Friday, October 10, 2008

Clongen Labs: Where have I been?

I just had an exciting conversation with Dr. Kilani. He is the director of Clongen Labs. It turns out that Clongen is on my street, literally a 5 minute walk from my office. Dr. Kilani is a well trained clinical pathologist/molecular biologist. He has some international acclaim. His specialty is PCR testing. He developed the first PCR test for Blastocytis, a controversial GI parasite. He has done extensive research on Morgellons disease including and analysis of its genome (looks like lettuce?). His current thinking is that it is a small worm pathogen from the botanical world which has acquired genes which allow it to infect some humans. This follows the current theory of Dr. Stricker, the leading Morgellons doc in the country. It does highly correlate with Lyme infection.(Luckily I only have one Morgellons patient in my practice). He performs a Lyme Western Blot which has more bands than the IgeneX test. He reports that in a few patients not only do WB bands appear, but the whole strip turns black! He postulates an autoimmune reaction. He offers a PCR test for Mycoplasma fermentans, a Lyme co-infection. Up to now I have not been testing for this. He has a PCR test for Bartonella which is based on non-specific areas of the genome and covers 20 different species. (I think that's what he said; our conversation covered a lot of topics). He has ultra sensitive PCR assays and tells me that he gets a fair number of positive results for Lyme. He is well trained in microbiology and parasitology. We talked about the Babesia problem. He thought that Babesia patients were all critically ill. I corrected this misconception. We discussed the PCR problem here: if you don't know the DNA of the species you are looking for the test will not get you the answer you seek.(There is no broad spectrum PCR test available here). He is willing to do blood smears with a variety of stains, (trichrome may the best), to look for blood parasites. He does offer a variety of super sensitive PCR tests for other co-infections as well. This testing is expensive and I will have to evaluate which tests are cost effective. He is working closely with Dr. Jones and other LLMDs, performing various assays. He told me that Lyme IS sexually transmitted. Apparently he has done PCR on semen and vaginal secretions which were positive. I think we can settle part of this issue. He also has a sensitive culture medium for Borrelia. I will try to find a WB positive Lyme patient, who will be willing to donate such samples. (This may take a while to find). This should be done before any antibiotics are given. If the PCR is positive, he will attempt to culture the specimen for Bb. This would be a step closer to proving the sexual transmission hypothesis. He is also doing research on developing a new Lyme vaccine. We agreed that the previous Lymerix vaccine was doomed from the start. It was based on OspA which is down regulated in early Lyme and only shows up with advanced disease. He thought this might have been the cause of the autoimmune reactions associated with the vaccine. Clongen's vaccine, under early development, will be based on OpsC, which is present in early Lyme. I had an extended conversation with Dr. Kilani about many facets of laboratory medicine as it applies to tick borne infections. He will be at the ILADS meeting next week. He agrees that Lyme is a burgeoning plague of untold proportions. He has an extensive menu of PCR tests, covering the extended spectrum of infectious agents around the world. I'm afraid he is about to fall into the black hole of Lyme. Brilliant guy! Great for us.

17 comments:

consilience said...

This is a great resource. I'll tell my Lyme doc about their website. Thanks!

pumpkinhead said...

"He told me that Lyme IS sexually transmitted. Apparently he has done PCR on semen and vaginal secretions which were positive." To what extent the Lyme is sexually transmitted? Tick has to stay in human body for around 36 hours to transmit the disease, is this statment true? If not, then any bite from the tick will transmit the disease?

My spouse is fine even I am sick for a while and did not take protective method. I don't think it can be easily transmitted.

Lyme report: Montgomery County, MD said...

See blog "urban myths" and discussion under first 41 band blog. I do not think Lyme is sexually transmitted.

At the last ILADS meeting there was a case report of a little boy who got Lyme after a tick bite on an eyelid after 4 hours. This is a thin area of skin, so this case is probably atypical.

How long does the tick have to be atached? Most "experts" say 24 hours. No one really knows. Most tick bites are never seen!

Don't believe all the claims made by patients or by "experts."

I don't pretend to be an "expert."
I am just a doctor trying to help patients to the best of my abilities. My answers are my opinions only, educated opinions, I hope.

gherbu1980 said...

my girlfriend is showing symptoms for lyme and we live in a country where lyme is extremely rare. i was dx'ed in chicago after 3 weeks there - spent time camping on a farm with woodland - and now she's showing symptoms: occasional neck pain, joints pop, mild flu, a small bruise-like mark on her arm that has a red centre.

the catch? we've never slept together.

lyme, i'm learning the hard way, is transmissable mouth-to-mouth. can't even bring myself to contemplate approaching her about this. she doesn't know much about the disease and i don't think she suspects anything.

