Lyme disease is an infection caused by a tick-borne spirochete, Borrelia burgdorferi. Matrix metalloproteinase 9 (MMP-9) was selectively upregulated in the erythema migrans skin lesions of patients with acute Lyme disease. In this study, the mechanism of upregulation of MMP-9 was investigated in vitro and in vivo. The concentrations of MMP-9 and soluble CD14 were markedly elevated in serum from patients with acute Lyme disease and were also upregulated in U937 cells by B. burgdorferi in a time-and concentration-dependent manner. MMP-9 mRNA was expressed at baseline in fibroblasts in the presence or absence of B. burgdorferi. However, when fibroblasts were incubated with supernatants from U937 cells with B. burgdorferi or recombinant CD14, the expression of MMP-9 was significantly increased. This effect was completely abolished by the anti-CD14 antibody. These data suggest that the upregulation of MMP-9 by B. burgdorferi involves the CD14 pathway in infiltrating inflammatory cells. Fibroblasts could be recruited to amplify local production of MMP-9 by acquiring CD14 from macrophages.Lyme disease is an infection caused by a tick-borne spirochete, Borrelia burgdorferi. It is the most common vector-borne disease in the United States (18, 37). The hallmark of acute Lyme disease is the characteristic skin lesions, known as erythema migrans (EM) skin lesions. Other acute clinical manifestations result from dissemination of the spirochete to the central and peripheral nervous systems, the heart, and the musculoskeletal system (7,21,36).Some bacteria that disseminate from a skin inoculation site secrete enzymes (e.g., collagenases and elastases) that are thought to participate in the spreading process by disrupting the extracellular matrix barrier (10,22,38). B. burgdorferi does not secrete any enzymes capable of digesting collagen, laminin, or gelatin (22). We have demonstrated that expression of matrix metalloproteinase 9 (MMP-9) was selectively upregulated in human EM skin lesions of acute Lyme disease. The activated fibroblasts and infiltrating mononuclear cells were the major sources of local MMP-9 production (43). Infiltration of the skin with mononuclear cells is frequently observed in EM lesions of acute Lyme disease (3). We hypothesize that bacterial induction of host proteases may play a major role in the dissemination of B. burgdorferi (43).CD14 on blood monocytes mediate monocyte/macrophage activation by lipopolysaccharide (LPS). LPS bound to CD14 may contribute to atherogenesis by stimulating macrophages to produce tumor necrosis factor alpha, interleukin 1 (IL-1), IL-6, IL-8, IL-12, alpha interferon, migration inhibitory factors, chemokines, eicosanoids, and reactive oxygen species, which in turn stimulate the production of a second wave of chemokines, cytokines, and adhesion and signaling molecules. The mature CD14 protein is present in two isoforms: membrane bound and soluble.Membrane-associated CD14 (mCD14) is expressed on myeloid cells, including tissue macrophages, monocytes, promonocytes, and activate...