Clarifying roles of Borrelia burgdorferi outer surface proteins during disease dissemination and pathogenesis to aid in prediction of optimal immunogenic targets for point of care testing alternatives

The testing paradigm for Lyme disease diagnosis has remained largely unchallenged and unchanged for nearly 30 years. Many of the challenges associated with new diagnostic developments are attributed towards Borrelia’s quick hematogenous dissemination into body tissues and challenges associated with characterization of the bacteria’s many proteins that can be utilized for identification. For these presented challenges, identification of Borrelia burgdorferi via its proteins is often quickly dismissed and considered unfeasible. However, continued efforts to identify Borrelia’s proteins and their functions, as well as advancements in diagnostic assays, may suggest a second, more in-depth evaluation using circulating antigens of Borrelia burgdorferi for plausible diagnostic alternatives. The goals of this review were to gain a better understanding of the outer surface protein profile of Borrelia burgdorferi B31, specifically their functions as they correlate to pathogenesis and dissemination. Understanding when and where certain proteins are expressed may aid in narrowing down potential candidates for further evaluation as immunotargets for point-of-care antigen-based assays. In summation, additional research is critically needed to further define the characteristics and protein profile of Borrelia burgdorferi. While this review highlights many possible targets available for further study, 11 proteins in total are recommended for further analysis. Highlighting the knowledge gaps on Borrelia proteins is of public health importance for identifying immunotargets to improve diagnostic success and serve as possible vaccine targets to reduce the overwhelming burden of disease as the most common vector borne disease in the U.S.