Cerebrospinal fluid protein profiling of inflammatory and neurobiological markers in Lyme neuroborreliosis

Lyme neuroborreliosis (LNB) is the most common form of disseminated Lyme borreliosis in Europe and North America. There are limitations in existing LNB diagnostics and a lack of reliable objective markers for disease-course. Here, extensive protein profiling with two panels of 184 proteins, was done in the search for new clinically useful diagnostic and prognostic candidate biomarkers. Cerebrospinal fluid (CSF) was collected from patients with definite LNB (n = 13) at the time of diagnosis before initiating antibiotic treatment, and at a follow-up one month later. When symptoms were evaluated at a six-month follow-up, six patients had recovered with no persistent symptoms (NPS), and seven experienced delayed recovery with persistent post-treatment symptoms (PS). Orthopedic patients (n = 60) served as controls. With the panels used, no protein biomarkers able to differentiate between PS and NPS were identified. However, from a diagnostic perspective, we identified multiple proteins that were differentially expressed between LNB and controls. The majority of them were downregulated following antibiotic treatment, at the one-month follow-up. IL10, TNF, and CCL8 were considered examples of potentially useful candidate biomarkers in both the early diagnostics and in monitoring of treatment response. These markers merit further investigation to understand their utility in relation to other neurological manifestations.