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Nathan Goodyear

Normalization of testosterone level is associated with reduced incidence of myocardial ... - 0 views

eurheartj.oxfordjournals.org/...eurheartj.ehv346

low T low Testosterone men Testosterone mortality stroke MI CVD cardiovascular disease hormones male

shared by Nathan Goodyear on 11 Aug 15 - No Cached
  • Normalized-TRT group had significantly fewer deaths than no-TRT
  • Mortality was also significantly lower in the non-normalized-TRT group compared with those in no-TRT group
  • the normalized-TRT group was associated with significantly increased all-cause mortality-free survival (log-rank, P < 0.05) compared with the non-normalized-TRT or no-TRT groups
  • ...10 more annotations...
  • normalized-TRT group showed lower risk of MI than non-normalized-TRT (HR: 0.82, CI 0.71–0.95, P = 0.008) and no-TRT
  • normalized-TRT group had significantly lower stroke events compared with non-normalized-TRT (HR: 0.70, CI 0.51–0.96, P = 0.028) and no-TRT
  • study of men with low TT levels and without prior MI or stroke, normalization of TT levels using TRT is associated with lower all-cause mortality, fewer MIs, and ischaemic strokes
  • retrospective study
  • the first study to demonstrate that significant benefit is observed only if the dose is adequate to normalize the TT levels
  • Patients who failed to achieve the therapeutic range after TRT did not see a reduction in MI or stroke and had significantly less benefit on mortality
  • selected patients without any previous history of MI or stroke prior to initiation of TRT to reduce bias related to CV outcomes
  • currently only half of the men on TRT had been diagnosed with hypogonadism.
  • 25% of users did not have their T concentrations tested prior to initiating therapy, and 21% of those prescribed TRT did not have their levels tested at any time during treatment.
  • men without a history of previous MI or stroke who have low TT levels, TRT might be associated with decreased risks of MI, ischaemic stroke, and all-cause mortality in long-term follow-up
  • Nathan Goodyear on 11 Aug 15
     
    Testosterone therapy in men with low T found to reduce all cause mortality, stroke and MI.
Nathan Goodyear

Multivitamin use and the risk of myocardial infarction: a population-based cohort of Sw... - 0 views

www.ajcn.org/...1251.abstract

multivitamin

shared by Nathan Goodyear on 20 Jan 11 - No Cached
  • he use of multivitamins was inversely associated with MI, especially long-term use among women with no CVD
  • Nathan Goodyear on 20 Jan 11
     
    Multivitamins reduce heart attack risk in women
Nathan Goodyear

Thyroid hormone attenuates cardiac remodeling and ... [Eur J Cardiothorac Surg. 2007] -... - 0 views

www.ncbi.nlm.nih.gov/...17560116

thyroid hormone Cardiovascular disease

shared by Nathan Goodyear on 02 Feb 11 - No Cached
  • CONCLUSIONS: Thyroid hormone administration early after infarction attenuates cardiac remodeling and significantly improves myocardial performance.
  • Nathan Goodyear on 02 Feb 11
     
    Wow, Thyroid replacement after MI, improves heart function and reduces damage
Nathan Goodyear

Coenzyme Q10 and statins: biochemical and clinical... [Mitochondrion. 2007] - PubMed re... - 0 views

www.ncbi.nlm.nih.gov/...17482884

Statins CoQ10

shared by Nathan Goodyear on 07 Feb 11 - No Cached
  • physicians should be aware of this drug-nutrient interaction and be vigilant to the possibility that statin drugs may, in some cases, impair skeletal muscle and myocardial bioenergetics.
  • Nathan Goodyear on 07 Feb 11
     
    Statins not good for those who have CoQ10 dysfunction
Nathan Goodyear

Direct effects of thyroid hormones on rat coronary... [Thyroid. 1998] - PubMed result - 0 views

www.ncbi.nlm.nih.gov/...9709915

T3 vasodilation rT3

shared by Nathan Goodyear on 01 Feb 11 - No Cached
  • Our results also suggest that thyroid hormones may play a role in preventing myocardial ischemia by inducing coronary artery vasodilation.
  • Nathan Goodyear on 01 Feb 11
     
