A leader in Lyme disease research

Lyme disease has been a concern for residents of the Coulee region for decades. In fact, Wisconsin and Minnesota are among the states that regularly report the highest number of cases in the country because the habitat is well-suited to the blacklegged tick (also called the deer tick) responsible for transmitting the bacteria to humans. 

Yet concerns about Lyme disease have increased in recent years as the number of people being diagnosed with the bacterial infection continues to rise. In 2022, for example, the Wisconsin Department of Health Services recorded 5,327 cases, which is about twice the number of cases reported just 15 years earlier, according to the Centers for Disease Control and Prevention. 

Although the numbers fluctuate from year to year, there is no doubt that the overall number of Lyme disease cases in Wisconsin is trending upward. Unfortunately, despite the growing number of cases, funding availability for Lyme disease research is limited. The disease is not equally prevalent everywhere, and far fewer scientists work on Lyme disease research than some other “higher profile” diseases. These factors make the research being conducted locally even more important.

“The research made possible by our community’s support for Gundersen Medical Foundation is critical to advancing vaccine testing and efficacy,”
says Stephen Shapiro, MD, chair of Gundersen Medical Foundation. “The people and families we serve deserve to feel safe and comfortable enjoying the outdoor activities this region has to offer, so we are committed to advancing the science surrounding an issue that has a direct impact on our community.”

Gundersen's Lyme disease research

Gundersen’s dedicated team of researchers is led by Arick Sabin, DO, an infectious disease physician who joined Gundersen in 2018. In 2022, he
became the director of the Foundation’s Clinical Microbiology Lab. 

“It is extremely enjoyable to work on problems from a clinical perspective (on the patient side, one at a time), as well as on the scientific/technical side (by generating the data and knowledge that allows us to make clinical judgments),” Dr. Sabin said.

This approach means the research being conducted at Gundersen advances the global understanding of Lyme disease and also ensures local patients receive the best care possible. 

“Decades of researching Lyme disease means that Gundersen’s providers have participated first-hand in the science,” shares Dr. Sabin. “They are,
therefore, well-informed and equipped to treat and counsel patients, helping them avoid the misinformation that can complicate an already complex issue.”

According to Dr. Sabin, the team has three research goals: develop better testing for Lyme disease, understand the immunology of how the disease works in humans and generate a human vaccine.

One reason the research is so difficult is because the bacterium that produces Lyme disease is hard to grow and study in a lab, which means scientists must rely on a more “indirect method” and, instead, study the bacterium within patients. Since the disease is difficult to accurately diagnose—and each patient reacts to the disease differently—the process is challenging.

Currently, there is no test that can diagnose Lyme disease with complete certainty, so improving the testing is an important goal. For decades, most
Lyme disease tests have used serology, an immunological process that relies on antibody production as the signal for the human immune system’s recognition of a recent or past infection.

Unfortunately, the serological signals produced by Lyme disease are not always clear or indicative of a current infection.

“The testing we use relies on finicky pieces of the immune system that don’t always behave the way we want them to. As such, it’s difficult at times to get a ‘straight answer’ out of the immune system. And, since Lyme disease can act like many other diseases (and produce a very broad array of symptoms), there’s a large cast of characters that can be confused for it,” Dr. Sabin said.

Contributions to Lyme disease research

The Microbiology Research Lab was founded in 1988, allowing Gundersen to conduct several research projects related to Lyme disease. This research has resulted in more than 100 scientific publications, along with several patents. As a result, Gundersen has become a recognized leader in the field of Lyme disease research.

One of the most successful research outcomes occurred in the late 1990s when the former director of the microbiology research lab, Steve Callister, PhD, and his staff helped develop the first Lyme disease vaccine for canines. This early version of the vaccine was approximately 60 to 80 percent effective, and through a partnership with Schering-Plough, Dr. Callister and his team helped to improve the vaccine. The updated version, available since 2009, is closer to
100% effective.

Today, the researchers at Gundersen are helping to improve Lyme disease testing. Recognizing the limitations of the serologic standard two-tiered testing (STTT) that has been in use for decades, the scientific community is moving toward using a modified two tiered testing (MTTT) algorithm. Research in this area conducted at Gundersen by Drs. Sabin, Scholze, Lovrich and Callister was published in the respected journal Diagnostic Microbiology and Infectious Disease.

The team’s paper, “Clinical Evaluation of a Borrelia Modified Two-tiered Testing (MTTT) Shows Increased Early Sensitivity for Borrelia Burgdorferi but Not Other Endemic Borrelia Species in a High Incidence Region for Lyme Disease in Wisconsin,” was published in October 2022 and examined the accuracy of a
modified two-tier test that had been recently approved by the FDA.

The study ultimately found that the MTTT performed as well as the previous tests available for Lyme disease, underscoring the effectiveness of the shift away from serology tests and towards a newer paradigm. In fact, Gundersen’s study “showed that the MTTT may actually perform a bit better in early detection of Lyme disease (per our study population),” says Dr. Sabin. “Unfortunately, the study also showed that MTTT cannot detect some of the other non-Lyme Borrelia in our area so well, which means we have more work to do here.”

The importance of research

Looking ahead, Lyme disease research is only likely to grow in importance. More cases (in both adults and children) are being reported in regions where Lyme disease has existed for years, and new regions are becoming impacted. In 2021, for example, researchers confirmed that for the first time, ticks infected with the bacteria that causes Lyme disease were found in Nebraska.

Some scientists attribute the spread to factors related to climate change, which is impacting temperatures and causing shifts in the movement of animals(such as the white-tailed deer and white-footed mice that carry deer ticks). Because the impacts of climate change are expected to grow, it is reasonable to expect that Lyme disease may also spread. 

“These factors are concerning because not only could more people and families be directly impacted, but Lyme is also a passenger. So, where Lyme goes, so do other serious diseases,” Dr. Sabin said.

The growing prevalence of Lyme disease in our region and beyond only serves to underscore the importance of investments in medical research. 

“Throughout our history, Gundersen has consistently valued medical research because of the immediate and long-term impact,” Dr. Shapiro said. “Our continued study of Lyme disease will help us provide the highest quality of care to our patients, while also contributing to the larger medical and scientific communities.” 

Milestones in Gundersen's Lyme disease research

For decades, Gundersen has been devoted to researching Lyme disease because of the significant impact on the people in this region. Funding provided by Gundersen Medical Foundation has led to these important milestones:

• Development of the Borreliacidal Assay, a test method serving as the foundation of Lyme research and development for many decades now

• Improvements in diagnostic capabilities for zoonotic disease in our region, over time

• Development of effective canine Lyme disease vaccines currently under patent/ license

• Collaboration with many novel diagnostic technologies over time (e.g. T2, ChromaCode, etc.)

• Ongoing development of next-generation Lyme disease diagnostic testing in the era of Modified Two- Tier Testing (MTTT) per recent updates by the Centers for Disease Control (CDC)

Help support research

You can help support research by donating to Gundersen Medical Foundation’s Medical Research Fund.

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