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Monday, July 22, 2013

Biofilms: hyperbaric?

Biofilms have long been a concern for Lyme patients. 

One reason for persistence of infections, including Lyme disease is the existence of Biofilms. It should be known that this is nothing unique to Lyme. Other pathogenic bacteria, for example, pseudomonas are known to exist within biofilms. Bacteria in biofilms are reported to be up to 1000X more resistant to the effects of antibiotics than free floating bacteria. Free swimming bacteria are called planktonic which distinguishes them from bacteria contained within a biofilm. Biofilms are composed of colonies of  bacteria and protozoans that are protected by a mucopolysaccharide covering as well as bits of DNA and other molecules. Biofilms are not limited to one species. Numerous species can live within the same structure.

Bacteria within biofilms somehow communicate by a process called quorum sensing. They communicate back and forth to "discuss" the best strategies for survival and expansion. The group as a whole develops a sort of "collective intelligence." There are many other examples in nature of a similar phenomenon, for example, the collective brilliance of an ant colony. Bacteria, the first life forms on the planet, have been around for 4.5 billion years and we have only been here for one hundred thousand or so. That may explain why bacteria through a very lengthy process of evolution, are so smart. Lyme bacteria within these structures are in a quiescent state of suspended animation. Every now and then, when conditions are ripe, a segment of the colony may break off to colonize another region, or release some bacteria in a planktonic (free swimming) state.

One of the "Holy Grails" in Lyme therapy has been finding a way to break down biofilms. Herbs have been tried which use enzymes to break down protein (proteolytic). I am a  skeptical since there is no likely no effective way of delivering the proteins to the targets --  and because they are targeting the wrong thing since biofilms are not primarily comprised of protein.

Hyperbaric therapy, in addition to producing reactive oxygen species, also produces reactive nitrogen species. One of these products is nitric oxide. The effects of this compound are complex and protean with literature that goes on forever. But one demonstrated effect is the dispersal of biofilms. This may be of additional benefit.


Janelle said...

Interesting post. I wonder what you would say of someone who has Lyme disease & apparently lots of biofilm (noted on results of a different test by Fry labs), but also has bartonella & babesia, one of which (I can't remember) apparently loves oxygen? Is there any research or anecdotal evidence supporting hyperbaric therapy even when there's also an oxygen-loving bug in the mix?

Lyme report: Montgomery County, MD said...

If you have (chronic) Lyme disease it can be assumed that you have bacteria living in biofilm communities, regardless of what a test shows.

Forget about the effects of oxygen on microbes. Germs don't "love oxygen." This is not how it works.

The direct killing of spirochetes is probably probably not how hyperbaric helps Lyme patients. Hyperbaric therapy creates reactive oxygen and nitrogen species as discussed.

Hyperbaric therapy helps oxygen get into tissues. It reduces inflammation. It helps the immune system work better. It facilitates the growth of new blood vessels. It helps the healing of muscles, joints and nerves, as well as brain neurons. it helps wounds heal and has many other positive effects.

With low pressure HBOT the concentration of oxygen in tissues is probably not adequate to directly kill Lyme. But the belief that high pressures accomplish this is theoretical. It would take a head to head study to see if high or low pressure is more effective.

One major difference is side effects. High pressure treatment has the potential for serious side effects, including oxygen toxicity. At high doses oxygen can cause severe lung, brain and multi-organ injury. Patients need breaks during therapy to mitigate this possibility.

Low pressure has very little risk of side effects.

Paced Runner said...

What is your opinion of some of the other methods used to degrade biofilms and address protomyxzoa? Primarily the low fat diet and deprivation of magnesium?

Do you think that the diet could be dangerous for someone who's underweight to start?

Also do you have any opinion on the use of medications such as Alinia or Ivermectin for this purpose?

Lyme report: Montgomery County, MD said...

I can only give some general opinions, not clinical advise.

There are unknown protozoa which many appear in blood and other tissues. We really do not know the significance of these organisms. Treatment, if needed is empirical.

Diets are a can of worms. There are many opinions. Some previous posts may address some of my thoughts.

radicale said...

I am having a hard time finding any definitive proof that the majority of patients who are given the chronic lyme disease diagnosis in fact have lyme disease. There are odd published cases where PCR and/or culture positive late lyme disease patients are described in literature but nothing substantive. In light of this lack of water-proof evidence who is to say that these patients are in fact not suffering from ME, auto-immunity, unknown infections or something else? These illnesses share most symptoms! Furthermore, persisting micro-organisms are the norm for most if not all infections. Without a capable immune system a patient can take antibiotics or antivirals for his entire life and still not eradicate the original bacteria. To complicate things, long term use of antibiotics causes mitochondria damage and general immune weakling, the opposite of the desired effect. So doctor please publish some results (like Dr. Sam Donta did), they are a lot more useful than your anecdotal stories.

