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A quick literature search on PubMed confirmed the role of OspA as an agonist of Toll 2 (and not Toll 4). The roll of Toll 2 activation in many other bacterial illnesses is described as well. Flagellin activates Toll 4.

Activation of Toll receptors leads to activation of pro-inflammatory gene transcription which leads to adverse effects on VIP and MSH production pathways (within 24 hours); activation of MMP9 in 48 hours via cytokine binding to endothelial cells and macrophages.

The link of Toll 2 activation to MMP9 is nicely described in joint and CSF. True Herx reactions will be associated with a rise in MMP9 at day 2 as well.

R Shoemaker MD
Pocomoke, Md