    T3 increases vasodilation of arteries and improves cardiac blood flow in rat model; rT3 does not
Nathan Goodyear

Magnesium metabolism in health and disease. [Dis Mon. 1988] - PubMed result - 0 views

www.ncbi.nlm.nih.gov/...3282851

magnesium disease health

shared by Nathan Goodyear on 21 Mar 11 - No Cached
  • Less than 1% of the total body magnesium is present in blood
  • A large segment of the U.S. population may have an inadequate intake of magnesium and may have a chronic latent magnesium deficiency that has been linked to atherosclerosis, myocardial infarction, hypertension, cancer, kidney stones, premenstrual syndrome, and psychiatric disorders.
  • Nathan Goodyear on 21 Mar 11
     
    Magnesium in health and disease
Nathan Goodyear

ScienceDirect - American Heart Journal : Plasma total cysteine and total homocysteine a... - 0 views

www.sciencedirect.com/...S0002870310000815

elevated homocysteine MI risk cardiac

shared by Nathan Goodyear on 03 Aug 11 - No Cached
  • Fasting homocysteine was positively associated with MI risk
  • Fasting plasma concentration of total homocysteine, but not total cysteine, was positively associated with MI risk.
  • Nathan Goodyear on 03 Aug 11
     
    homocysteine associated with MI risk
Nathan Goodyear

High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fat... - 0 views

www.thelancet.com/...abstract

apolipoprotein B A-1 cardiovascular risk AMORIS cardiac

shared by Nathan Goodyear on 03 Aug 11 - No Cached
  • Nathan Goodyear on 03 Aug 11
     
    BCBS says that there is not enough evidence to support apolipoprotein testing?!  Somehow they missed this 2001 article
Nathan Goodyear

Calcium supplements with or without vitamin D and ... [BMJ. 2011] - PubMed result - 0 views

www.ncbi.nlm.nih.gov/...21505219

calcium supplements cardiovascular events women MI myocardial infarction

shared by Nathan Goodyear on 15 Aug 11 - No Cached
  • Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events
  • Nathan Goodyear on 15 Aug 11
     
    Nutrient levels must be evaluated prior to therapy.  Calcium supplementation increases cardiovascular events in women.
Nathan Goodyear

Thyroid Replacement Therapy and Heart Failure - 0 views

circ.ahajournals.org/...385.full

thyroid T3 hormone hormones cardiovascular disease heart health failure CHF MI myocardial infarction heart attack heart disease

shared by Nathan Goodyear on 24 Sep 14 - No Cached
  • A good biomarker of intracardiac TH signaling would be helpful but has not been identified. In the absence of such a marker, a rational, cautious therapeutic approach might be to restore and maintain over time biochemical euthyroidism as documented by normal circulating levels of TSH, FT4, and FT3.
  • a low-T3 state resulting from altered peripheral TH metabolism secondary to caloric restriction is associated with impaired cardiac contractility
  • Low-T3 syndrome is the central finding and defines the illness in a variety of acute and chronic severe nonthyroidal illnesses with cardiac origin, including MI, HF, and surgically treated cardiac disease.1 Low circulating levels of T3 in the absence of primary thyroid hypofunction have been found in 20% to 30% of patients with dilated cardiomyopathy.
  • ...1 more annotation...
  • FT3 levels were inversely correlated to coronary artery disease
  • Nathan Goodyear on 24 Sep 14
     
    Great review of the current understanding of thyroid hormone metabolism in cardiac tissue.  Low T3 and increased rT3 (via increased D3 activity) is CLEARLY associated with poor cardiac performance and post MI and CHF is associated with poor outcomes.  T3 is critical in cardiac remodeling and recovery post MI.  T3 is actually a vasodilatory in the coronary arteries.   Why a endocrinologist would call rT3 useless only points to their ignorance of the literature.
Nathan Goodyear

