: Disulfiram–breakthrough drug for Lyme and other tick-borne
: diseases?

: By Daniel A. Kinderlehrer MD

: I have been practicing medicine long enough to be very
: skeptical of “breakthroughs.” But disulfiram may be the
: real thing. Let’s keep our fingers crossed.

: Anyone who reads the financial pages has heard of Steven
: Cohen, the multi-billionaire hedge fund manager and
: philanthropist. Cohen lives in Connecticut where his wife,
: Alexandra, became ill with Lyme disease.

: The Cohens established Target Lyme, a division within their
: philanthropic organization devoted to supporting Lyme
: research. The Cohen Foundation has committed over $50
: million dollars to support more than 20 Lyme disease
: research projects.

: In 2016, the Cohen Foundation sponsored the “First Annual Lyme
: Disease in the Era of Precision Medicine Conference” at the
: Mount Sinai School of Medicine in New York.

: Those of us who actually treat Lyme disease know there is
: nothing precise about it. Treating chronic infection with
: Borrelia burgdorferi, complicated by any number of
: co-infections, is often hit or miss. Nevertheless, we who
: practice where the rubber meets the road are grateful for
: whatever clues basic researchers provide that can help our
: patients.

: At that conference, Kim Lewis, leader of Northeastern
: University’s Antimicrobial Discovery Center, presented data
: on the relative effectiveness of different antibiotics
: against Borrelia burgdorferi in his laboratory.[1] Lewis
: was testing different pharmaceuticals against Bb, and one
: of the drugs he tested was disulfiram, also known as
: Antabuse.

: Disulfiram
: What is disulfiram? Let’s take a step back. If you drink
: alcohol, your body converts it to acetaldehyde via the
: enzyme alcohol dehydrogenase. Acetaldehyde is then broken
: down to acetic acid via the enzyme acetaldehyde
: dehydrogenase: Disulfiram inhibits the enzyme acetaldehyde
: dehydrogenase, leading to a buildup of acetaldehyde.

: This is bad news if you drink alcohol, because acetaldehyde is
: responsible for the symptoms we know of as hangovers. This
: drug is prescribed to alcoholics as a deterrent to drinking
: alcohol, since having just one drink will result in a
: vicious headache.

: It turns out disulfiram has known activity as an
: antimicrobial. Studies have demonstrated its action against
: gram-positive bacteria such as Staphylococcus and
: Streptococcus species[2] as well as Plasmodium falciparum,
: a.k.a. malaria.[3]

: Number one against Bb
: In 2016, Venkata Raveendra Pothineni and colleagues at
: Stanford reported on new drug candidates against Borrelia
: burgdorferi using a technique known as high-throughput
: screening.[4] They ranked disulfiram as number one in
: activity against Bb among their top 20 hits.

: On the basis of Pothineni’s work, Lewis compared the activity
: of disulfiram against a few other well-known drugs used in
: the treatment of Lyme disease. In his talk at the Precision
: Medicine conference, Lewis showed a slide that looked like
: this: More at this link:
: https://www.lymedisease.org/disulfiram-kinderlehrer/?fbclid=IwAR1Qc4SC9i2iX8MZ4UIVk8XMtn8KtVsORdJNoSPxNYtXdtID4AVCuJ9pERw

: Many Blessings,
: CrystalRiver