WTF do i do now. i can handle my own life being ruined... her's too? no. please, no.

gherbu1980 said...

just to clarify: she was not on the trip with me. EXTREMELY unlikely she has been bitten here.

dogdoc said...

Doc- will he package us a group of tests? I have been able to work deals with labs before on big test packages.
Even if PCR positive in semen and vaginal secretions doesn't prove whole organisms or infective ones. However, it bears further examination. We volunteer for samples if you need them.

Lyme report: Montgomery County, MD said...

I will working with him to create a special panel for me.

Kissing?

We don't even know if your girlfriend has Lyme.

What country?

The epidemic is fairly worldwide at this point.

Lyme report: Montgomery County, MD said...

dogdoc: thanx for volunteering.

I need to find someone who is an antibiotic "virgin" or who has been off antibiotics for several months.

If there are viable organisms in the secretions the antibiotics may interfere with growth in the culture medium. There is a technology negate the antibiotics. I'll have to look into this.

The doc doesn't even know we will be doing this experiment yet. I am sure he is up for it though.

It's not too late to grab a flight to San Fransisco this weekend!

MariaJ said...

Me? I don't have the sticker of Lyme or of having any disease... I am still a "limbo patient"; but I fill out all the list of symptoms except for dementia? I did have antibiotics and I have had colloidal silver that has controlled - not killed - the what ever bug it is; but the medicines where more than 6 months ago and I am still ad- portas of falling down the roller coaster again so easily...!
I can stop for a while my rudimentary treatment, "risking my well being", to get "cleaned of" any medication, if I can be of any help!!!!
I am in Florida and yes,
I think it can be transmitted easily! In fact it is not about what we believe or not, that is not the point; it is about asking how did we get it? I got no tick!!!!
God bless you all!!!

Pat.

Bryan Rosner said...

We know that Lyme disease and syphilis are similar in many ways, so what good reason is there to believe that Lyme is NOT sexually transmitted? There is a disconnect here that I just don't understand.

Couples having sex usually do so multiple times and exchange quite a bit of fluids, sometimes blood. Even if Lyme only got transmitted 1 in 20 times, that would mean a very high chance after having sex with the partner 20 times, which might happen in 1-3 months. If you are married, and have sex consistently for years, it seems possible that a few organisms could get transmitted.

I read somewhere that only 20 organisms need be transferred from tick to host for likely infection to occur. It is outrageous to me to think that this "can't happen" over repeated sexual intercourse for years between monogomous partners in which one partner has Lyme and the other doesn't.

pumpkinhead said...

I wish a more justified conclusion to be reached based on more rigorous scientific research in considering many variables regarding the transmission of the disease if it is possible. We don’t want to be in one extreme end to another extreme end.

dogdoc said...

Brian-
What exactly do syphilis and Lymes have in common? They are both spirochetes but are very different spirochetes in metabolic capacity and dna/ plasmid structure. They really are very different organisms on just about every level I can think of.
I agree there is the potential for alternative forms of transmission- we have studied none of it however, so we shouldn't go around saying it is or it isn't sexually transmitted. It would be appropriate to say we don't know but the potential exists. However, some vector bourne (ie tick, mosquito, ect) diseases require time in their intermediate host to become infective. In this case, there might be a requirement for time in the tick to become infectious. We really don't know. I personally think the epidemiologic characteristics support horizantal or vertical transmission. But that is my opinion and doesn't mean anything and certainly cannot be stated as fact.

dogdoc said...

Doc- wish we'd thought of that before. Oh well. I wish on ILADS. Hard to justify just for me. Can you get lecture notes?

Sunnisideup said...

dogdoc:

check sidestep for cheap/last minute flights. I just checked, saw round trip, one stop for under $400.00. That was out of Dulles to San Fran. Know that is not most convenient for you,.... Not sure about hotels, lots in location, can't beat airfare and conference open to anyone and offers CME's (to VET's???) what do I know... ? Just FYI...

Bryan Rosner said...

I will be going to ILADS and making a video of various aspects publically available.

I agree, dogdoc, we can't say for certain about sexual transmission. However it is reasonable given probabilty to be cautious and not blind to the possibility pending confirming studies. Confirming studies have value but so does common sense. Maybe I'm just old fashioned.

Bryan Rosner said...

By the way, docdog and all, FYI, please please please learn to stop saying "Lymes" - the proper name has no "s." It is Lyme disease.

Bryan

dogdoc said...

To the nice lady who called this afternoon- my phone battery died and I didn't have a way to get the number to call you back. Sorry.