Dynamics of IgM and IgG responses in Lyme neuroborreliosis – a Norwegian longitudinal study

PURPOSE: We investigated longitudinal antibody responses against 13 different Borrelia burgdorferi (Bb) antigens in patients with Lyme neuroborreliosis (LNB) and explored whether antibody profiles were linked to length of symptoms and burden of symptoms prior to and after initiation of treatment. METHODS: A well-characterized cohort of 106 patients of whom 85% had definite LNB were followed for twelve months, with serum and cerebrospinal fluid (CSF) sampled at baseline, six- and twelve-months follow-up. Antibodies were measured by the recomBead Borrelia IgG and IgM assay, with a subgroup examined for oligoclonal IgG production restricted to CSF. RESULTS: Antibody levels in both serum and CSF declined gradually after antibiotic treatment, with most of the reduction occurring within the first six months after treatment. Higher baseline IgM reactivity against p18 in both serum and CSF was associated with higher symptom burden prior to treatment. We found no differences in CSF antibody reactivity between patients with short (< 42 days) and long (≥ 42 days) symptom duration prior to treatment. In serum, patients with short symptom duration prior to treatment had higher IgM reactivity against p58 and higher IgG reactivity against OspC and p18. At baseline, 68% exhibited oligoclonal IgG production, falling to 41% six months after treatment. There was no correlation between oligoclonal IgG production and symptom burden. CONCLUSION: Both specific antibody production against a variety of antigens and intrathecal oligoclonal IgG production decreased after treatment for LNB, reflecting reduced antigenic load and thus reduced neuroinflammation. IgM and IgG reactivity against p18 were indicative of a shorter symptom duration and higher symptom burden prior to treatment.