Eva Sapi Interview

I would love to hear about your Lyme research studies at the University of New Haven. I spoke with Alan MacDonald recently, and he talked about the recent discovery of biofilms, and I wondered if you could elaborate on that discovery?

Sure. We have several programs at the University of New Haven. One program, which you just mentioned, is the biofilm research, which we just started a few months ago, initiated as a common project with Dr. MacDonald. And the whole idea is to try to explain why we cannot cure this bacteria by just using regular antibiotics.

And there's a lot of ideas in the literature, and Dr. MacDonald is always sending me those beautiful pictures of his. One day we were looking at those pictures and the idea came up that there was something else in the picture with Borrelia, the Lyme bacteria. It might be something which resembles biofilm. And we started to focus on that and we actually started conducted some experiments to see whether really, biofilm can be produced by Borrelia, and we do have some evidence now that it might be a potential mechanism for this bacteria to escape from us.

I don't know how much you know about biofilm, but it's basically slime, the same slime that somebody could have in the bathroom, and the whole idea is the bacteria is trying to protect itself from the environment so it's growing in a film, a layer, which has all kinds of other material
to protect the bacteria. And for example, when you try remove this biofilm you usually have to use some kind of harsh agent to remove it.

Now you can imagine the body, with a biofilm form. It's very difficult just to remove by regular antibiotic treatment. One study showed that if you have a biofilm form in the body you need a thousand-fold dose of antibiotics than you would need otherwise. It's not achievable, therapeutically. I mean the patient won't stand it. You cannot give that many antibiotics to a patient.

So we tried to figure out what else you could do with this biofilm other than just giving more antibiotics. And we have a couple of ideas, such as an enzymatic treatment, or if there is some other treatment you might add to the therapeutic approach, and destroy the biofilm so that the antibiotic can work.

So over the next couple of months, a year, two years, this is the research plan for the University of New Haven students. I'm hoping at the end of it that we have something to give the physicians, so they could use the antibiotics treatment plus add some agents, so the biofilm will be destroyed and the patient can be healed. I hope it's going to work.

Yes, that would be great.

And the other idea we have also comes from the same question: Why can't we kill this bacteria? Why do have people after a year, two years of taking antibiotics and still complaining? Why is it they cannot stop the antibiotic treatment?

And the first question was, is it the biofilm? Might be. Or is something else at work with this complicated question. And the idea is that maybe some other bug - pathogen - is in the mixture, in the soup, how should I call it, from the ticks. And when you treat the Borrelia, you might be able to cure the Borrelia using the antibiotics but there may be something else there which contributes to the problem.

Last year we conducted some research which we just finished and sent it out for publication. We found that in ticks, in deer ticks, eighty-four percent of the ticks can harbor mycoplasma, it's a different bacteria. So, why is this important?

The problem with mycoplasma, is it's very, very slow-growing. So you cannot just kill mycoplasma using the same treatment you would give to Borrelia. You need a different approach. Mycoplasma is a bacteria that doesn't have cell walls, so any of those antibiotics which don't get treatments which against cell wall won't work...And we also need a different treatment, and from different research we know for mycoplasma that you need at least 8 to 9 months of treatment. And that could explain why some people need longer treatment.

I talked to a couple of physicians, and several of them, for example Dr. Horowitz from New York, is already testing for mycoplasma, and he agrees with me that he sees mycoplasma all the time in his Lyme disease patients. So, is it time to add a protocol just for mycoplasma? And of course, is it just mycoplasma and Borrelia that is in ticks?

That's not true, because two years ago we conducted another study and we looked for other pathogens. And we found other bacterias, other parasites. So the whole idea is when you get bitten by a tick, it's not just one bacteria. You could get a whole mixture of bacteria and parasites and maybe even yeast, and who knows what else? And the physicians have this challenge to deal with that when you're showing symptoms.

What's the difference between co-infections and these... you're talking about mycoplasmas, and I'm not sure if I understand exactly what that is. Could you just explain that to me, and does the mycoplasma have the Borrelia bacteria, the same as the spirochete?