American College of Cardiology Foundation | Journal of the American College of Cardiolo... - 0 views

content.onlinejacc.org/article.aspx

lipoprotein(a) Lp(a) cardiovascular disease risk heart health

shared by Nathan Goodyear on 26 Aug 14 - No Cached
  • Lp(a) is a circulating lipoprotein composed of liver-derived apo(a) covalently bound to apoB, which is similar in lipid composition to apoB of LDL
  • multiple studies have shown that elevated Lp(a) levels are independently and linearly predictive of future CVD
  • higher levels were continuously related to risk of myocardial infarction.
  • Nathan Goodyear on 26 Aug 14
     
    good discussion of Lipoprotein(a) and its associated cardiovascular risk.
Nathan Goodyear

High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fat... - 0 views

www.thelancet.com/...fulltext

lipoproteins apolipoproteins apo B apo A1 Apo B:Apo A1 Apolipoprotein B Apolipoprotien A1 cholesterol heart health cardiovascular disease risk

shared by Nathan Goodyear on 26 Aug 14 - No Cached
  • Nathan Goodyear on 26 Aug 14
     
    Study finds strong correlation between Apo B and Apo B:apo A1 in fatal MI risk in men and women.  Apo B was a stronger than LDL in predicting risk in men and women.  Apo A1 was noted to be protective, but the stats were less strong.
Nathan Goodyear

Sex Hormone Levels in Patients with Sudden Cardiac Arrest - Heart Rhythm - 0 views

www.heartrhythmjournal.com/...abstract

hormone hormones Testosterone Estrogen men women heart health cardiac arrest myocardial infarction cardiovascular disease

shared by Nathan Goodyear on 07 Sep 14 - No Cached
  • Nathan Goodyear on 07 Sep 14
     
    Study looked at hormone levels via serum analysis at the time of sudden cardiac arrest in both men and women.  Low Testosterone and elevated Estrogen levels in  men were associated with increased odds (OR) versus women only had increased odds with elevated Estrogen.   ManBoob nation, my first book, discusses the mechanism behind this for men.  The finding in women really calls into question the Estrogen only model currently employed by physicians for post menopausal women.
Nathan Goodyear

Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy - 0 views

aop.sagepub.com/...1138.abstract

testosterone therapy treatment MI heart disease cardiovascular men male hormone hormones health men's health

shared by Nathan Goodyear on 15 Aug 14 - No Cached
  • Nathan Goodyear on 15 Aug 14
     
    Testosterone therapy in older men found to provide no increase in MI risk.  In fact, those men with high MI risk, Testosterone provided protection against MI.
Nathan Goodyear

Testosterone level in men with type 2 diabetes mellitus and related metabolic... - 0 views

www.ncbi.nlm.nih.gov/...PMC4364844

low T low Testosterone Diabetes Testosterone men male hormones metabolic syndrome

shared by Nathan Goodyear on 30 Mar 15 - No Cached
  • defined by consistent symptoms and signs of androgen deficiency, and an unequivocally low serum testosterone level
  • the threshold serum testosterone level below which adverse clinical outcomes occur in the general population is not known
  • most population-based studies use the serum testosterone level corresponding to the lower limit, quoted from 8.7 to 12.7 nmol/L, of the normal range for young Caucasian men as the threshold
    • Nathan Goodyear
      Nathan Goodyear on 31 Mar 15
       
      this equals 251 to 366 in serum Total Testosterone
  • ...57 more annotations...
  • Researchers tried to examine whether serum total or free testosterone would be a better/more reliable choice when studying the effect of testosterone. The results were mixed. Some reported significant associations of both serum total and free testosterone level with clinical parameters25, whereas others reported that only serum free testosterone26 or only serum total testosterone6 showed significant associations.
  • −0.124 nmol/L/year in serum total testosterone
    • Nathan Goodyear
      Nathan Goodyear on 31 Mar 15
       
