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.