Borrelia burgdorferi-specific IgA in Lyme Disease

Highlights

• Approximately one-third of all patients diagnosed with early Lyme disease have significant levels of antigen-specific IgA

• Approximately one-half of patients seropositive for IgM and/or IgG are also seropositive for IgA

• Antigen-specific IgA correlated with disseminated disease and neurological symptoms in patients with early Lyme disease

The significance of serum IgA production in patients with early Lyme disease has not been previously evaluated. In the present study, we demonstrated that IgA antibodies against Borrelia burgdorferi, the causative agent of Lyme disease, were present in ~ 33% of patients diagnosed with early disease. Anti-B. burgdorferi IgA production correlated with disseminated disease as well as neurological manifestations in a subset of these patients. Though further study is necessary, these results suggest that monitoring serum IgA could have potential diagnostic and/or prognostic value in early Lyme disease.

Abstract

The laboratory diagnosis of Lyme disease is currently dependent on the detection of IgM and IgG antibodies against Borrelia burgdorferi, the causative agent of the disease. The significance of serum IgA against B. burgdorferi remains unclear. The production of intrathecal IgA has been noted in patients with the late Lyme disease manifestation, neuroborreliosis, but production of antigen-specific IgA during early disease has not been evaluated. In the current study, we assessed serum IgA binding to the B. burgdorferi peptide antigens, C6, the target of the FDA-cleared C6 EIA, and FlaB(211-223)-modVlsE(275-291), a peptide containing a Borrelia flagellin epitope linked to a modified VlsE sequence, in patients with early and late Lyme disease. Specific IgA was detected in 59 of 152 serum samples (38.8%) from early Lyme disease patients. Approximately 50% of early Lyme disease patients who were seropositive for peptide-specific IgM and/or IgG were also seropositive for peptide-specific IgA. In a subpopulation of patients, high peptide-specific IgA could be correlated with disseminated disease, defined as multiple erythema migrans lesions, and neurological disease complications. These results suggest that there may be an association between elevated levels of antigen-specific IgA and particular disease manifestations in some patients with early Lyme disease.