Objective
Lyme arthritis (LA) is caused by infection with Borrelia burgdorferi and usually resolves following spirochetal killing with antibiotics. However, in some patients, arthritis persists after antibiotic therapy. To provide insights into underlying pathogenic processes associated with post-infectious LA, we analyzed differences in microRNA expression between LA patients with active infection compared with those with post-infectious LA.
Methods
MicroRNA expression was assayed in synovial fluid (SF) from LA patients before and after oral and IV antibiotic therapy, and from synovial tissue from post-infectious LA patients obtained months after antibiotic therapy. SF and tissue from patients with other forms of arthritis such as rheumatoid arthritis and osteoarthritis were used for comparison groups.
Results
SF from LA patients during active infection had marked elevation in white blood cells, particularly polymorphonuclear leukocytes, accompanied by elevated miR-223 levels. In contrast, SF from post-antibiotic LA patients contained greater percentages of lymphocytes and mononuclear cells. Post-antibiotic LA SF also exhibited marked inflammatory (miR-146a, miR-155), wound repair (miR-142), and proliferative (miR-17~92) microRNA signatures, and higher levels of these microRNAs correlated with longer arthritis duration. miR-146a, miR-155, miR-142, miR-223, and miR-17~92 were also elevated in synovial tissue in late post-infectious LA, and let-7a was reduced, similar to RA.
Conclusions
During active infection, microRNA expression in SF reflected an immune response associated with bacterial killing, whereas in post-infectious LA, microRNA expression in SF and synovial tissue reflected chronic inflammation, synovial proliferation, and breakdown of wound repair processes, showing that the nature of the arthritis was altered after spirochetal killing.