BIO from the BAYOU: Build Your Biotech Network with Key Opinion Leaders and Investors
30 Sept 2023 · 13 min
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In this episode of Bio from the Bayou, hosts interview Dr. Monica Embers, Director of Vector‑Borne Disease Research at the Tulane National Primate Research Center, about her work on Lyme disease. Dr. Embers explains that Lyme disease is caused by the spirochete Borrelia burgdorferi, transmitted by ticks, and can manifest as cardiac, joint, and neurological symptoms, often mimicking other illnesses. She describes the challenges of diagnosis, especially when the characteristic bullseye rash is absent, leading to chronic symptoms such as joint pain, arthritis, and brain fog. The conversation then shifts to her research program, which leverages a unique non‑human primate (NHP) model that replicates natural tick transmission. Using this model, her lab discovered that standard 28‑day doxycycline therapy often fails to eradicate the bacteria, prompting investigation into antibiotic tolerance and persistence. Dr. Embers outlines several therapeutic avenues: combination antibiotic regimens modeled after tuberculosis treatment, small‑molecule inhibitors identified through a collaboration with Duke cancer researchers, and a novel “one‑two‑punch” strategy that pairs doxycycline‑induced antigen expression with targeted antibodies. Vaccine development is also a focus, with the NHP colony allowing testing of vaccines that must block tick‑borne infection. The lab is exploring repurposed drugs such as disulfiram (Antabuse) for anti‑Borrelia activity. Dr. Embers emphasizes extensive collaborations with academic, industry, and foundation partners, noting that most of her funding is foundation‑based because federal agencies have been reluctant to support Lyme disease research. She provides contact pathways through Tulane’s Business Development Office and her personal email, and mentions involvement with the Federal Tick‑Borne Disease Working Group and interest from ARPA‑H. The episode closes with acknowledgments and resources for listeners.
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Welcome back to Bio from the Bayou. Today's guest is Dr. Monica Embers. Monica is Director of Vector-Borne Disease Research at the Tulane National Primate Research Center. Welcome to the show, Monica.
Thank you.
Now, Monica, you're one of the foremost global experts in Lyme disease, and you're often sought out for your incredible research in this area. Now, Lyme disease had been unknown for a long time, but has been getting more and more media attention as ticks carrying the disease are migrating further south and affecting more and more people. So for folks who don't know out there, can you explain what Lyme disease is and what Lyme symptoms look like in humans?
So Lyme disease is a tick-transmitted bacterial infection caused by a spirochete bacteria similar to the one that causes syphilis, and it's called Borrelia burgdorferi. These bacteria enter the bloodstream and then they disseminate through the blood into the tissues, and they can cause cardiac, joint and neurological manifestations in humans.
What do those look like? Does it mask as other diseases or?
Yeah, oftentimes it does mask as other diseases and that's the problem. It becomes very difficult to diagnose clinically. Initially, people can have joint pain, fatigue, headaches, things that could mimic any other infection. So, it's important to be able to Trace it back to a tick bite if you can. A lot of times people will develop erythema migrans rash or a bullseye rash at the site of the tick bite, and if that happens, you're one of the lucky ones. That means you'll be diagnosed readily and treated readily and probably have a very good prognosis. But if you don't see that rash and you start to develop long-term symptoms like joint pain, arthritis, brain fog is very common. Neurological complications, then it becomes a lot more difficult to treat. And that's the part of the research that really interests me.
That's kind of perfect because I was going to ask next, what does your Lyme disease research program entail? So, can you tell us a bit more about that?
Certainly. So, many years ago, I became very interested in Lyme disease because these bacteria are able to what we call evade the host immune response. And so they can persist in people like us who have good immune systems, and they can cause all kinds of different damage, and they have many different ways to be avoided by the immune response. And so what's interested me is how they respond to antibiotic treatment as well. And so we found a number of years ago that when we treated non-human primates with with the standard course of antibiotics, the standard of care, which is doxycycline, for 28 days, that we were still able to find the infection in these subjects. We went further to try to understand what is it about the bacteria that allows it to tolerate the antibiotic treatment. And it's become a very controversial topic whether or not people who continue to have symptoms actually have a persistent infection or if it's just autoimmunity or something else. And so this is something we've been really working very hard to try to decipher in our lab. And being at a primate center doing translational research, we also have projects focused on diagnostics and preventatives of vaccines. So we do everything. We do diagnostics, we do treatments, and we do vaccines.
So can you tell us a bit more, moving beyond kind of the diagnostics into the therapeutic strategies, your treatments and vaccines? Can you tell us about some of the pathways you're looking at for that and what some of those are more specifically?
Sure. So the standard treatment for Lyme disease is doxycycline, as I mentioned. So we've looked at how we can use combinations of antibiotics to treat the infection. For instance, if you look at tuberculosis, it's not treated with one antibiotic. It's a slow-growing bacterium and is treated with multiple different antibiotics over a fairly long period of time. And so we've been testing different combinations for treatment of Borrelia burgdorferi.
Gesundheit. Sorry, it was right there.
Yes. And then we've also entered some novel therapeutic avenues. And one strategy is to look at small molecule inhibitors of the bacteria. And this technique to identify these small molecules was developed by cancer researchers at Duke University.
Oh, interesting.
