Why antibiotics to fight antibodies?

[bubbasmom]

I'm confused, and trying to help my son. If PANDAS is caused by strep antibodies attacking the brain, why the need for antibiotics? Does antibiotics help antibodies go away, or only bacteria go away. From what I understand, the bacteria is alreay gone that's why the antibodies has 'moved on' to other cells.

Perhaps my brain is just fried (that's quite possible) and I'm not getting it.

'

[peglem]

I'm confused, and trying to help my son. If PANDAS is caused by strep antibodies attacking the brain, why the need for antibiotics? Does antibiotics help antibodies go away, or only bacteria go away. From what I understand, the bacteria is alreay gone that's why the antibodies has 'moved on' to other cells.

Perhaps my brain is just fried (that's quite possible) and I'm not getting it.

'

Antibodies don't last forever, but the body stores a copy of them so that it can mount a speedy attack next time it "sees" the invader. The antibiotics do not kill or fight antibodies- you're right about that. Abx are only to help prevent another bacterial invasion, so that future exposure does not trigger the production of more harmful antibodies.

[bubbasmom]

Got it!! I swear we should all go to medical school after this. After studying PANDAS it seems like the rest of it would be a breeze!!!

Dr. Denna HERE!

I'm confused, and trying to help my son. If PANDAS is caused by strep antibodies attacking the brain, why the need for antibiotics? Does antibiotics help antibodies go away, or only bacteria go away. From what I understand, the bacteria is alreay gone that's why the antibodies has 'moved on' to other cells.

Perhaps my brain is just fried (that's quite possible) and I'm not getting it.

'

Antibodies don't last forever, but the body stores a copy of them so that it can mount a speedy attack next time it "sees" the invader. The antibiotics do not kill or fight antibodies- you're right about that. Abx are only to help prevent another bacterial invasion, so that future exposure does not trigger the production of more harmful antibodies.

[Guest Angela Shaw]

Antibodies don't last forever, but the body stores a copy of them so that it can mount a speedy attack next time it "sees" the invader. The antibiotics do not kill or fight antibodies- you're right about that. Abx are only to help prevent another bacterial invasion, so that future exposure does not trigger the production of more harmful antibodies.

so is that why the symptoms wax and wane, because the level of antibiodies goes up and/or down depending on how recently you were infected? What about these kids who have had PANDAS for years?

For instance, my daughter has struggled with this for 3 years. This fall things got much worse and she was pretty much non-functioning. We had her aso and dnase checked recenlty and they were in the normal range. Yet, she just began antibiotics and she is already MUCH better. How does that work?

 

Angela

[peglem]

Antibodies don't last forever, but the body stores a copy of them so that it can mount a speedy attack next time it "sees" the invader. The antibiotics do not kill or fight antibodies- you're right about that. Abx are only to help prevent another bacterial invasion, so that future exposure does not trigger the production of more harmful antibodies.

so is that why the symptoms wax and wane, because the level of antibiodies goes up and/or down depending on how recently you were infected? What about these kids who have had PANDAS for years?

For instance, my daughter has struggled with this for 3 years. This fall things got much worse and she was pretty much non-functioning. We had her aso and dnase checked recenlty and they were in the normal range. Yet, she just began antibiotics and she is already MUCH better. How does that work?

 

Angela

I'm only making an educated guess...based mostly off of Buster's info and explanations. My daughter has struggled with this since before Swedo started researching it!

 

I think yes, this is why you see the wax and wane. My daughter's A&A titers have been low every time they were checked. She is a carrier (I'm just now learning to admit this!), she doesn't get infections...the strep hang out inside of her epithelial cells (intracellular strep) and when those cells die...the strep is released and triggers antibodies. Had a "der" moment yeasterday, when I realized that she always gets worse with teething/dental procedures. Whenever there is tissue damage...strep release and antibodies rise and we see a flare....looking back over her whole lifetime, this has been a pattern. I'll bet that's why, after her T & A, she had her worst episode ever...poor kid. BTW, she just turned 15yo.

[Buster]

so is that why the symptoms wax and wane, because the level of antibiodies goes up and/or down depending on how recently you were infected? What about these kids who have had PANDAS for years?

 

Hi Angela, Let me try a response here, but please post again if this isn't clear.

 

Q: What is the trigger for symptoms in PANDAS?

The key item in PANDAS appears to be

a break down in the blood-brain barrier

such that antibodies circulating in the blood stream can interact with neuronal tissue. I write it this way because that seems to be the actual trigger of symptoms. As long as the blood brain barrier remains closed, symptoms seem to not emerge.

