# Neuroimaging and blood markers in post treatment Lyme disease with persistent neurologic symptoms

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $522,935

## Abstract

PROJECTSUMMARY/ABSTRACT
 Lyme disease is an inflammatory disease, transmitted by ticks that are infected with the bacterium Borrelia
bugdorferi. Despite treatment with antibiotics, 10-20% of patients develop post-treatment Lyme disease (PTLD)
that often includes neurocognitive symptoms. The mechanisms underlying this are not well understood. Prior
published and preliminary data from our research group suggests that cognitive performance is impaired in PTLD
and that white matter (WM) changes on functional MRI (fMRI) are part of this process. WM changes are also,
however, associated with better patient-reported outcomes. Thus, WM changes during Lyme disease may be
part of a healing process following injury that comes at a cost to cognition, but more information is needed. In
this study, we will draw upon a unique longitudinal cohort of patients with early Lyme disease and erythema
migrans who will be studied longitudinally for 12 months. Their data will be compared to that of healthy controls
without a history of Lyme disease.
 Our overall objective is to study the underlying mechanism of neurologic symptoms in PTLD. We will test the
overarching hypothesis that WM changes reflect an adaptive response, and these changes predict better
outcomes after treatment of early Lyme disease. To accomplish this goal, we will track WM activity immediately
after initial antibiotic therapy and longitudinally 6 and 12 months later. Functional MRI (fMRI) will be used to
measure WM activity that will be compared to outcomes, which will be measured using clinical scales and
cognitive testing (AIM 1).
 We will also address the underlying neurobiological basis of WM changes by determining whether the myelin
sheath or the underlying axon, both of which comprise WM, are affected in PTLD. To do so, we will use
multimodal neuroimaging measures including diffusion tensor imaging (DTI), QSM and 𝜒-separation to
understand axon and myelin integrity and health. A blood plasma marker, neurofilament light chain (NfL), will be
used to quantify axonal injury. These variables will be correlated with cognitive performance, clinical scales, and
blood inflammation markers, which, if successful, would provide simple prognostic indicators. (AIM 2)
 Finally, we will examine inflammatory markers including the chemokine ligand 19 (CCL19), which has been
associated with increased risk of developing PTLD, and Interleukin-6 (IL-6), which plays a role in mediating
inflammation and demyelination. These have not been shown to correspond with central nervous system
markers in Lyme disease thus far, but they may correspond with MRI WM values, which has never been tested.
(AIM 3). Collectively, our studies represent a rigorous approach by including multimodal neuroimaging combined
with blood biomarker measurement towards elucidating determinants that are associated with the cognitive and
clinical outcomes of PTLD. The long-term goal is to generate insights that may lay the foundation for new
diagnos...

## Key facts

- **NIH application ID:** 10932440
- **Project number:** 5R01AI178774-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** CHERIE L MARVEL
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $522,935
- **Award type:** 5
- **Project period:** 2023-09-20 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10932440

## Citation

> US National Institutes of Health, RePORTER application 10932440, Neuroimaging and blood markers in post treatment Lyme disease with persistent neurologic symptoms (5R01AI178774-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10932440. Licensed CC0.

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