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Lyme Disease

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A long personal struggle with Lyme disease prompted me to review the current literature to better understand what remains elusive to researchers and physicians. Lyme disease was first discovered in Connecticut in the mid-1970’s, however, in Europe, it was already

A long personal struggle with Lyme disease prompted me to review the current literature to better understand what remains elusive to researchers and physicians. Lyme disease was first discovered in Connecticut in the mid-1970’s, however, in Europe, it was already being treated with antibiotics. The disease is caused by a spirochete bacteria named Borrelia burgdorferi after the scientist who married the European syndromes associated with the microbe to the disease found in the United States. Borrelia burgdorferi is capable of evading the immune system through a variety of methods, some of which are still not clearly understood. Treatment for Lyme disease is effective and involves antibiotics over a variable duration depending on the presentation of the disease. Post-treatment Lyme Disease Syndrome (PTLDS) is the heart of the controversy surrounding this disease as patients continue to have debilitating symptoms with no clear cause.

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Date Created
2020-05

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For Ashley: A Plan of Care for her Chronic Illness Illustrated in a Blog

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This past summer, I met a young lady named Ashley (name has been changed) who has been diagnosed with chronic Lyme disease. Upon researching this condition in greater detail, I learned that many medical providers who base their practice on

This past summer, I met a young lady named Ashley (name has been changed) who has been diagnosed with chronic Lyme disease. Upon researching this condition in greater detail, I learned that many medical providers who base their practice on the best evidence do not support treating patients for a chronic Lyme infection, the existence of which has not been substantially supported with research. I inquired about the process that led her to seek treatment for chronic Lyme disease at Jemsek Specialty Clinic. I learned that after many inaccurate diagnoses and years of unhelpful treatments, Ashley finally rejected the help offered by traditional medical doctors because she felt they were uncaring and inattentive, and went somewhere she felt heard. What she deserved, however, was both care that was based in scientific research and care that felt compassionate, as has been promoted by the nursing field. Despite the lack of a confirmed medical diagnosis, Ashley's day to day symptoms and struggles could be addressed with nursing care. I then constructed a nursing care plan to be implemented by Ashley's family and friends to help her feel her best and live a fulfilling life despite chronic disease. Patients should not have to choose between a healthcare provider who utilizes the strongest scientific evidence and one they feel understands them, though many do. Nursing can unite these mindsets by alleviating the daily challenges patients face. Please see the website http://careplanforashley.blogspot.com

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Created

Date Created
2014-05

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Identification of structural mechanisms that modulate glycosaminoglycan affinity in various strains of decorin binding protein A

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Glycosaminoglycans (GAGs) are a class of complex biomolecules comprised of linear, sulfated polysaccharides whose presence on cell surfaces and in the extracellular matrix involve them in many physiological phenomena as well as in interactions with pathogenic microbes. Decorin binding protein

Glycosaminoglycans (GAGs) are a class of complex biomolecules comprised of linear, sulfated polysaccharides whose presence on cell surfaces and in the extracellular matrix involve them in many physiological phenomena as well as in interactions with pathogenic microbes. Decorin binding protein A (DBPA), a Borrelia surface lipoprotein involved in the infectivity of Lyme disease, is responsible for binding GAGs found on decorin, a small proteoglycan present in the extracellular matrix. Different DBPA strains have notable sequence heterogeneity that results in varying levels of GAG-binding affinity. In this dissertation, the structures and GAG-binding mechanisms for three strains of DBPA (B31 and N40 DBPAs from B. burgdorferi and PBr DBPA from B. garinii) are studied to determine why each strain has a different affinity for GAGs. These three strains have similar topologies consisting of five α-helices held together by a hydrophobic core as well as two long flexible segments: a linker between helices one and two and a C-terminal tail. This structural arrangement facilitates the formation of a basic pocket below the flexible linker which is the primary GAG-binding epitope. However, this GAG-binding site can be occluded by the flexible linker, which makes the linker a negative regulator of GAG-binding. ITC and NMR titrations provide KD values that show PBr DBPA binds GAGs with higher affinity than B31 and N40 DBPAs, while N40 binds with the lowest affinity of the three. Work in this thesis demonstrates that much of the discrepancies seen in GAG affinities of the three DBPAs can be explained by the amino acid composition and conformation of the linker. Mutagenesis studies show that B31 DBPA overcomes the pocket obstruction with the BXBB motif in its linker while PBr DBPA has a retracted linker that exposes the basic pocket as well as a secondary GAG-binding site. N40 DBPA, however, does not have any evolutionary modifications to its structure to enhance GAG binding which explains its lower affinity for GAGs. GMSA and ELISA assays, along with NMR PRE experiments, confirm that structural changes in the linker do affect GAG-binding and, as a result, the linker is responsible for regulating GAG affinity.

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Created

Date Created
2015

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Membrane-directed Expression of BBA57 and Other Virulence Targets from Borrelia burgdorferi Reveals Structural Evidence of an Outer Membrane Oligomer in the Lyme Disease Pathogen

Description

Borrelia burgdorferi (Bb), the causative agent of Lyme disease, is a unique pathogen, with a complex genome and unique immune evasion tactics. It lacks genes encoding proteins involved in nutrient synthesis and typical metabolic pathways, and therefore relies on the

Borrelia burgdorferi (Bb), the causative agent of Lyme disease, is a unique pathogen, with a complex genome and unique immune evasion tactics. It lacks genes encoding proteins involved in nutrient synthesis and typical metabolic pathways, and therefore relies on the host for nutrients. The Bb genome encodes both an unusually high number of predicted outer surface lipoproteins of unknown function but with multiple complex roles in pathogenesis, and an unusually low number of predicted outer membrane proteins, given the necessity of bringing in the required nutrients for pathogen survival. Cellular processing of bacterial membrane proteins is complex, and structures of proteins from Bb have all been solved without the N-terminal signal sequence that directs the protein to proper folding and placement in the membrane. This dissertation presents the first membrane-directed expression in E. coli of several Bb proteins involved in the pathogenesis of Lyme disease. For the first time, I present evidence that the predicted lipoprotein, BBA57, forms a large alpha-helical homo-multimeric complex in the OM, is soluble in several detergents, and purifiable. The purified BBA57 complex forms homogeneous, 10 nm-diameter particles, visible by negative stain electron microscopy. Two-dimensional class averages from negative stain images reveal the first low-resolution particle views, comprised of a ring of subunits with a plug on top, possibly forming a porin or channel. These results provide the first evidence to support our theories that some of the predicted lipoproteins in Bb form integral-complexes in the outer membrane, and require proper membrane integration to form functional proteins.

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Created

Date Created
2020