"Finally, we are opening the Columbia University Lyme Disease Research Center, a state-of-the-art interdisciplinary center dedicated to helping hundreds of thousands of people suffering from Lyme and associated tick-borne diseases. The center will fast-track scientific studies focused on improving diagnostic tools and treatment.

"These studies are expected to earn NIH funding for further basic research on unresolved questions about the spirochetes (spiral-shaped bacteria) that cause Lyme disease.

"The New Jersey-based national Lyme Disease Association and the Connecticut-based organization Time For Lyme spent five years raising $3 million to start up the Columbia Lyme center. Now that this primary goal has been achieved, let the research begin and the breakthroughs emerge."

Diane Blanchard,
Co-President, Time for Lyme

This April, a new center for research on chronic Lyme disease is scheduled to open at Columbia University. Pat Smith, president of the Lyme Disease Association (LDA), hailed the Columbia center as "the first of its kind in the world devoted to addressing the multiple possible causes of persistent symptoms from Lyme disease." Establishment of the center, Ms. Smith said, is the outgrowth of a "legal partnership" entered into by the LDA, Time for Lyme (TFL, an affiliate of the LDA), and Columbia University during the summer of 2002. Subsequently, the LDA and TFL led efforts to raise the $3 million necessary to launch a multi-disciplinary university center. Brian Fallon, MD, MPH, will direct the center's research programs. Dr. Fallon, a specialist in neurological Lyme disease, is Associate Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons.

"We are all excited that an academic medical center as prestigious as Columbia University has committed itself to focus scientists and the latest biotechnologies toward unraveling the problem of chronic Lyme disease," exclaimed Ms. Smith, who noted that Columbia University "has already been at the forefront internationally in research on neurological Lyme." Contemplating materialization of the center, she commented: "Patients with Lyme disease, whose manifestations in some cases can be as devastating as congestive heart failure, deserve the respect, focus, and funds that Columbia University can generate." Lyme disease, she pointed out, has become "the most prevalent vector-borne infection in the US, and unlocking the secrets of its debilitating chronic effects is urgent."

This reporter interviewed Dr. Fallon for Townsend Letter's issue on Lyme disease. The interview follows:

MC: Dr. Fallon, when and how did you get involved in Lyme disease?

BF: I first became interested in Lyme disease in 1990 when my wife (a psychiatrist at Yale) and I (a psychiatrist at Columbia) received a telephone call from Polly Murray, who lived with her children in Old Lyme, Connecticut. It was Polly Murray who first noticed an odd clustering of arthritis among children in Old Lyme, and it was her persistent letters to the public health authorities that led to the first reports of Lyme arthritis in the United States in 1976.

When Polly Murray told my wife and me that she suspected Lyme disease was causing prominent neuropsychiatric symptoms in her neighbors with Lyme, we became curious. We made a home visit, interviewed her neighbors with Lyme disease, then conducted a survey of over 1,000 people in the United States diagnosed with Lyme. The results surprised us; we learned that depression occurred far more commonly in these Lyme disease patients than in patients with lupus or rheumatoid arthritis.

MC: Some 17 years have passed since your first encounter with Lyme. What were the steps between point A and the opening of the Columbia Lyme Center with you as director?

BF: As a researcher, I began to study the neuropsychiatric aspects of Lyme disease in adults and children more objectively. I also became interested in the dilemma faced by patients regarding treatment: some physicians said no more antibiotic was needed; others said patients needed treatment until the symptoms were gone. The fact was that these patients were quite sick, very disabled as a result of the initial tick bite and infection. Why? And what was the best treatment strategy to help them?

These questions led me to conduct a number of research studies, including, most recently, a $4.7 million re-treatment study of chronic Lyme encephalopathy funded by the National Institutes of Health (NIH). The idea of the Center at Columbia emerged several years ago, based on a recognition that far more scientific work needed to be done on the problem of Lyme disease, particularly the problem of why patients were persistently symptomatic.

MC: In a paragraph, can you state the "mission" of the new center – as you envision it?

BF: The Center will engage in multi-disciplinary scientific research relevant to the spiral-shaped bacterium that causes Lyme disease, such as how it might evade antibiotics or lead to persistent symptoms even when no longer present. On the clinical side, the Center will address unresolved problems concerning diagnostic tools and treatments.

MC: Can you give readers of this report a rundown of funding for the center's research activities?

BF: All of the funding for the Center to date has come from the work of private foundations, most notably TFL and the LDA, as well as from very generous individual donors within their relatives and friends.

The Center's "start-up" contains funds for an endowment (providing interest income annually) to support ongoing Lyme and tick-borne disease research at Columbia. The "start-up" also contains funds for new research projects, some of which have already begun. For example, we've hired a post-doc in microbiology, Dr. Rafal Tokarz, to work with Dr. Ian Lipkin at Columbia to apply previously unavailable molecular genetic technologies to determine whether persistent symptoms in humans might be caused by previously unidentified organisms in ticks.

Outside Columbia, we're funding a project on proteomics (analysis of miniscule amounts of proteins expressed by spirochetes – i.e., Lyme bacteria) with Dr. Steven Schutzer at the University of Medicine and Dentistry of New Jersey. Dr. Schutzer's study aims to identify a more sensitive diagnostic tool for Lyme disease.

MC: You mentioned earlier a recent study you conducted, which received nearly $5 million in NIH funds; that's for one study. The Columbia center's start-up funds amount to $3 million. Where will you look for additional research funds?

BF: Research is an expensive enterprise, and the NIH funding has become much more limited compared to the number of applications for grants. They are now much less likely to take risks with novel ideas. Thus, it is necessary to have the private foundation funds to allow for pilot studies that can test out creative hypotheses on a small scale that later will be approved for NIH funding on the larger scale. As a Center, we have committed ourselves to continue providing research funds to support research being conducted by investigators from around the world. Projects will be evaluated using a multi-institutional scientific review board to ensure unbiased awards. We recognize that we will regularly need the generous support of private foundations and individual donors to fund this international grant program.

Our Center also has a strong educational component. This year, we launched two fellowships, one in Lyme-related molecular biology and one in clinical diagnosis and treatment. We expect the results of these pilot research investigations to lead, as they have in the past, to NIH funding.

MC: What do you see farther along the research road?

BF: Symptoms may persist in patients for a variety of reasons, reflecting a complex interaction of various mechanisms, including persistent infection, autoimmunity, tissue damage from prior infection, and imbalances in neurotransmitters or neurohormones. The portfolio of clinical research for the new chronic Lyme disease research center at Columbia will likely include a wide range of treatment approaches. Among those under consideration are promising herbal treatments, non-IV antibiotics, immune modulators, and neuroactive agents.

MC: The second paragraph of this report quotes Pat Smith on the elation she feels at the opening of the Columbia center. In the broadest sense, what's your view of the role of the new center at Columbia University in the Lyme world?

BF: One of the difficult aspects of illness is feeling sick. Another very difficult aspect is having an illness that is the source of so much confusion in the medical community regarding its cause and treatment. Patients with very disabling symptoms from Lyme disease are sometimes dismissed by doctors. The presence of this Lyme Center in a nationally prominent academic medical institution sends a clear message to these patients that not only are they being taken seriously by medical scientists but, with the joint effort of leading researchers and the support of the community, scientific breakthroughs can occur that will ease their symptoms.