Okay, microplasma is very similar. In some ways it's similar to the spirochete, the Borrelia. What's the difference between the two bacteria? Obviously, they look awfully different. The mycoplasma doesn't have a cell wall. However, you could say, yes but you've heard that sometimes Borrelia doesn't have a cell wall either, you know, Borrelia has different forms sometimes. So maybe they're not that different when they evade the body. But they're definitely a different species.

And definitely we know that mycoplasma needs a completely different treatment. This we know from other illnesses, because mycoplasma can cause some other problems in the human body. The interesting thing about mycoplasma, is that we always knew that mycoplasma causes something that is chronic.

The obvious other question is: Is Lyme a chronic illness? We have two major sides, some people say no, it's not the same thing, and others say yes, it's a chronic illness. So, why does it become chronic? Is it really chronic, or is it just that we don't know how to treat it?

I believe that just looking at the research, we're finding more and more different species that can be isolated from the ticks, and we know if it is dead or it is alive and when the ticks bite us, we might get it. Of course, we need more research to really prove this, but because we find that like mycoplasma in ticks, and this mycoplasma is very, very tiny, they're smaller than spirochetes, so if you can get spirochetes from ticks, you can very easily get mycoplasma from ticks, on paper, but again, we have to prove it.

However, the high percent of 84% of the ticks will have one of the mycoplasma species, which we know can cause human illness. That raises the question, whether it is only Borrelia that we're dealing with?

And to go back to the biofilm idea. In biofilm, and the idea of biofilm from different sources, we're always talking about not only one species and one biofilm. So who knows, maybe when Borrelia is making this biofilm, maybe it's mycoplasma next to it, maybe Babesia is next to it, or who know what else is next to it in the biofilm. Yes, Babesia is showed mostly in the red blood cells, but. You know I've seen so much, what this Borrelia can do. And I can even imagine what other pathogens can do, so we need to learn a lot more of what it can do before we can even think about killing them.

So you're talking about it from a scientist's point of view. You've seen what Borrelia can do you're talking about its capabilities as an organism?

Right now we're going to present our findings at the University of New Haven, coming up at the Lyme conference, the later research shows that if you try to kill Borrelia, it is really clear that it's a completely different form. And yes, from the previous research we knew that it makes the L-form and the cyst form. But when you're looking at the forms, one experiment was we actually treated Borrelia with penicillin. This was one experimental approach to see what Borrelia is capable of. Actually, what we saw is that it's not just capable of making the cyst form, which was in the literature, but it's also capable of making a protective layer around the cyst form. And that's what we see in the biofilm. So, what I see here is a lot more strategy from Borrelia, than what we saw before from what we saw before. I think it's definitely a bacteria that knows us, and knows how to evade us.

It's curious to me that medical doctors who don't believe Lyme exists in every state, and even go so far as to tell their patients that it doesn't exist in the state where they reside, so they couldn't have gotten Lyme where they live. But what you're saying, is that there are possibly other bacteria that cause Lyme-like symptoms, or what we call Lyme disease symptoms, and we just don't know the strength of the bug that we're dealing with. Is that what you're saying?

I think the problem is multilevel. One, is Borrelia itself is capable of doing all kinds of tricks to evade our approach. To evade the immune system and our approach to kill it. And I think it's not over. Let's say we figure out how to deal with Borrelia, I'm afraid there will be other bacteria next in line that we will have to deal with. One will be mycoplasma, and obviously some other pathogens.

We really have to be ready for a multilevel approach. We cannot, I personally believe as a researcher, I am not a physician, but just from the research, I'm afraid that we cannot just give antibiotics, we have to think about what else we can give the body to be able to destroy this multilevel problem.

Is this a unique program that you head at the University of New Haven?

Yes, we have a Lyme disease research group, and it's a graduate program, I have graduate students. Usually I have 8 to 10 students working with me. This year we have the biofilm project, this is one our big projects. And we have one more interesting project, we got a grant from the Turn the Corner Foundation to study. The whole idea is to look for more pathogens, more bugs, as they say, that could be in the ticks and maybe could be transmitted to humans. The idea this time was not to look for a bacteria, but to look for a parasite.