We've been collaborating with them and we are the animal model people. So they develop the drugs, they identify them, and then we test them in animal models to see if they work. And we've done this for not only Borrelia, but also for Bartonella, which causes cat scratch disease and is present in a lot of patients who have Lyme disease. And I think this is because they are immunosuppressed by the bacterial infection of Lyme disease. So, we've entered the field of bartonellosis as well. And so it's been exciting. The other strategy that we've taken, which is a little bit non-conventional, is to treat the bacteria with antibiotics, look at the genes that are differentially expressed, identify those that are what we call antigens that can be targeted by the immune response, and then to try to generate antibodies, like we use to treat different arthritic diseases that will target the bacteria specifically. So we could treat them with what I call the one-two punch. So we hit them with the doxycycline, they upregulate antigen X, and then we give them an antibody that targets antigen X to try to kill the bacteria. So really killing spirochetes is my life's goal.
Very nice, I like that. And you mentioned earlier that you are at the Tulane National Primate Research Center, of which I think there are only 6 in the country, is that correct? Or is it 7? 7 in the country, and those are the top-tier NIH-funded thought leaders in primate research. So how does that help you with your research line being located there?
That's a really good question, and I really never envisioned myself as being a researcher at a primate center. The person who developed the non-human primate model for Lyme disease was at Tulane, and I was interested in doing a postdoctoral fellowship with him. And I learned a lot from him, Dr. Mario Filipe. And believe it or not, the primary canine Lyme disease test was developed at Tulane. This is an antibody-based test. And so we're building on what he has done with the diagnostic to build our own diagnostic test that can be used for humans at all stages of disease, where this other antigen test can fail, especially in the early phases. I ended up at the Primate Center because of his work. And now we are the only ones working with this model of Lyme disease. And so, it's incumbent upon us to share and collaborate. And this is what I do. I have so many different collaborators. And it's really, it's wonderful for me to be able to reach out to different people and to have the resources to do the experiments that can be translated to humans.
So you mentioned wanting to come here because of the mentor that you had. I think we're all aware that there is no— like, we have a Captain Marvel, we don't have a Captain Lyme Disease action figure out there for you to have looked up to. What made you decide to go into Lyme disease research of all things?
Another good question. I was in Pennsylvania. I did my graduate work in Pennsylvania and it was becoming a lot more prevalent there. I knew people who were affected and I started to read about it and I did my PhD in virology. So it was a big shift to go into bacterial. because of the ability of this pathogen to cause so many problems, because it's one of the most controversial infectious diseases our society has ever known, that means it's a hard question to tackle, and that just excites me. I've never in my life taken an easy path, and so—
So you picked the thing with the least amount of funding and the hardest pathway to decipher?
Exactly. Yes, precisely.
All right, so along that, obviously you can't just do this on your own. Are you looking for partnerships and collaborations in this space?
Absolutely. We have a number of collaborations with vaccine development. We have the best model to test a vaccine because it's not only important to use a good model that replicates human infection, but it's very important to model the tick transmission because the vaccine has to protect against tick transmission. And we have our own colony at the Tulane Primate Center, so we, we raise our own ticks and we, we model the natural course of infection. We're also very interested in novel therapeutics. We have interests with drug companies testing new antibiotics, antimicrobials, even some things that might be repurposed. We've done some testing with repurposed drugs. For example, disulfiram, which is a a drug used for alcoholics. They have a negative response to drinking. And it's— it was also called Antabuse. And this drug has been shown to be very effective against Borrelia burgdorferi. And so, you know, we've tested it in the lab, and a number of patients are trying it. It's not the best drug in the world, but there's a lot out there to be done, and we want to be part of it.
And one question that I hadn't thought about asking, but I'm going to now. So obviously, you know, the federal government Funds this in limited ways, but not as much as some other areas of research. So I know you're always looking for funding for lines. If someone out there at a foundation, you know, a company or a family office or an individual who's been affected by this wants to fund part of your research, how do they get in touch with you?
They can definitely reach out through Tulane, through the Business Development Office.
Thank you for that plug.
The National Primate Research Center that we have, or at my personal email, which I know you'll provide I should mention that we have a lot of foundation funding, and that's because the federal government doesn't really recognize the difficult-to-treat nature of Lyme disease. And so, every study that we have that's focused on better treatments is foundation-funded and not government-funded. So, I think it's really important for patients who are suffering to have a lifeline, and we're doing good science too. That's really important. I teach rigor and reproducibility to all the The trainee is at our center and it's incumbent upon us as scientists to do the work well so that it's believable and so that the results actually can translate to better outcomes for humans.
Well, I hope in addition to the folks you mentioned that ARPA-H is listening and maybe they can be the people who will do some transformational program in this space since it's so cutting edge.
Absolutely. I served on the Federal Tick-Borne Disease Working Group And ARPA-H was brought up several times because the goal is to really focus on chronic illnesses. And we're shifting the language more towards infection-associated chronic illness. And Lyme disease is definitely one of these, and long COVID is one of these. And we really need to find better solutions to these problems.
Well, Monica, as always, it's been a pleasure talking to you. You were one of the very first scientists that I dealt with when I came to Tulane almost 9 years ago. And it's nice that we're sitting here doing this right now. I wanted to thank you for making time to come on the show with us.
It's a pleasure to be here. Thanks so much.
As always, we'll have Monica's contact info and all the other links and information she mentioned posted in our show notes. Make sure you check them out to learn more and join us again for Bio from the Bayou. Thanks for joining us for Bio from the Bayou, and we hope you'll join us again.
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