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. 2020 Nov 9;10:19340. doi: 10.1038/s41598-020-75051-3

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© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Proposed sources and shedding mechanism of Borrelia derived proteins and molecules that are detected in the urine. (A) During the immune response, Borrelia proteins and molecules are processed and presented by antigen presenting cells (e.g. dendritic cells and macrophages) in conjunction with MHC II or CD1 proteins. Digested Borrelia antigens bind to endosomal TLRs and trigger the production of pro-inflammatory cytokines. Bacterial peptides are released following apoptosis of APC, or by secretion of soluble molecules or extracellular vesicles. (B) Proteins and molecules can be directly secreted by Borrelia into the extracellular environment, released in extracellular vesicles, or liberated by degenerated non-viable bacterial fragments. (C) Proteins, protein fragments and molecules of a size inferior to 60 kDa can permeate blood vessel walls and enter the blood circulation, (D) be filtered in the kidneys through glomeruli filtration and (E) accumulate over time in the urine.