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Its neuronal form, neuroborreliosis, comprises 3 to 38% of borreliosis cases in Europe. <jats:italic>Borrelia<\/jats:italic> outer surface proteins and virulence factors, OspE and BBK32, have been previously reported to help cause infection by promoting attachment to human host epithelial cells and evading complement attack. We assessed the serological responses to BBK32 and OspE in 19 individuals diagnosed with neuroborreliosis to see whether antibodies that could both target the bacteria and neutralize the virulence mechanisms on the microbial surface emerge. Results evaluate levels of total protein, IgG and the chemokine CXCL13, a determinant for B\u2010cell recruitment during neuroinflammation, in patients' cerebrospinal fluid samples. Antibody levels against BBK32 and OspE correlated with those against VlsE, a well\u2010characterized diagnostic serological marker of the disease. A dual serological profile of the patients was observed. K\u2010means clustering split the cohort into two discrete groups presenting distinct serological and CNS responses. One group contained young patients with low levels of anti\u2010BBK32 and OspE antibodies. The other group showed stronger responses, possibly following prolonged infections or reinfections. Additionally, we assessed anti\u2010ganglioside antibodies that could cause autoimmunity or complement dysregulation but observed that they did not correlate with neuroborreliosis in our patient cohort. The dual nature of antibody responses against the virulence factors BBK32 and OspE in neuroborreliosis patients may suggest the necessity of repeated exposures for efficient immune responses. Better protection could be achieved if the virulence factors were formulated into vaccines.<\/jats:p>","DOI":"10.1111\/sji.13353","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T10:30:04Z","timestamp":1704969004000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Antibody responses to immunoevasion proteins <scp>BBK32<\/scp> and <scp>OspE<\/scp> constitute part of the serological footprint in neuroborreliosis but are insufficient to prevent the disease"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-9987","authenticated-orcid":false,"given":"Vinaya","family":"Dulipati","sequence":"first","affiliation":[{"name":"Translational Immunology Research Program, Department of Bacteriology and Immunology, Faculty of Medicine University of Helsinki  Helsinki 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