      this equates to a 4 ng/dl decline annually in total Testosterone.
  • In experimental studies, androgen receptor knockout mice developed significant insulin resistance rapidly
  • In mouse models, testosterone promoted differentiation of pluripotent stem cells to the myogenic lineage
  • testosterone decreased insulin resistance by enhancing catecholamine induced lipolysis in vitro, and reducing lipoprotein lipase activity and triglyceride uptake in human abdominal tissue in vivo
  • by promoting lipolysis and myogenesis, testosterone might lead to improved insulin resistance
  • testosterone regulated skeletal muscle genes involved in glucose metabolism that led to decreased systemic insulin resistance
  • In the liver, hepatic androgen receptor signaling inhibited development of insulin resistance in mice
  • independent and inverse association of testosterone with hepatic steatosis shown in a cross-sectional study carried out in humans
  • In short, androgen improves insulin resistance by changing body composition and reducing body fat.
  • Although a low serum testosterone level could contribute to the development of obesity and type 2 diabetes through changes in body composition, obesity might also alter the metabolism of testosterone
  • In obese men, the peripheral conversion from testosterone to estrogen could attenuate the amplitude of luteinizing hormone pulses and centrally inhibit testosterone production
  • leptin, an adipokine, has been shown to be inversely correlated with serum testosterone level in men
  • Leydig cells expressed leptin receptors and leptin has been shown to inhibit testosterone secretion, suggesting a role of obesity and leptin in the pathogenesis of low testosterone
    • Nathan Goodyear
      Nathan Goodyear on 31 Mar 15
       