Lyme report: Montgomery County, MD said...

I am a practicing physician not an academic researcher. Obviously this is what the debate has been about. I have cases where after-extensive antibiotic use, synovial fluid has tested positive for Lyme by PCR. I have many cases of positive PCRs in the colon of all places, I am sure not reported in the literature, after extensive antibiotic therapy. (You may call Dr. Kilani at Clongen who will verify this finding).

Studies in animal models, mouse, dog and primate have shown persistence of Lyme in the face of massive amounts of antimicrobials.

Lyme has been shown to survive in the intracellular milieu, the basis for which Dr. Donta posits the persistence of the organism.

Lyme is well known to be pleomorphic, forming blebs impervious to most antibiotics which also exhibit antigen shifts defeating humoral responses. The ability of Lyme to penetrate immune privileged areas has been well documented. The facility with which Lyme crosses the BBB is remarkable. Bb organisms have been shown to live within biofilm communities which further makes eradication difficult. The spiral morphology together with the anerobic nature of the organisms allows them to invade tissues with minimal blood flow, like cartilage and tendons.

OK, you admit that persistence of microorganisms may be the norm for most infections.

These persisters offer a wide range of clinical consequences.

All bacteria are unique. Borrelia have a small linear chromosome but a very large number of plasmids. They are unique in this way. As parasitic organisms they are dependent on host metabolites.

Infection with these spirochetes is known to cause an unusually robust amount of inflammation marked by high levels of cytokines, complement activation, innate and acquired immune responses. I am sure that a lot of symptoms these patients have result from an autoimmune process. Otherwise it would be impossible to explain why an elbow hurts one day and a knee the next.

There is a lot of debate about the nature of autoimmunity. One theory is that persistent infection fuels the response.

As a clinician my job is to help patients. I would rather not prescribe antibiotics for these patients, but they are frequently very ill and only respond to this approach.

I always have to weight the risks and the benefits. You sir, should see patients who have come into my office, unable to talk in wheel chairs, who now have a normal quality of life.

If you want research, there is lots of it out there.

I am just a blogger, not an expert about anything except doing the best for my patients.

radicale said...

I understand your point of view with respect to trying to help your patients; however, you should not assume that Lyme Disease causes all ailments even though it can.
Antibiotics kill bacteria, have various immune-modulation properties, reduce vitamin absorption and in some instances are immune-suppresive, so they may be effective for infections, autoimmunity, Antiphospholipid syndrome (through reduction of Vitamin K) and other ailments.
Why did I originally mention PCR/culture? I was wondering if there was a difference in treatment response for those who were PCR/culture positive and those who were not. This seems to be a case for other similar infections like Coxiella burnetii, Enterovirus, etc.

T9im said...

Hi radicale:

From personal experience. We took our daughter to Henry Feder who was the IDSA MD author on the IDSA's position on "chronic" Lyme.

At our 3rd visit he stated I know Lyme and your daughter doesn't have Lyme disease. He wouldn't even run a Western Blot.

That was the visit where my wife and I knew something terribly wrong was going on with our daughter being in the center of it.

When we did run receive the band readings from a WB there were 2 positive markers, 1 Lyme specific.

We are now almost 4 years into this nightmare. Of the 11 Western Blots she was never CDC positive.

This would make you think she does not have Lyme.

This recent February, we ran 2 tests a WB from Igenex, no positive bands but we also ran the new culture test. I have a fax copy of the spirochetes cultured.

Positive after 3+ years with 2 straight of oral medications.

It was Alan Steere who did the supporting study reinforcing the diagnostic guidelines he co developed followed by Dr. Wormser with a similar study supporting the diagnostic guideline he endorsed for the IDSA.

My CPA license would be taken away if I had this type of conflict of interest with my work.

You can do a google search and read both, positive feedback loops for both.

So I'm in the camp Lyme is persistent and is drug resistant.

Lyme report: Montgomery County, MD said...

C. Burnet to, AKA Q fever. Great example. This is one of few infections where the chronic infection paradigm is supported by the CDC. Two antibiotics may be needed for two years per CDC website for difficult to treat chronic forms of infection.

Time and again we find that all laboratory tests are flawed. With Lyme we might not have the right test in the first place because of diversity of strains and even species, discussed above. Lab testing is an adjunct for diagnosis, not the linchpin.