The idea came from Dr. Burrascano, who talked to me about looking for a very special parasite called microfilaria parasite. And at first, I didn't understand when he mentioned this because those parasites are usually known in the Asian countries. And I didn't understand why he was asking me to do this.

So I did more research, and I discovered that in the 1980s a paper, they discovered that this parasite is found already in ticks. There is one paper on it. And actually it's very interesting, that the author of this paper was Burgdorferi, who discovered the Lyme bacteria. And I tried to find more papers, and I even tried to find him, but it was not easy.

So, what we tried to do was some preliminary experiments to see, we collected ticks and tried to do some DNA technology to find this parasite, and we found it. So that's when we wrote the grant and decided to ask the Turn the Corner Foundation to support further research, and to prove whether really this parasite can be found in the ticks, and transmitted to humans.

Again, why is this important? It's important because parasites are not bacteria. And when you give a treatment usually the treatment. is antibiotics. Now, antibiotics is working on the bacteria, but not on the parasite. I could give you the whole biology behind it, but for parasites, especially this parasite, you need a very specific drug.

I was very pleasantly surprised when I was looking at a European website for Lyme disease, and they already talk about this drug, and I was surprised. How did they know? Somehow the Europeans have already included this drug in the treatment. And this other very interesting website, that I couldn't really figure out who was behind it, but they talk about this kind of parasite and also mention the salt and vitamin C treatment. And I didn't know anything about this protocol. But this protocol, they claim, is actually after the parasite I'm intending to find.

So, it looks like the patients are already treating themselves. They're already treating themselves for the parasites we researchers haven't even found yet! So we're behind, so we definitely have to actually justify what they're using right now.

I'm aware of the salt and vitamin C protocol.

You've heard about it, yes?

Yes, it's very popular online. I've also heard that it can be quite harsh. In fact, my own doctor cautioned me not to use it when I was really sick, and I've heard that other people have had trouble with it too. Are you saying that that particular protocol is treating a parasite that you haven't even really started to isolate here yet?

Yes. Exactly, because when I was doing some research, Dr. Burrascano asked me to look into it and obviously this website came up. Probably you've seen this website, there are pictures of parasitic forms. And I obviously was trying to figure out where these pictures came from, and who discovered this. And I couldn't find too much about that.

And I talked to Lyme patients, some of them who, like you, were very familiar with the protocol, and said that it even helped them tremendously. So that just gave me the additional idea that there might be something really behind this idea, and maybe it would be worthwhile to study.

Microfilaria nematode, that's the official name of the parasite. It's in the ticks, and we just have to prove it further, and we have to prove it is live, and we have to prove it is transmittable to humans. If we can prove these three ideas, at this point we can ask the doctors to look into it and test for it in patients. And maybe at that point they may not be against this vitamin C and salt protocol, or some other drug that can address this infection.

Do you think the US medical community is preparing adequately for an epidemic of Lyme disease? Or are you seeing that we need to give more attention to these studies?

First of all, right now, it's very difficult to publish in this field because there's so much controversy about Lyme disease research.

You're talking about the controversy over whether it's recognized as a late stage disease or not, right?

Exactly. And exactly what is behind it. Any new ideas, any new ideas have to proven one hundred, two hundred percent before you're able to publish it. I've never seen this. When I was doing cancer research I had an easier time publishing.

No kidding.

It's very upsetting. I was complaining to one of my collaborators that I've had a hard time publishing. Actually, my publication record is getting kind of low, and I really need publications, otherwise I cannot get the grants.

I have, right now, three papers on my desk, not published yet. Hopefully one is going out very soon. But every time I send it it comes back with very harsh comments. And I say they are not even reasonable comments. I definitely feel that there is a political push behind that. To me it is not scientific anymore, and when you're dealing with these political issues it gets, sometimes, unreasonable. You understand that.

Yes. It's interesting to me because it seems to be getting worse. I often wonder if it's getting worse because it's just about to get better, and I wonder if you have any insight or intuition about that? Do you think there will be a turning point pretty soon?