      So what is "unequivocal"?
  • Baltimore Longitudinal Study of Aging (BLSA) cohort made up of 3,565 middle-class, mostly Caucasian men from the USA, the incidence of low serum total testosterone increased from approximately 20% of men aged over 60 years, 30% over 70 years, to 50% over 80 years-of-age
  • 30–44% sex hormone binding globulin (SHBG)-bound testosterone and 54–68% albumin-bound testosterone
  • As the binding of testosterone to albumin is non-specific and therefore not tight, the sum of free and albumin-bound testosterone is named bioavailable testosterone, which reflects the hormone available at the cellular level
  • Serum total testosterone is composed of 0.5–3.0% of free testosterone unbound to plasma proteins
  • alterations in SHBG concentration might affect total serum testosterone level without altering free or bioavailable testosterone
  • listed in Table​T
  • A significant, independent and longitudinal effect of age on testosterone has been observed with an average change of −0.124 nmol/L/year in serum total testosterone28. The same trend has been shown in Europe and Australia
  • Asian men residing in HK and Japan, but not those living in the USA, had 20% higher serum total testosterone than in Caucasians living in the USA, as shown in a large multinational observational prospective cohort of the Osteoporotic Fractures in Men Study
  • subjects with chronic diseases consistently had a 10–15% lower level compared with age-matched healthy subjects
  • In Caucasians, the mean serum total testosterone level for men in large epidemiological studies has been reported to range from 15.1 to 16.6 nmol/L
  • Asians, higher values, ranging from 18.1 to 19.1 nmol/L, were seen in Korea and Japan
  • Chinese middle-aged men reported a similar mean serum testosterone level of 17.1 nmol/L in 179 men who had a family history of type 2 diabetes and 17.8 nmol/L in 128 men who had no family history of type 2 diabetes
  • The reduction of total testosterone was 0.4% per year in both groups
  • HK involving a cohort of 1,489 community-dwelling men with a mean age of 72 years, a mean serum total testosterone of 19.0 nmol/L was reported
  • pro-inflammatory factors, such as tumor necrosis factor-α in the testes, could locally inhibit testosterone biosynthesis in Leydig cells47, and testosterone treatment in men was shown to reduce the level of tumor necrosis factor-α
  • In Asians, a genetic deletion polymorphism of uridine diphosphate-glucuronosyltransferase UGT2B17 was associated with reduced androgen glucuronidation. This resulted in higher level of active androgen in Asians as compared to Caucasians, as Caucasians' androgen would be glucuronidated into inactive forms faster.
  • Compared with Caucasians, the frequency of this deletion polymorphism of UGT2B17 was 22-fold higher in Asian subjects
  • Other researchers have suggested that environmental, but not genetic, factors influenced serum total testosterone
  • The basal and ligand-induced activity of the AR is inversely associated with the length of the CAG repeat chain
  • In the European Male Aging Study, increased estrogen/androgen ratio in association with longer AR CAG repeat was observed
  • a smaller number of AR CAG repeat had been shown to be associated with benign prostate hypertrophy and faster prostate growth during testosterone treatment
  • In India, men with CAG ≤19 had increased risk of prostate cancer
  • the odds of having a short CAG repeat (≤17) were substantially higher in patients with lymph node-positive prostate cancer than in those with lymph node-negative disease or in the general population
  • assessing the polymorphism at the AR level could be a potential tool towards individualized assessment and treatment of hypogonadism.
  • In elderly men, there was reduced testicular response to gonadotropins with suppressed and altered pulsatility of the hypothalamic pulse generator
  • a significant, independent and longitudinal effect of age on serum total testosterone level had been observed
  • A significant graded inverse association between serum testosterone level and insulin levels independent of age has also been reported in Caucasian men
  • Low testosterone is commonly associated with a high prevalence of MES
  • most studies showed that changes in serum testosterone level led to changes in body composition, insulin resistance and the presence of MES, the reverse might also be possible
  • MES predicted a 2.6-fold increased risk of development of low serum testosterone level independent of age, smoking and other potential confounders
  • Other prospective studies have shown that development of MES accelerated the age-related decline in serum testosterone level
  • In men with type 2 diabetes, changes in serum testosterone level over time correlated inversely with changes in insulin resistance
  • weight loss by either diet control or bariatric surgery led to a substantial increase in total testosterone, especially in morbidly obese men, and the rise in serum testosterone level was proportional to the amount of weight lost
  • To date, published clinical trials are small, of short duration and often used pharmacological, not physiological, doses of testosterone
  • In the population-based Osteoporotic Fractures in Men Study cohort from Sweden, men in the highest quartile of serum testosterone level had the lowest risk of cardiovascular events compared with men in the other three quartiles (hazard ratio [HR] 0.70
  • low serum total testosterone was associated with a significant fourfold higher risk of cardiovascular events when comparing men from the lowest testosterone tertile with those in the highest tertile
  • Shores et al. were the first to report that low serum testosterone level, including both serum total and free testosterone, was associated with increased mortality
  • low serum total testosterone predicted increased risk of cardiovascular mortality with a HR of 1.38
  • low serum total testosterone increased all-cause (HR 1.35, 95% CI 1.13–1.62, P < 0.001) and cardiovascular mortality (HR 1.25
  • European Association for the Study of Diabetes 2013 suggested there was an inverse relationship between serum testosterone level and acute myocardial infarction
  • Diabetic men in the highest quartile of serum total testosterone had a significantly reduced risk of acute MI when compared with those in the lower quartiles
  • serum total testosterone level in the middle two quartiles at baseline predicted reduced incidence of death compared with having the highest and lowest levels
  • Nathan Goodyear on 30 Mar 15
     
    Nice review of Testosterone levels and some of the evidence linking Diabetes with low T.  However, the conclusion by the authors regarding what is causing the low T in men with Diabetes is baffling.  The literature does not point to one cause, it is clearly multifactorial--obesity, inflammation, high aromatase activity...I would suggest the authors continue their readings in the manner.
Nathan Goodyear

Normalization of testosterone level is associated with reduced incidence of myocardial ... - 0 views

eurheartj.oxfordjournals.org/...2706

low T low Testosterone Testosterone Testosterone therapy mortality MI stroke heart men male hormones

