Advantage of recombinant borrelial proteins for serodiagnosis of neuroborreliosis

Two enzyme immunoassay (EIA) systems were compared for their ability to det ect Borrelia burgdorferi sensu late specific IgG and IgM, antibodies and to differentiate between symptomatic (83 patients with neuroborreliosis) and asymptomatic seropositive subjects (80 healthy controls). Antibody concentr ations were determined by EIA; the antigens used were either a sonicate of B, burgdorferi or three recombinant borrelial proteins: the 14-kDa flagelli n fragment, the outer surface protein C (22 kDa) and the high molecular mas s protein p83 (83 kDa). In the sonicate, EIA, IgG or IgM antibodies to B, b urgdorferi, or both, were detected in all patients with neuroborreliosis an d in all controls. Pre-absorption of sera with Treponema phagedenis sonicat e diminished the sensitivity of detection of borrelial specific IgG (IgG or IgM or both) antibodies in patients with neuroborreliosis from 80 to 57% ( 100 to 82%) and in the controls from 100 to 32% (100 to 37%), While being s pecific for B, burgdorferi, the recombinant EIAs proved to be significantly more sensitive than the sonicate EIA: IgG or IgM, or both antibodies again st any of the recombinant antigens were detected in 92% of patients with ne uroborreliosis and in 24% of controls. The increase in sensitivity in patie nts with neuroborreliosis was mostly due to the higher detection rate of Ig M antibodies in the recombinant EIA (77% versus 48% in the sonicate EIA), w hile IgG antibodies were demonstrated with similar frequencies in both EIA systems (57% versus 60%), It was concluded that the recombinant EIAs are su perior to the sonicate EIA with preabsorption of cross-reactive antibodies in the confirmation of an acute borrelial infection and in the differentiat ion between symptomatic and asymptomatic infections.