First of all, the political side is definitely getting worse. But it's not just that. The other part of it is that the winters are getting very mild. You cannot imagine how many people are already calling me after having already been bit by a tick. I'm afraid it's going to be a very bad year. And epidemically it will be even worse.

We finished a study last fall, we studied half of it, because you can collect the ticks during the fall time, in Fairfield county, in Connecticut, very close to New York. And we found that sixty percent of the ticks were infected with Borrelia. That is a very, very high number. Usually, what we've seen before is like twenty, thirty percent. But we've started to see in some there were seventy, eighty percent infection.

Why do you think the number of ticks with the Lyme bacteria is going up?

I definitely blame the weather, I think this kind of mild weather is affecting the whole ecology. I'm not an ecologist, so you have to talk to an ecologist, but somehow I feel that is helping the bacteria to survive, and helping it to transmit during the winter. Ask an ecologist, they can probably explain it better.

Look at the last two winters, at least here in Connecticut. They were very mild. And right now the ticks are already out, and actually we're going out now to finish a study. This time of the year you have the nymphs, which is the smaller form of ticks, and it's very difficult to see them because they're tiny, tiny. And of course they carry Lyme disease.

So you really have to be very, very careful. And when I have my talk at the University of New Haven I'm going to repeat myself regarding what you have to do when you go out and take a leisurely walk in the woods.

Okay, so tell me, what would you advise me to do. I live in a very woodsy area, and everything is turning green. So what would you advise me to do when I dress up and take my dog out for a walk?

These studies come from our experience, when we go out and collect ticks for our studies. Usually we wear white suits so I can immediately see when the ticks are crawling on me.

There are two different issues here. One is, obviously wear long pants with socks. I recommend white socks, because you can see the ticks very well with white socks, and spray yourself with permethrin-based, not DEET-based spray. I tried both. At first, because everybody said forty percent DEET should work to retard the ticks. And I was shocked when I was spraying my students with forty percent DEET and finding places where the ticks were crawling on us.

Really? So, forty percent DEET wasn't even strong enough? So you're recommending, what is the other spray?

Permethrin-based. You can buy it at Walmart in the hunting section, usually. That one you cannot use on your skin, only on your clothes. But that's okay because you have to spray yourself from the waist down very well. Of course you can spray on your upper part. You can spray lightly around the waist. You cannot use it on your skin, unfortunately. If you want to use something on your skin, believe it or not those alternative sprays work very well, for example, something with essential oil is very effective. So spray yourself. And right after you finish the walk, if it's possible, take a shower.

Right, and check yourself for any visitors.

Exactly. If you do all this, the chance that you'll get bitten is very, very low. But I wouldn't recommend that you go into the woods without any protection, not anymore. Especially for kids. The problem, if you look at the statistics for kids, age four through nine, kids have a very high risk of getting bitten by ticks.

Why is that, because kids generally roll in the grass?

Exactly. I mean, they're just running around. And I don't know really that the parents are thinking about Lyme disease. The problem is people don't understand that Lyme disease is not just in the woods. Actually Lyme disease, if you have those bushes, you know like hickory bushes, they are definitely, usually infected. A lot of times you have this beautiful yard, and at the end of the yard close to the woods you have these bushes, and the kids are just playing there. So, your backyard could be worse than going into the deep woods.

Right. You just have to brush up against the wrong bush.

Exactly. Of course you could spray your yard. This year we're going to try something, it's not scientific, but I'm going to try something new. It is a garlic-based spray, because I have a kid, and I want to use something natural. I don't know yet. I can tell you next year if it works or not. I check my yard every day so I know exactly what's going on.

Well that's kind of a professional hazard, isn't it? You know so much about what can go wrong. You want your child to go outside and have a good time and play.

It isn't easy to have a house in the woods and look outside and I say okay, "this part looks like a tick heaven, this part might be okay..:

What is your title there at the UNH, and how old is that program that you're heading right now?

