodle? Because those are
just as familiar, and way more similar.

What syphilis and lyme have in common is that they are both spirichete
bacteria, and a huge portion of the disease burden if it's not diagnosed
quickly (and it's often not...) is due to autoimmune injury. You can
completely kill all the bacteria in the chronically infected person, and their
life will not get any better, because the autoimmunity is present, and
unrelenting. Which is the second big criticism of this blog post: killing all
the bacteria is not the challenge, and this discovery, while awesome, is not
awesome for the reasons described.

PragmaticPulp really nailed it here with what is now the top comment on this
thread.

> for reasons that are unclear, the antibiotics don't work for up to 20% of
> people with the tick-borne illness. One possibility is that drug-tolerant
> bacteria cause the lingering symptoms.

these reasons are only unclear to the alt-lyme community.

> Many researchers believe that doxycyline's inability to clear the persisters
> may account for the ongoing symptoms of some Lyme sufferers.

Yes, the same researchers that are working on climate change for Exxon. It
doesn't mean they won't disprove climate change, but it means they are outside
the conventional understanding of this area of science.

Overall, though, the science story here is legitimately cool! The scientists
are using the application of a high-throughput system to test multiple
compounds with known safety profiles against a pathogenic organism. That's an
awesome form of problem solving consistent with the hacker ethos, and is done
a disservice when presented along side this alt-lyme woo.

[1]
[https://news.ycombinator.com/item?id=20749216](https://news.ycombinator.com/item?id=20749216)

~~~
vimy
>Even the other treatment outlined in this blog post (disulfuram) has an open
study that is still looking for volunteers. That tells you a little bit about
the level of need (modest, but not zero) and the disinterest of the patient
community in advancing science (you can draw your own conclusions here).

This shows a lack of empathy. Patients are either too sick to travel or lack
the money. And how would they hear about this trial when so many doctors, like
you, deny the severity of the problem? But the main reason is that patients
don't need the trial, Lyme communities are full of people taking disulfiram on
their own and finally recovering.

www.disulfiram.net

See my other comment:
[https://news.ycombinator.com/item?id=22769152](https://news.ycombinator.com/item?id=22769152)

~~~
dumbneurologist
> This shows a lack of empathy.

Well, now you are attacking my humanity. It's very difficult to have
constructive dialog about these issues when individuals attack the speaker,
and not what's being said. We are talking about public health policy, which
necessarily glosses over individual patients who are suffering and aggregates
them into cold, sterile statistics in order to make decisions that are best
for society. It's not particularly compassionate, but it's unavoidable if you
want resource allocation to be proportional to need.

> like you, deny the severity of the problem

This is a straw man argument, where you take a crummy version of my argument
and knock it down. "Severity" is not the word I used. I said "level of need",
which is different because it takes severity (magnitude) _and_ frequency into
account. Progeria is a devastating (severe) disease, but it's also
exceptionally uncommon. From a public health standpoint, both are an important
part of determining the level of need, and therefore the level of support that
these problems receive.

> how would they hear about this trial

from the internet, where the conventional doctors you are assailing created
clinicaltrials.gov in order to make such information accessible to everybody.

> But the main reason is that patients don't need the trial, Lyme communities
> are full of people taking disulfiram on their own and finally recovering.

Nothing makes us happier than when our patients are connected with effective
treatments. Nevertheless, the publications you site appear to lack random
assignment, placebo control, or a double blind. Therefore I find the data
uncompelling, even as I am happy to see that there is a trial for it; I hope
it includes these three elements which make the results most meaningful.

Absent that study it remains possible that disulfuram will be the miracle cure
you claim that it is, but I'm not _expecting_ that to happen, and I suspect
that chronic lyme will be a topic on HN in another 9 months exactly because
the needle hasn't moved far enough. Please prove me wrong! That's how big
breakthroughs are made! (witness h pylori infection and gastric ulcers). But
please excuse me if I don't hold my breath for the announcement, and advocate
more more conventional research during that time.

