Chronic Lyme / PTLDS
Post-Treatment Lyme Disease Syndrome and the contested 'chronic Lyme' framing — persistent fatigue, cognitive, musculoskeletal, neuropsychiatric, and GI symptoms after acute Lyme treatment. The most clinically contested axis in this library.
What changes during this transition
Chronic Lyme / PTLDS is the most clinically contested axis in the peptide library — two organized clinical camps (IDSA / mainstream-ID vs ILADS / chronic-Lyme community) disagree fundamentally on whether 'chronic Lyme' as persistent Borrelia infection exists, and both have peer-reviewed published guidelines (IDSA 2020 vs ILADS 2014). Juno's editorial position is to honor BOTH camps without endorsing either — the patient community is large, frustrated, and often underserved by whichever framing they didn't land in. The peptides surfaced here are the ones most-discussed in the chronic-Lyme patient community: KPV for the GI-dominant / MCAS-overlap subset, BPC-157 for gut-healing during prolonged antibiotic protocols, thymosin alpha-1 for the immune-axis framing (with autoimmune-overlap flag), and Selank for the neuropsychiatric symptom overlay. NONE of them have a chronic-Lyme or PTLDS RCT. LL-37 is the editorially complex case (in vitro Borrelia activity per Lusitani 2002 + autoimmunity-amplification concern in autoantibody-positive subsets) — substrate-only, not surfaced for discovery. Standard-of-care workup (two-tiered serology, coinfection screening, alternative-diagnosis rule-out) is the precondition for any peptide adjunct, not optional. The Klempner 2001 NEJM, Krupp 2003, and Fallon 2008 trials showed long-term IV ceftriaxone for PTLDS does NOT improve outcomes vs placebo — that's the IDSA-side evidence anchor; the ILADS camp argues persister cells and biofilms explain residual symptoms regardless of those trial outcomes. Both positions deserve to appear in front of patients making decisions.
Important caveat
Confirm the Lyme diagnosis with two-tiered serology (Western blot per CDC) if not already done; rule out alternative diagnoses (hypothyroidism, B12 deficiency, sleep apnea, depression, autoimmune disease, ME/CFS, fibromyalgia, SIBO) before attributing residual symptoms to Lyme. Coinfection screening (Babesia, Bartonella, Anaplasma, Ehrlichia) is reasonable workup regardless of camp affiliation. Active acute Lyme is a DIFFERENT context (antibiotic treatment, not peptides). The Klempner 2001 NEJM, Krupp 2003, and Fallon 2008 trials showed long-term IV ceftriaxone for PTLDS does NOT improve outcomes vs placebo — patients deserve to see that evidence regardless of which clinical camp they're working with.
Peptides editorially relevant to chronic lyme / ptlds
4 peptides from the library — each evidence-tiered honestly.
- KPVTier 3
α-MSH C-terminal tripeptide
Short tripeptide fragment of a natural hormone (alpha-MSH). Appears to carry the anti-inflammatory signaling of the parent hormone without its pigmentation effects. Growing animal and early-human work, especially for inflammatory bowel disease.
- BPC-157Tier 3
Gastric pentadecapeptide
Extensively studied in rodents for tissue healing across tendon, gut, vascular, and CNS injury models. Human evidence is essentially absent — community framing far outpaces the data.
- Thymosin Alpha-1Tier 2
Immunomodulatory peptide
Approved in 30+ countries for chronic hepatitis B and C and as a sepsis adjunct in critically ill patients — but not in the US. Evidence quality varies sharply by indication, and the popular 'general immune support' framing has no clinical backing.
- SelankTier 3
Synthetic tuftsin analog (heptapeptide)
Russian-developed anxiolytic/nootropic peptide. Most clinical data is in Russian and methodologically thin by Western standards. Tier 3. Routes include intranasal — a natural pair with Juno's nasal-spray prep guide.
Want this list to grow? The library is editorial — if there’s a peptide you think belongs on this page with documented or mechanistically-clear evidence, send us a note with the citation and we’ll review it under the same evidence-tier discipline as every other entry.