AUTHOR=Djokic Vitomir , Primus Shekerah , Akoolo Lavoisier , Chakraborti Monideep , Parveen Nikhat 

TITLE=Age-Related Differential Stimulation of Immune Response by Babesia microti and Borrelia burgdorferi During Acute Phase of Infection Affects Disease Severity

JOURNAL=Frontiers in Immunology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2018.02891

DOI=10.3389/fimmu.2018.02891

ISSN=1664-3224

ABSTRACT=<p>Lyme disease is the most prominent tick-borne disease with 300,000 cases estimated by CDC every year while ~2,000 cases of babesiosis occur per year in the United States. Simultaneous infection with <italic>Babesia microti</italic> and <italic>Borrelia burgdorferi</italic> are now the most common tick-transmitted coinfections in the U.S.A., and they are a serious health problem because coinfected patients show more intense and persisting disease symptoms. <italic>B. burgdorferi</italic> is an extracellular spirochete responsible for systemic Lyme disease while <italic>B. microti</italic> is a protozoan that infects erythrocytes and causes babesiosis. Immune status and spleen health are important for resolution of babesiosis, which is more severe and even fatal in the elderly and splenectomized patients. Therefore, we investigated the effect of each pathogen on host immune response and consequently on severity of disease manifestations in both young, and 30 weeks old C3H mice. At the acute stage of infection, Th1 polarization in young mice spleen was associated with increased IFN-γ and TNF-α producing T cells and a high Tregs/Th17 ratio. Together, these changes could help in the resolution of both infections in young mice and also prevent fatality by <italic>B. microti</italic> infection as observed with WA-1 strain of <italic>Babesia</italic>. In older mature mice, Th2 polarization at acute phase of <italic>B. burgdorferi</italic> infection could play a more effective role in preventing Lyme disease symptoms. As a result, enhanced <italic>B. burgdorferi</italic> survival and increased tissue colonization results in severe Lyme arthritis only in young coinfected mice. At 3 weeks post-infection, diminished pathogen-specific antibody production in coinfected young, but not older mice, as compared to mice infected with each pathogen individually may also contribute to increased inflammation observed due to <italic>B. burgdorferi</italic> infection, thus causing persistent Lyme disease observed in coinfected mice and reported in patients. Thus, higher combined proinflammatory response to <italic>B. burgdorferi</italic> due to Th1 and Th17 cells likely reduced <italic>B. microti</italic> parasitemia significantly only in young mice later in infection, while the presence of <italic>B. microti</italic> reduced humoral immunity later in infection and enhanced tissue colonization by Lyme spirochetes in these mice even at the acute stage, thereby increasing inflammatory arthritis.</p>