------
jonathanjaeger
When I got Lyme as a teenager I was very lucky to notice a bulls-eye pattern
(which not everyone gets) and quickly get treatment, with no complications
after. I wonder if this new drug, or any future drugs, that work for the 20%
of the people that doxycycline doesn't help, will also help people who figured
out they had Lyme very late after being infected.

~~~
rzimmerman
I had a similar experience. I had a tick bite on my ear and didn't think much
about it. A week or two later I noticed a secondary bullseye rash on my leg. I
am also very lucky that my mother knew what it was and I was treated quickly
with no complications.

------
hhas01
Something starting to really itch here, and, no, it’s not a tick bite.

Is there a reliable scientific cite† for this PR piece’s statement that
“antibiotics don't work for up to 20% of people with [Lyme disease]”?

Because the only “20%” I’m seeing commonly mentioned elsewhere describes the
10-20% of patients who develop post-infection sequelae. Which is NOT the same
as “antibiotics don’t work”.

Or has Stanford PR just put its size thirteen in its mouth?

(†And I don’t mean the “Lyme-literate” quacks and other AltMed scammers.)

------
Metacelsus
Reading the actual paper (the journal is Scientific Reports, which will
publish anything:
[https://www.nature.com/articles/s41598-020-59600-4](https://www.nature.com/articles/s41598-020-59600-4))
does not inspire confidence. In vitro killing is definitely not the same as in
vivo efficacy. Furthermore, the authors try to build a homology model of a
putative target protein and then dock the antibiotic. However they provide no
evidence to show their model is correct, and speaking as a biochemist, they
use completely inappropriate techniques. Their structural analysis is
meaningless. And this casts doubt on the competence of the authors.

(Also, the numerous grammar errors show that the paper wasn't edited or
reviewed at all!)

------
rb808
I can't go out of my apartment because of the virus and can't hang out in the
forest because of the bacteria in ticks. What century is this?

------
nickysielicki
I come from Wisconsin and I've been bit by ticks so many times. If you don't
deal with them you probably miss out on how tiny these little motherfuckers
are. They look like freckles. That pic with the dime is the same one on my leg
there.

[https://photos.app.goo.gl/vs4d1k8CGPekvPUC7](https://photos.app.goo.gl/vs4d1k8CGPekvPUC7)

Now imagine if it's not on your leg but in your hair. Yeah, good luck finding
that. I think it's also relevant to say that the bullseye appears less than
half the time that people get lyme, and it's not always a bullseye. I've had
weird scaly white rashes, etc.

My advice is go here and buy medicine so you don't have to bother with a
doctor. [https://fishmoxfishflex.com/collections/fish-
antibiotics](https://fishmoxfishflex.com/collections/fish-antibiotics)

Sucks, but that's the life. Take care of yourself.

edit: I highly recommend this video if you're interested in learning more
about tick-bourne diseases in the midwest, Lyme is often just the name applied
to a bunch of diseaes.
[https://www.youtube.com/watch?v=-N9rx1Vqxbc](https://www.youtube.com/watch?v=-N9rx1Vqxbc)

------
heelix
As someone who is a very active camper (pre-zombie-apocalypses summers) a
human vaccination would be wonderful. When our kid was bitten, she had the
same textbook bulls eye pattern so it was easy to see a clue. They use to have
one, but it was pulled off the market.

~~~
mc32
Yes definitely agree. With deer pop growth and climate change the ticks are
found in most places now. It’d be nice to know that if bitten they’d be more
of a nuisance than a threat to health.

~~~
acheron
There are still other tick-borne diseases. Let’s see if we can treat alpha-gal
allergy too.

------
nyxtom
This is neat, very curious about how this process has been scaled/automated:

>>> This process entails acquiring "libraries" of thousands of known chemical
compounds and drugs, then mixing Lyme bacteria with each in tiny wells to see
which ones are best at killing the organisms. The best drug candidates were
retested in larger culture dishes, then the safest of these were tested in
vivo in seven mice.

------
OliverJones
COOL! I live in a tick-infested beach community in northeast Mass, USA. Maybe
soon it won't be such a high-stakes deal for summer houseguests to inspect
themselves carefully. One guest got the dreaded, but she was lucky:
antibiotics dealt with it.

Thanks docs!

------
dj_gitmo
The author gave an interesting interview on the War Nerd podcast
[https://www.krisnewby.com/media/radio-war-
nerd](https://www.krisnewby.com/media/radio-war-nerd)

------
deesep
The roots of the plant Cryptolepis, also known as yellow-dye root, was found
to be very effective against Lyme disease. So was the the Japanese Knotweed:
[https://blog.frontiersin.org/2020/02/21/ethnobotanical-
medic...](https://blog.frontiersin.org/2020/02/21/ethnobotanical-medicine-is-
effective-against-the-bacterium-causing-lyme-disease/)

Cryptolepis contains quinine and used by some tribes in West Africa to treat
malaria.

------
onetimemanytime
So while the FDA has not approved it for this, it is an already approved drug
and people can get it, one way or another. Pretty good news

------
olliej
Wait they’ve patented the use of this drug to treat Lyme disease? That’s
something you can do?

------
ericand
"but for reasons that are unclear, the [traditional] antibiotics don't work
for up to 20% of people with the tick-borne illness"

This is very exciting for a group of people that have felt forgotten and
ignored by the medical industry

------
nsxwolf
Well shit, wrong disease right now.