My title is associate professor, and the program is the department of biology and environmental sciences, and the Lyme disease program is five years old, it is part of the graduate program which is now, I think, fifteen years old.

And you're partially funded by the Turn the Corner Foundation of New York, then, right?

Yes, right now I have two grants from the Turn the Corner Foundation. One is for the biofilm idea, and one is for the parasite idea. The whole graduate program we have over sixty student, and in the Lyme disease group, we have about ten students.

Congratulations on getting those grants and following through. So these students, are they going to be researchers?

Yes, yes. It's a master's program, to be in the sciences. I infected them with the idea, one of my graduate students is following her dream, she went for PhD studies, and she's going to follow this infectious agents project, so I guess she hasn't had enough.

It sounds like you are a great professor, a wonderful inspiration. How did you get started, and where were you educated?

I am from Hungary, originally, whether you heard my accent.

I can, it's a beautiful accent.

I was a professor at the University for a couple of years, actually I stayed there as a research scientist until 2001. I did mostly cancer research, and in 2001 I got a professor position at University of New Haven. And unfortunately, at the same time, I got Lyme disease. So, since I got Lyme disease and I had a very hard getting diagnosed, and I saw the problems in Lyme disease, I decided to continue in Lyme disease research.

I'm so sorry to hear that. But it's really a credit to your character that you would continue to research. Most people with this disease, once they get 90% cured, they don't want to think about it anymore. And who can blame them?

Oh, I cannot blame them. Everybody asks me, how can I go out into the woods and face the ticks. I keep telling them that this time, it's my turn. This time I'm chasing them.

It's like the Scientist's Revenge, right? What is your research goal right now?

I have a very simple goal. I want to kill this bug.

I want to find out exactly how to kill it efficiently. Every experiment I do, that's my question. I don't study different proteins, or different mechanisms of regulation, like other people study. I don't. I want to kill it. Really every experiment and every idea is all about how to kill it and how to help Lyme patients.

So this is not about talking softly to Lyme bacteria to get it to leave.

No. It is really a war between me and this bacteria.

Oh boy, well you have a lot of people on your side, I think that's fantastic.

And every day I am getting phone calls, and they're really emotional phone calls. And I have to promise them that whatever I do, it's going to create some kind of idea about how physicians can be of more help to the patients.

And not next year, and not ten years from now, but soon. I did some research, some very basic scientific research, and I enjoyed it, but this is personal. This time it's personal. This time I want quick results, and I want to have the finish as soon as possible.

That's fantastic. I'm really psyched to hear you talk about it like that. There is such a feeling of being mired down in this political controversy around Lyme, and it has absolutely nothing to do with getting better and with treating people. I always feel that the patient is lost in that battle between doctors who say that there is a problem, and doctors who say that it's cured in two weeks with antibiotics.

That's very unfortunate that we have to even deal with this issue. Because we have enough to do with dealing with this disease, and we have to deal with these doctors who deny this problem. It's very unfortunate.

You've been very generous with your time and I want to thank you so much for talking with me today.

Yes, the Lyme symposium is on May 17th. I think it's going to be a very exciting symposium.

I've invited Dr. MacDonald and he's going to explain the biofilm idea to the patients and to the doctors. And also I've invited Dr. Cowden and Dr. Horowitz, who are going to talk about alternative methods to treat this bacteria. I think that's very important to understand that we need a multilevel approach to deal with Lyme disease. They're going to bring the latest results, which Dr. Horowitz has initiated in this clinical trial last year, using herbals for that. So we're going to hear about his work. And of course, we're going to hear more about chronic Lyme, and chronic problems, and how we can deal with them. We're going to see a lot of patients and doctors.

I wholeheartedly support you in spirit, with what you're doing, Dr. Sapi. I really appreciate that you have the courage and the intellect to go forward and study this, and that you can inspire students to go forward and kill the bug, because that's what we need to do.

Thank you very much, and thanks to everybody for the support. As I mentioned, it's very hard to publish in this field, but regardless, I'm getting lots of support from doctors and agencies, and it's fantastic. Thank you.

Yes, thank you.