Proof? The proof is clinical. Ultimately the paradigm or opening premise dictates the approach.

I have an ongoing feud with evidence based medicine. There is an emerging paradigm for the practice of medicine as a whole, translational medicine. Here the clinician looks for patient based therapies which may take into account information from a variety of sources including basic laboratory science and anecdotes like the one posted above. Thousands of unpublished cases do have meaning.

Lyme report: Montgomery County, MD said...
This comment has been removed by the author.
radicale said...

You guys shouldn't assume I am some IDSA doctor or for that matter that I support their point of view. I am skeptical to all points of view when it comes to chronic lyme disease and am looking for waterproof evidence to support one or the other.

You can find similar sympthomology for other ailments like ME (thought to be caused by an Enterovirus). Patients who suffer from ME are consistently found to have viral proteins in their stomach lining, and it can be said that they are suffering from a persistant infection. Q Fever patients who are PCR positive benefit from prolonged antibiotics, those who are PCR negative do not.

If we are to bring these infections up as analogs to CLD then it is inappropriate to gleam over the PCR/culture positive antibiotic response relationship.

So once again I am asking if you see any correlation between PCR/culture positivity and antibiotic response.

Thank you.

radicale said...


I am sorry to hear about your daughter. It also saddens me to hear the 3+ years of antibiotics did not help her.

That raises serious questions in my head as to the appropriate use of antibiotics for patients suffering from symptoms which fall under the Chronic Lyme Disease umbrella. Clearly they are not effective and we are in dire need of better treatments.

Lyme report: Montgomery County, MD said...

This is America, feel free to agree with me and I will respect your view when you are forthcoming as to what they are.

Our ability to have an open and honest debate is part of what makes this country great.

He(the girl's father) did not say the treatment did not help. He said he has been through a nightmare. Do not put words in his mouth.

My patients who are PCR positive and culture positive are treated the same as those who do not test positive with these tests. It is hard to get positives with these tests for a variety of reasons: Lyme is a microaerophilic, fastidious bacteria which is hard to culture. Advanced Laboratory Services in PA has developed a sensitive culture which shows persistent bacteremia in the face of prior long term antibiotics, both intravenous and oral, in many of my patients. But of course detractors like yourself are quick to impugn the lab: If you don't like the message, kill the messenger.

Treatment is better than no treatment. Ask the distraught father what he believes the outcome would likely have been if his daughter had received no treatment versus the treatment she has receive. The vast majority of my patients respond beautifully to antibiotic therapies.

If you noticed, the thread of this blog speaks to the utility of HBOT.

Everyone wants less toxic therapy.

Your phrase "chronic Lyme disease umbrella," speaks volumes.

Thousands of patients have a disease for which you say there is no waterproof evidence. There was no waterproof evidence for relativity and quantum mechanics. It took decades before experiments could be designed/performed to prove the accuracy of these theories. A better understanding of the laws of physics has changed the world you live in in miraculous ways.

Your IDSA myopia does not permit you to look at the evidence. There are numerous studies which support the existence of chronic Lyme disease and merits of treatment. A few extramural, NIH sponsored studies have been misinterpreted and generalized to the point of absurdity.

Patients with chronic Lyme and their doctors are not having mass hallucinations.

I can give you science until the cows come home for all the good it will do.

History will tell us who was right. The patients suffering with Lyme disease cannot wait that long.

I believe your compassion for the writer's daughter is disingenuous at best. This tactic will not help you ingratiate yourself with the thousands who protest against the IDSA and get laws changed as they have done most recently in Virginia.

Give me a break.

radicale said...

I have gone through several LLMDs with no benefit and only adverse reactions. In the end it turned out to be ME.

Lyme report: Montgomery County, MD said...

OK. Thank you for that. Now we know where you are coming from. Maybe you were given the wrong diagnosis or treatment. Unfortunately, some people(doctors included) think everything is Lyme. Of course this is not the case. Hope you are doing better these days.

Unknown said...

Hello! What do you think of the Cowden Support Program considering the fact that antibiotics may not be the answer to Lyme? Here is a link for more information:

I have ALS and I will be starting this protocol as soon as it arrives. 100 out of 250 ALS patients were discovered to have Lyme Disease upon autopsy. I'm not waiting until I'm dead to find out if I have Lyme Disease or not!

Oceanside Hyperbaric said...

Could someone post a link to any evidence that Hyperbaric Oxygen Therapy disrupts biofilms in Lyme?

Jorge said...

Thanks for sharing valuable hyperbaric oxygen therapy testimonials with us. Dr Shai Efrati provided detailed information about hyperbaric oxygen.