shared by Nathan Goodyear on 18 Jan 16 - No Cached
  • In this study of men with low TT levels and without prior MI or stroke, normalization of TT levels using TRT is associated with lower all-cause mortality, fewer MIs, and ischaemic strokes.
  • retrospective study
  • significant benefit is observed only if the dose is adequate to normalize the TT levels
  • ...9 more annotations...
  • the mechanisms for these effects remain speculative
  • It can be postulated that the beneficial effect of normal T levels on adipose tissue, insulin sensitivity, and lipid profiles or by its anti-inflammatory and anticoagulant properties, as reported by other investigators, might have contributed to our findings
  • off-label use of TRT remains a concern
  • Recent FDA analyses suggest that currently only half of the men on TRT had been diagnosed with hypogonadism
  • 25% of users did not have their T concentrations tested prior to initiating therapy
  • 21% of those prescribed TRT did not have their levels tested at any time during treatment
  • two very recent meta-analyses suggested a lack of convincing evidence posed by TRT.
  • men without a history of previous MI or stroke who have low TT levels, TRT might be associated with decreased risks of MI, ischaemic stroke, and all-cause mortality in long-term follow-up
  • TRT should aim for doses resulting in normalization of TT level as this was shown to be associated with reduction in adverse CV events
  • Nathan Goodyear on 18 Jan 16
     
    Testosterone therapy in men with low T to restore physiologic Testosterone levels found to reduce mortality, MI, and stroke risk.
Nathan Goodyear

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease - NEJM - 0 views

www.nejm.org/...NEJMoa1707914

inflammation lipids cholesterol atherothrombosis cardiovascular disease CRP myocardial infarction stroke cardiovascular death

shared by Nathan Goodyear on 05 Sep 17 - No Cached
  • Nathan Goodyear on 05 Sep 17
     
    new study challenges the cholesterol = cardiovascular event story?  Good science asks questions and challenges dogma.  The authors claim the inflammatory hypothesis of atherothrombosis is yet unproven?  Maybe they need to get out and read more.  The point here Is not the drug in question, but the fact that a reduction in inflammation reduced recurrent cardiovascular events independent of cholesterol.
Nathan Goodyear

Late Disseminated Lyme Disease: Associated Pathology and Spirochete Persistence Post-Tr... - 0 views