~~~
mtremsal
Because of lockdowns? I find some comic relief in concurrent studies on
"Corona and Lyme".

------
fallingfrog
Of course if we had a vaccine for Lyme, which already exists for dogs, this
wouldn’t even be necessary, but hey, cures are more profitable than
prevention...

~~~
ncmncm
The story of how the Lyme disease vaccine trials were successfully sabotaged
is among the most shameful episodes in modern medicine.

------
mrfusion
Great news! Let’s hope the FDA doesn’t hold this up for years.

~~~
greenburger
Let's hope the FDA does its job of ensuring it is safe and actually works as
its proponents say. I'd rather they not give it 737 MAX style review.

~~~
jseliger
The issue is not "current practice" or "737 MAX," which is a false binary; the
main issue is whether the FDA is optimally hitting the space between "safety"
and "getting new drugs and treatments fast," and it appears that the FDA is
overly conservative. See for example _Launching the Innovation Renaissance_
[https://marginalrevolution.com/marginalrevolution/2011/12/la...](https://marginalrevolution.com/marginalrevolution/2011/12/launching-
the-innovation-renaissance.html)

~~~
greenburger
Not sure that I understand the argument. The FAA is also clearly not hitting
optimal space between "safety" and "getting new planes flying fast". Sometimes
it appears the FDA hasn't been conservative enough, see Vioxx and
labelling/guidance around opioids.

~~~
evanpw
The difference is that preventing new planes from entering the market doesn't
kill people.

~~~
hhas01
But allowing unsafe planes onto the market will.

Because this is not just about those people who are sick right now. It’s about
the many, many more who will be sick in future: useless or harmful treatments
released to market will negatively impact _all of them_ too.

So let’s not lose perspective here. The FDA does not kill people. _Diseases_
kill people. It’s the FDA’s role to reduce that toll _over time_. For there is
no problem that cannot be made still worse through addition of greed and
histrionics.

As per usual, follow the money to see who’s championing lowered standards.
Short-termism works fantastically for quarterly bonuses, not so much for
delivering decades-long improvements in the healthcare that will affect your
children and your grandchildren and your great-grandchildren too.

[https://sciencebasedmedicine.org/federal-right-to-try-
over-a...](https://sciencebasedmedicine.org/federal-right-to-try-over-a-year-
later-still-a-failure-and-still-about-the-money-and-weakening-the-fda/)

\--

Oh, and it really shouldn’t need repeating that the FDA _already provides_
early access to still experimental treatments, but I guess it does:

[https://www.fda.gov/news-events/public-health-
focus/expanded...](https://www.fda.gov/news-events/public-health-
focus/expanded-access)

You might want to consider why those calling for the FDA’s neutering commonly
fail to point that little factoid out. Since, you know, they’re wanting to
help the patients n’all.

\--

[https://www.google.com/search?tbm=isch&q=medicine+wagon](https://www.google.com/search?tbm=isch&q=medicine+wagon)

[https://www.google.com/search?q=frances+kelsey](https://www.google.com/search?q=frances+kelsey)

------
mrfusion
Has anyone tested hydroxychloroquine against Lyme disease?

~~~
danielhlockard
ah yes, the flavor of the month drug. What makes you think it'd work on Lyme.

~~~
mrfusion
Did we have any reason to think it would work on corona? (I really don’t know)

~~~
James_Henry
Yes, it is an antiviral.

