Articular joints are a major target of Borrelia burgdorferi, the causative agent of Lyme arthritis. Despite antibiotic treatment, recurrent or persistent Lyme arthritis is observed in a significant number of patients. The host immune response plays a crucial role in this chronic arthritic joint complication of Borrelia infections. During the early stages of B. burgdorferi infection, a major hinder in generating a proper host immune response is the lack of induction of a strong adaptive immune response. This may lead to a delayed hyperinflammatory reaction later in the disease. Several mechanisms have been suggested that might be pivotal for the development of Lyme arthritis and will be highlighted in this review, from molecular mimicry of matrix metallopeptidases and glycosaminoglycans, to autoimmune responses to live bacteria, or remnants of Borrelia spirochetes in joints. Murine studies have suggested that the inflammatory responses are initiated by innate immune cells, but this does not exclude the involvement of the adaptive immune system in this dysregulated immune profile. Genetic predisposition, via human leukocyte antigen-DR isotype and microRNA expression, has been associated with the development of antibiotic-refractory Lyme arthritis. Yet the ultimate cause for (antibiotic-refractory) Lyme arthritis remains unknown. Complex processes of different immune cells and signaling cascades are involved in the development of Lyme arthritis. When these various mechanisms are fully been unraveled, new treatment strategies can be developed to target (antibiotic-refractory) Lyme arthritis more effectively.

中文翻译：

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共同努力：莱姆关节炎先天免疫系统和适应性免疫系统之间的相互作用。


关节是伯氏疏螺旋体（莱姆关节炎的病原体）的主要目标。尽管接受抗生素治疗，仍有大量患者出现复发性或持续性莱姆关节炎。宿主免疫反应在疏螺旋体感染的慢性关节炎并发症中起着至关重要的作用。在伯氏疏螺旋体感染的早期阶段，产生适当宿主免疫反应的主要障碍是缺乏强烈的适应性免疫反应的诱导。这可能会导致疾病后期出现延迟性高炎症反应。已经提出的几种机制可能对莱姆关节炎的发展至关重要，并且将在本次综述中重点介绍，从基质金属肽酶和糖胺聚糖的分子模拟，到对活细菌或关节中疏螺旋体螺旋体残留物的自身免疫反应。小鼠研究表明，炎症反应是由先天免疫细胞引发的，但这并不排除适应性免疫系统参与这种失调的免疫状况。通过人类白细胞抗原 DR 同种型和 microRNA 表达的遗传易感性与抗生素难治性莱姆关节炎的发生有关。然而（抗生素难治性）莱姆关节炎的最终原因仍然未知。莱姆关节炎的发展涉及不同免疫细胞和信号级联的复杂过程。当这些不同的机制被完全阐明后，就可以开发新的治疗策略来更有效地针对（抗生素难治性）莱姆关节炎。