Borrelia Burgdorferi binds Serum Amyloid A and Modulates Subcutaneous Adipose Tissue Immune Signaling

Borrelia burgdorferi causes over 470,000 infections annually [1]. Following a tick bite, Borrelia spirochetes replicate in human skin and disseminate through tissues, including subcutaneous adipose tissue. Adipose tissue is a complex organ containing non-immune and immune cells that play a significant role in the immune response [2], yet little is known about adipose tissue signaling after Borrelia infection. We investigated the landscape of immune signaling within adipose tissue-resident cells during Borrelia infection in human tissue (skin and adipose tissue) ex vivo. Immune pathways overall were downregulated in adipose tissue during Borrelia infection. Despite this, adipose stem/progenitor cells exhibited increased pro-inflammatory and extracellular matrix (ECM)-related signaling (IL-6, MIF, collagen, laminin, fibronectin), positioning them as key hubs of intercellular communication during infection. Myeloid lineage cells showed cluster-specific upregulation of immune genes such as IL1B and TNF. Network analyses highlighted laminin, and strong outgoing MIF signals in all adipose-resident cell clusters. Among the identified genes modulated after Borrelia infection, we observed reduced expression levels of serum amyloid A in adipose tissue-resident cells, a marker typically elevated in Lyme disease patient serum during acute infection. Here, we show that human serum amyloid A1 and serum amyloid A2 directly bind B. burgdorferi spirochetes, using flow cytometry. Functionally, serum amyloid A2 reduces spirochete viability in vitro in a dose-dependent manner and enhances opsonization and phagocytosis by macrophages. Together, these findings show that adipose tissue is a site of active immune signaling in the setting of Borrelia infection and identifies SAA as a host defense factor against Borrelia.