Borrelia: Molecular Biology, Host Interaction and Pathogenesis

Since the discovery of Borrelia burgdorferi as the tick-borne spirochetal agent of Lyme disease in 1982, perhaps no other bacterial organism has captured the attention of clinicians and scientists while developing a parallel, internet-fueled mistaken identity as the mysterious agent of myriad maladies labeled “chronic Lyme disease.” Although the evil twin protagonist is a common device in many fictional genres, the book Borrelia: Molecular Biology, Host Interaction and Pathogenesis soundly resists wading far into the implausible mire, but rather aims to provide a clear-headed compendium of scientific knowledge gained since discovery that also includes noncontroversial agents of the genus responsible for relapsing fever. The editors have organized and edited the book consistently with little unintended overlap. The text is divided into 18 multi-authored chapters, written by leading investigators in their field, speaking to all aspects of the bacterium. A lucid overview serves as an introduction by succinctly but engagingly framing clinical and epidemiological studies of Lyme borreliosis both in North America and Europe. Three chapters tackle the interesting Borrelia genome, including how the 20 segmented DNA chromosomal molecules replicate and undergo differential expression in tick hosts versus mammals, and they include considerable attention to the peculiar number of plasmids and their potential roles that make it such a novel bacterial organism. Other chapters are devoted to the metabolism and physiology, structure, and function, exploring that complex orchestration and interplay of proteins and lipoproteins, as well as the nascent field (for this organism) of motility and chemoprophylaxis. The difficulties of genetic manipulation of Borrelia species have recently yielded somewhat, and a practically written chapter may aid anyone considering experimentation in this arena. How borreliae have developed by interacting with their arthropod vectors and other species are reviewed in chapters dedicated to evolutionary genetics, enzootic ecology, and tick interactions. Although B. burgdorferi takes the lion's share of the book, including examination of bacterial protein interactions that elicit inflammatory responses as well as immune evasion mechanisms, relapsing fever Borrelia species have its own chapter devoted to pathogenesis, highlighting issues such as characteristic multiphasic antigenic variation. Two particularly instructive chapters examine animal models of Borrelia species that have been used extensively to better understand pathogenesis, followed by an excellent section examining host responses including innate and adaptive immunity in both animal models and human hosts with comparisons of similarities and differences. The final 3 chapters examine diagnostic methods in a thorough discussion, cover Lyme vaccinology, and finally, provide a masterful overview of Lyme disease in humans that integrates highly relevant scientific knowledge into features of the clinical infection, providing many insights for both the investigator and the health care practitioner. Overall, the text makes judicious use of figures and has a small number of color plates. Each chapter is heavily referenced, and perhaps my only criticism of the book is that some authors chose to cite recent reviews rather than original research. In sum, this is a landmark resource in the field of borreliae. It is truly the first and the sole resource that comprehensively synthesizes the state of knowledge gained from decades of research. This book is a must for any investigator in this field and will no doubt be consulted frequently. It should be a required acquisition for any medical school library, research institution, and microbiology laboratory, including especially those with interests in genetics and immunology. For clinicians, although this book intentionally does not offer a comprehensive treatise of clinical studies that may be best gathered from journal review articles, it does offer an approachable method for the nonscientist to examine the mechanisms used by Borrelia species to maintain its lifecycle, establish infection, and cause illness. Borreliae are fascinating organisms, and the editors and the authors have produced a paragon for writing about a genus. Potential conflicts of interest. P.G.A. is a consultant for Oxford Diagnostics, has stock options with Johnson & Johnson, received lecture fees and/or is on the speakers' bureau for Greater Baltimore Medical Center, Lakenau Hospital, and Calvert County Medical Society.