ajp.amjpathol.org/...fulltext

Lyme Lyme disease borrelia burgdorferi

shared by Nathan Goodyear on 14 Dec 17 - No Cached
  • In this study, we have demonstrated microscopic pathology ranging from minimal to moderate in multiple different tissues previously reported to be involved with LD, including the nervous system (central and peripheral), heart, skeletal muscle, joint-associated tissues, and urinary bladder 12 to 13 months following tick-inoculation of rhesus macaques by Bb strain B31
  • Based on histomorphology, inflammation consisted predominantly of lymphocytes and plasma cells, with rare scattered histiocytes
  • in rare instances, morphologically intact spirochetes were observed in inflamed brain and heart tissue sections from doxycycline-treated animals
  • ...41 more annotations...
  • colocalization of the Bb 23S rRNA probe was not observed in any of the sections of experimental inoculated animals shown to harbor rare persistent spirochetes (Supplemental Figure S1). Previous in vitro work has shown large decreases in Bb rRNA levels when in a stationary phase of growth despite the majority of spirochetes remaining viable
  • The possibility that the spirochetes were intact but dead also exists, though this may be unlikely given the precedence for viable but non-cultivable B. burgdorferi post-treatment
  • The doxycycline dose utilized in this study (5mg/kg) was based on a previous pharmacokinetic analysis of oral doxycycline in rhesus macaques proven to be comparable to levels achieved in humans and was meant to mimic treatment of disseminated LD
  • In addition to the brain of two treated animals, rare morphologically intact spirochetes immunoreactive to OspA were observed in the heart of one treated animal
  • Although we did not measure the doxycycline levels in the cerebrospinal fluid, they have been found to be 12% to 15% of the amount measured in serum
  • We and others have demonstrated the development of a drug-tolerant persister population when B. burgdorferi are treated with antibiotics in vitro
  • The adoption of a dormant or slow-growing phenotype likely allows the spirochetes to survive and re-grow following removal of antibiotic
  • The basic premise that antibiotic tolerance may be an adaptation of the sophisticated stringent response required for the enzootic cycle by the spirochetes is described in a recent review as well
  • Although current IDSA guidelines recommend intravenous ceftriaxone (2g daily for 30 days) over oral doxycycline for treatment of neuroborreliosis, a randomized clinical trial failed to show any enhanced efficacy of I.V. penicillin G to oral doxycycline for treatment of Lyme neuroborreliosis (no treatment failures were reported in this study of 54 patients).
  • we can speculate that the minimal to moderate inflammation that was observed, especially within the CNS and PNS can, in part, explain the breadth of symptoms experienced by late stage Lyme disease patients, such as cognitive impairment and neuralgia.
  • Erythema migrans, the clinical hallmark of early localized Lyme disease, was observed in one of the rhesus macaques from this study.
  • In 2014, a trailblazing study in mice demonstrated a dramatic decline in B. burgdorferi DNA in the tissues for up to eight months after antibiotic treatment followed by the resurgence of B. burgdorferi growth 12 months after treatment
  • This study provides evidence that the slow-growing spirochetes which persist after treatment, but are not cultivable in standard growth media may remain viable.
  • The first well-documented indication of Lyme disease (LD) in the United States occurred in the early 1970s
  • Lyme, Connecticut.
  • Lyme disease is now known to be caused by multiple closely related genospecies classified within the Bb sensu lato complex, representing the most common tick-borne human disease in the Northern Hemisphere
  • approximately 30,000 physician-reported cases occur annually in the United States, the annual incidence has been estimated to be 10-fold higher by the Centers for Disease Control and Prevention.6
  • Current antibiotic therapy guidelines outlined by the Infectious Disease Society of America (IDSA) are successful in the treatment of LD for the majority of LD patients, especially when administered early in disease immediately following identification of erythema migrans (EM)
  • ‘post-treatment Lyme disease syndrome’ (PTLDS)
  • host-adapted spirochetes that persist in the tissues, probably in small numbers, inaccessible or impervious to antibiotic
  • inflammatory responses to residual antigens from dead organisms
  • residual tissue damage following pathogen clearance;
  • autoimmune responses, possibly elicited by antigenic mimicry
  • Experimental studies on immunocompetent mice, dogs, and rhesus macaques have provided evidence for the persistence of Bb spirochetes subsequent to antibiotic treatment in the form of residual spirochetes detected within tissue by IFA and PCR, and recovered by xenodiagnoses
  • Ten male rhesus macaques
  • half (five) of the NHP received antibiotic treatment, consisting of 5 mg/kg oral doxycycline twice per day.
  • Minimal and focal lymphoplasmacytic inflammation
  • inflammation was observed in the leptomeninges overlying a section of temporal cerebral cortex
  • Minimal localized lymphoplasmacytic choroiditis
  • Peripheral nerves contained minimal to moderate lymphoplasmacytic inflammation with a predilection for collagen-rich epineurium and perivascular spaces
  • Inflammation was observed in 56% (5/9) of the NHPs irrespective of treatment group
  • For all animals, inflammation was reserved to perineural tissue
  • The treatment lasted 28 days
  • Minimal to mild lymphoplasmacytic inflammation of either the myocardial interstitium (Figure 2Figure 2A), pericardium (Figure 2Figure 2B), or combination therein was observed in 60% of NHPs
  • A single morphologically intact spirochete, as indicated by positive red immunofluorescence (Figure 2Figure 2C), was observed in the myocardium of one treated animal
  • mild, multifocal lymphoplasmacytic inflammation was observed in one doxycycline-treated animal
  • three animals exhibited minimal to mild lymphoplasmacytic inflammation affecting joint-associated structures
  • 10% to -20% of human patients treated
  • Multiple randomized placebo-controlled studies which evaluated sustained antimicrobial therapy concluded that there is no benefit in alleviating patients’ symptoms and indicated that long-term antibiotic therapy may even be detrimental to patients due to potential associated complications (ie, catheter infection and/or clostridial colitis)
  • and the rapid clearance of dead spirochetes in a murine model
  • higher doses may be needed to combat neuroborreliosis
  • Nathan Goodyear on 14 Dec 17
     
    persistent borrelia burgdorferia were found in the brain (2) and the heart (1) up to 13 months post standard antibiotic treatment suggesting borrelia burdorferia, the cause of Lyme, can persist in a chronic, persistant state poste acute treatment.
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