Borrelia is a genus of spirochete bacteria that encompasses three major clades: the Lyme borreliosis (LB) group, the relapsing fever (RF) group, and a less well-characterized group seemingly restricted to reptiles. Borrelia taxonomy is in flux with the advent of molecular methodologies that allow genome and proteome comparisons, as is true of most other taxonomic groups1,2,3,4,5,6,7. The LB group (also called the Lyme disease group) has traditionally been termed Borrelia burgdorferi sensu lato after its best-characterized member Borrelia burgdorferi sensu stricto. This paper uses the currently most widely used terminology: the LB, the RF, and the reptile-associated group, and describes the culture protocols for the LB and the RF groups.
As would be expected for a member of the family Spirochaetaceae, Borrelia can adopt the distinctively long and thin spiral shape, typically 20-30 µm long and 0.2-0.3 µm wide. However, Borrelia cells are highly pleomorphic and can adopt many other shapes in both culture and in vivo1,8 as a result of their complex cellular and genetic structure. In its spirochetal form, the planar sine wave morphology results from its axial endoflagella rotating in the periplasmic space between the inner and outer membranes. This structure enables the cells to be highly motile, with the outer membrane containing proteins that enable the cell to interact with host tissues9,10. The expression of the outer membrane proteins is tightly regulated and affect not only host tissue invasion but also interaction with the host immune system11. This complex gene expression allows the Borrelia cells to shuttle between the very different environments of vertebrate hosts and invertebrate vectors. The genome of Borrelia is unusual among prokaryotes, consisting of a linear rather than a circular chromosome. In addition to the linear chromosome, Borrelia species contain 7-21 plasmids, some linear and some circular. The plasmids harbor the majority of genes required for host adaptation and virulence, and the circular plasmids derived from prophages are thought to be responsible for the majority of horizontal gene flow between spirochetal cells12,13. Consistent with a role in host adaptation, some, possibly many or all, members of the Lyme borreliosis group lose plasmids in culture14. The best studied "lab adapted" strain of B. burgdorferi, B31, has only seven of the nine plasmids found in wild isolates of this species15. Similarly, B. garinii loses plasmids in culture16. Some studies have shown that RF species and B. miyamotoi retain plasmids when cultured14,17, but recent work demonstrates altered plasmids and infectivity with long-term in vitro cultivation18.
Culture-based methods remain the gold standard for the laboratory detection of bacterial infections, for both research and clinical work14,17. The culture of pathogens from bodily fluids or tissues directly detects replicating pathogens and provides source material for research14,17. This protocol demonstrates the methodology and recipes required to successfully culture the spirochetes of the LB group as well as RF Borrelia and B. miyamotoi. The basic medium for growing Borrelia spirochetes is the Barbour-Stoenner-Kelly medium (BSK-II or the commercially available BSK-H), with or without antibiotics to reduce the growth of contaminating prokaryotes. This medium was adapted from a medium originally used to support RF Borrelia19, further modified by Stoenner20 and then by Barbour21. Many modifications have since been developed, each having effects on bacterial physiology that can affect growth, infectivity, and pathogenicity22. This medium reliably supports the growth of spirochetes in established cultures and has been used to isolate spirochetes from tick, mammal, and clinical samples23. The more recently developed variation, modified Kelly-Pettenkofer (MKP) medium, can provide better isolation success, morphology, and motility when isolating new Borrelia isolates from environmental samples, when the number of spirochetes present in the sample available to seed the culture is low23,24. In all cases, the success of cultivation is critically dependent on the freshly prepared medium and the use of appropriate ingredients; not all commercial ingredients produce high-quality medium. Inoculated cultures can be conveniently incubated without shaking in a conventional 32-34 °C incubator in the presence of a small amount of residual ambient oxygen. Borrelia spirochetes are anaerobes but are exposed in nature to fluctuations in oxygen and carbon dioxide concentrations and respond with changes in gene expression26,27,28,29. Thus, gene expression, growth, and other metabolic studies should control for oxygen and carbon dioxide levels with the use of an oxygen-controlled incubator or anaerobic chamber. In culture, cultures are checked weekly, or more often, for the presence of spirochetes with either darkfield microscopy or phase contrast microscopy. Culture smears can be stained with either silver stains, immunohistochemistry, or through the use of fluorescently tagged strains29,30. PCR followed by DNA sequencing is a sensitive and specific method to detect and genetically identify or confirm the Borrelia species30,31,32,33.
Many minor variations on BSK-II exist, and some are commercially available. The protocol described here in section 1 has been adapted from Barbour (1984)21. Liquid MKP medium is a more recently developed medium and is described in section 2. It is prepared according to a previously reported protocol33,34, which, similarly to BSK medium, consists of two steps: preparation of basic medium and preparation of complete medium. Borrelia culture medium can be prepared with or without antibiotics, as described in section 3; the antibiotics act to reduce contaminating bacteria introduced when inoculating with clinical or environmental samples, as described in section 4; if inoculating with pure Borrelia sp. culture, antibiotics may not be needed. Making long-term Borrelia stocks is often important, and a protocol for doing so is described in section 5. Section 6 describes using these media to isolate pure Borrelia sensu lato clones from clinical or environmental samples. There are a number of approaches possible36; below is one found to be effective. The plating medium used in this protocol is a modification of BSK-II plating medium37 and MKP medium34 (with rabbit serum increased to 10%38).