~~~
thomasmeeks
It is an anti-parasitic and immune-regulation drug. Not really an antiviral. I
guess the theory is that it’d regulate an immune over-response. But I don’t
think the science is m showing that to be true in this case.

~~~
James_Henry
Yes, it is an antimalarial. It also seems to be an antiviral, too.

[https://www.ncbi.nlm.nih.gov/pubmed/8546725](https://www.ncbi.nlm.nih.gov/pubmed/8546725)

[https://www.sciencedirect.com/science/article/abs/pii/S10434...](https://www.sciencedirect.com/science/article/abs/pii/S1043466614002427)

------
AndyMcConachie
I heard a great interview with the author, Kris Newby, concerning her recent
book, Bitten.

I haven't read her book, but it sounded good, and she definitely knows what
she's talking about.

Bitten: The Secret History of Lyme Disease and Biological Weapons, By Kris
Newby.

~~~
krisn
Thanks. I've spent 3.5 years on research for the Lyme documentary UNDER OUR
SKIN, and 5.5 years of research for the book. I believe that some of the 20%
of treated patients who go on to have chronic symptoms have undetected co-
infections. The book explains the reasoning behind this. I'm giving a 20
minute online presentation on this Sat. at 11EST:
[https://zoom.us/webinar/register/6715850012795/WN_KUIbToN3S_...](https://zoom.us/webinar/register/6715850012795/WN_KUIbToN3S_OPp7cnWtIP0w)
Tick Talk

------
tenant
Coming from a farming background I spent a lot of time in close contact with
grass etc. No one I know of ever came down with something like this but now
it's becoming increasingly common though not among farmers. I have a suspicion
that a lot of the people who would have formerly complained of Fibromyalgia,
or mercury allergy, or ME are now getting this.

------
cryptogoth
To me, this is an interesting result for three reasons:

1) it appears to be effective against three main forms of the Borrelia
spirochete: the normal corkscrew shape, the round-body cyst, and biofilm (they
don't call it by that name, but say "drug-tolerant persisters" whose meaning
I'm inferring from rest of the literature).

2) it was approved to be tested in mice, which is a step on the way to human
clinical trials. Other results, such as the active compound in honeybee venom,
melittin, were only tested "ex vivo" on pigskin at body temperature.

3) it has the potential to work as quickly as antibiotics, and not 9 months to
2 years as many plant-based protocols take. Potentially without killing human
gut flora.

There is anecdotal evidence of PTLDS patients who are skilled with phlebotomy
being able to culture lyme bacteria from their blood samples after letting
them sit for a day or two, something that no conventional blood lab has time
to do.

Self-directed guide to blood microscopy to identify lyme borrelia (unverified
by me):
[https://www.healingwell.com/community/default.aspx?f=30&m=37...](https://www.healingwell.com/community/default.aspx?f=30&m=3753190)

Videos of spirochetes emerging from red blood cells (unverified by me), please
excuse funky beats. This one is a little too horrifying for me to watch, as
the bacteria is super creepy-looking. [https://howirecovered.com/lyme-disease-
under-the-microscope/](https://howirecovered.com/lyme-disease-under-the-
microscope/)

Unfortunately, the lack of peer-reviewed results to verify this could mean
either this method is not reliably reproducible, or there is no funding /
appropriately prestigious or profitable way to pursue this line of research.

It's a question I'm interested in, and would help fund as a citizen scientist.
Even without a proposed treatment, the methodology of reliably detecting Lyme
borrelia in blood could itself be patented.

I'm very grateful this kind of research continues!

~~~
fludlight
Re: #1

I think you missed the caption on the black and green picture:

> This image shows how the Lyme bacteria, Borrelia burgdorferi, form
> protective round body "persisters" when threatened by defensive immune
> system biochemicals in blood serum.

Re: #2

You don't need approvals to test in mice.

Re: #3

Antibiotics kill/greatly-diminish gut flora. Azlocillin is an antibiotic
related to penicillin.

The other promising drug mentioned, disulfiram, is nothing to be trifled with,
either:

[https://www.drugs.com/mtm/disulfiram.html](https://www.drugs.com/mtm/disulfiram.html)

[https://www.drugs.com/sfx/disulfiram-side-
effects.html](https://www.drugs.com/sfx/disulfiram-side-effects.html)