 

Q: "What opens the blood-brain barrier?"

It turns out that stress, infections, high-blood pressure, epinephrine, .... all can cause leakage across the blood brain barrier. Also certain exotoxins (for example those from strep) can cause leakage across the BBB.

 

Q: "What closes the blood-brain barrier?"

This is the central question in Multiple Sclerosis (and other) studies. If the BBB breach is due to inflammation, removing the original antigen or reducing the "pro-inflammatory" chemicals help. This is why antibiotics, prednisone, and IVIG are all thought to work. Antibiotics help the immune system get rid of bacteria. Prednisone is anti-inflammatory and immuno-suppressant. IVIG is highly anti-inflammatory. PEX is also anti-inflammatory by removing antigens and removing antibodies that might cross the BBB.

 

Q: "What gets rid of the anti-bodies?"

Time removes antibodies -- if the antigen goes away, then the antibodies decline in 4-6 weeks. Unfortunately, they can come back if the B or T-cells encounter a similar antigen. In addition, PEX removes antibodies by filtering. IVIG removes antibdodies but we aren't exactly sure how. It looks like IVIG resets what are called regulatory cells. Once reset, these cells seem to remove faulty antibodies. Prednisone also suppresses B-cell activation so at least new antibodies aren't created.

 

Q: "Does everyone get these antibodies?"

Apparently not. The kirvan and cunningham tests have isolated a number of antibodies that are thought to be the culprit in the above scenario. These antibodies are created by some individuals in response to GABHS infection. A specific antibody (24.3.1) interferes with neuronal messaging and dopamine levels.

 

Q: "Why does there seem to be exacerbations even without strep?"

The current theory is that the antibodies are already in the blood stream. Some other event (stress, infection, ...) opens the blood brain barrer and the symptoms re-emerge.

Q: "Why high doses of antibiotics?"

First, it is important to know that antibiotics don't kill GABHS. Most antibiotics (especially at common dosage levels) inhibit the growth of bacteria, but the body's own immune system has to come along and get rid of the bacteria.

 

For people who are immuno compromised, higher doses of antibiotics are needed so that the antibiotic becomes bacteriacidal.

 

In addition, it appears that some forms of strep go intracellular (like a virus) and thus can't easily be eradicated except when the cell bursts. The high antibiotic level helps ensure that no growth is occuring by the "bursting" bacteria before the immune system can remove them.

 

Hope the above helps...

 

Regards,

 

Buster

[EAMom]

So even if strep were completely eliminated (which may be difficult if someone has a poor immune system against strep and/or it is intracellular hiding out in small amounts), as long as the blood brain barrier is open, more antibodies will be produced b/c the body will mistake brain (basal ganglia) cells for strep. This may be why some (many) PANDAS kids aren't "fixed" with antibiotics alone...they need the addition of steroids and/or IVIG/PEX to "turn off" the inappropriate immune response, close the blood brain barrier, stop the cycle of anti-bodies being produced in response to either strep or an open blood brain barrier ("exposed" brain cells).

 

To further complicate matters...I think that simply EXPOSURE to strep (not necessarily infection) may be enough to trigger more anti-body production.

 

So Buster, it is your understanding that other illnesses (viruses, non-strep illnesses) do not trigger more anti-body production, but rather just open the blood brain barrier so existing anti-bodies can get through? And once these anti-bodies get through, they reach the brain tissue (which looks like strep to the confused immune system) to further produce more anti-bodies?

[Buster]

So Buster, it is your understanding that other illnesses (viruses, non-strep illnesses) do not trigger more anti-body production, but rather just open the blood brain barrier so existing anti-bodies can get through?

I'm not sure we exactly know, but yes, I think the principal impact of other viruses/illnesses is to weaken the BBB.

And once these anti-bodies get through, they reach the brain tissue (which looks like strep to the confused immune system) to further produce more anti-bodies?

Yes, the B-cell engulfs a possible antigen and presents parts on the surface of the B-cell. A T-cell recognizes the fragment and the two compare notes and decide it's something worthy to "destroy" and so release the B-cell antibodies. It's hard to say who is at fault, the B-cell (for presenting a bad fragment) or the T-cell (for recognizing the host fragment), but the result is the same -- more antibodies released. More macrophages go out and find more cells tagged with the antibody and reactivate more T-cells causing the cycle to continue.