Dr. John Aucott has studied Lyme disease for more than 15 years, focusing particularly on prevention, diagnosis, and treatment. As director of the Johns Hopkins Lyme Disease Clinical Research Center, Dr. Aucott works with Dr. Mark Soloski on the Study of Lyme disease Immunology and Clinical Events (SLICE), a longitudinal study of patients diagnosed with early-treated Lyme disease and matched controls. As a scientific advisor for the LymeX Diagnostics Prize, a prize competition to accelerate the development of Lyme disease diagnostics, Dr. Aucott is helping mentor participating teams through office hours and webinars.

Through October 2023, the 10 teams in Phase 2 of the LymeX Diagnostics Prize are participating in a virtual accelerator designed to help them refine their concepts for detecting active Lyme disease infections in people. As part of the accelerator, teams have access to scientific advisors who provide valuable insight and feedback from their extensive experience in Lyme disease diagnostics. Note these scientific advisors are not official representatives of LymeX and are not in any way involved with submission evaluation or award decisions.

We spoke with Dr. Aucott to learn more about his work with the Johns Hopkins Lyme Disease Clinical Research Center, why it’s an exciting moment to be involved in Lyme disease diagnostics, and the LymeX Diagnostic Prize’s potential impact on future research. 

As a scientific advisor for the LymeX Diagnostics Prize, you bring extensive experience in Lyme disease research. Why did you first begin to study Lyme disease?
Dr. Aucott: “I’m an infectious disease physician who got introduced to Lyme disease when I moved back to Maryland in 1996. I started practicing where the Lyme disease epidemic was already underway. So I sort of got thrown into the epidemic in the late nineties, and started to see complicated patients where we didn’t understand exactly why they were staying sick. We also didn’t have good diagnostic tests, especially for the early stages of Lyme disease. Seeing the patients, I then decided it would be good to be part of the solution and got involved in clinical research at Johns Hopkins. That’s what started our work, and it’s continued ever since.”

We know that Lyme disease—from the causative bacteria to the disease pathogenesis—is quite complex, and more research is needed to improve treatment and care. What is the Johns Hopkins Lyme Disease Clinical Research Center focusing on?
Dr. Aucott: “One of the things that we’re discovering at Johns Hopkins is that the infection seems to mess with the immune system. There’s not a normal immune system response to the infection. And so it’s causing dysregulation of the immune system in a way that may make it difficult for the human host to fight the infection, because fighting infections requires a good, competent, intact immune system. 

That’s probably not a surprise because this bacteria has learned how to live in animals—that’s what it does for a living. It lives in mice; that’s its reservoir host. So it had to learn long ago how to avoid the animal’s immune system. But unfortunately that’s also happening in humans, where our immune system isn’t able to get rid of the infection easily. So that’s why humans likely end up with chronic problems.”

The current two-tier antibody testing system for Lyme disease was first developed in 1994, and there have been no major developments since—which the LymeX Diagnostics Prize aims to change. What makes this effort so exciting?
Dr. Aucott: “Over the 20-some years that I’ve been involved [in Lyme disease research], we’ve recently seen a dramatic increase in the number of both companies and investigators that are tackling this problem of finding better diagnostics. So it’s exciting because there’s so much interest in it now. If you turn the clock back 20 years ago, there were very few people interested in working in this field. So that’s exciting to see the change. These are really competent, high-quality companies and investigators that are involved now.

This stuff takes a long time. It’s hard. And these teams are working really hard and doing great stuff. That’s spectacular, but it still takes a long time. The moonshot you’ve set isn’t just to move the field forward. The goal is to get an FDA-approved test. That’s a serious moonshot. I mean, we didn’t get to the moon in three years, right?”

Developing diagnostics for active infection is only the first step in transforming treatment and care. How could the teams’ work help advance other research in Lyme disease?
Dr. Aucott: “The basics of the work can give us insights into this fight between the organism and the human immune system. The insights could be a couple things. One is how the human immune system responds to the infection. We’re probably going to get insights into different aspects of the immune system response, both the timing of it and how fast it occurs, and also the quality of it. As I mentioned, the immune system may be dysregulated. So we may get insights into the quality of the immune system response by looking at some of the nuances of the immune biomarkers that the teams are working on.

And then on the bacterial side, from the teams that are working on direct detection of Borrelia burgdorferi [the bacteria most commonly responsible for Lyme disease], we may get insights into how the organism is behaving early in an infection. The organism may only be present transiently in the bloodstream, so we may get insights into when it comes and goes during the natural course of the first few weeks of infection and how many of the bacteria are present in the bloodstream. We expect that there’s very few organisms. But the research looking at direct detection probably will give us more insights into how many bacteria there actually are, and then the timing of their appearance and disappearance.

There’s more interest in other infectious diseases that are associated with these long-term outcomes. With long-haul COVID, for instance, there’s interest in how infections can lead to longer-lasting problems. And so as we learn more about Lyme disease in the context now of other infections like COVID and other illnesses like chronic fatigue syndrome, there’ll be a chance for maybe learning from each other.”

Phase 2 accelerator offers access to a range of expert resources

Over the course of the Phase 2 accelerator, the cohort has access to virtual learning, mentorship, biorepository subject matter expertise, and networking opportunities designed to help the teams progress toward Food and Drug Administration review. A selection of accelerator resources will be made available to the public on the competition website to support broader innovation in Lyme disease diagnostics and treatment. Following the conclusion of the accelerator in October 2023, the cohort will submit concept papers that detail solution refinement, clinical and patient input, and a roadmap from lab to market.

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