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Effect of host defenses on Clostridium difficile toxin–induced intestinal barrier injury

Olson, Alicia MD; Diebel, Lawrence N. MD; Liberati, David M. MS

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 983–990
doi: 10.1097/TA.0b013e3182858477
AAST 2012 Plenary Papers
Editor's Choice

INTRODUCTION The severity of Clostridium difficile–associated infection depends on the virulence factors of the organism and host factors, including intestinal barrier function. The intestinal mucus layer has recently been recognized as the first line of defense against enteric pathogens. Its interaction with mucosal humoral immunity provided by secretory immunoglobulin A (SIgA) is unknown as it relates to C. difficile disease severity. This was studied in vitro.

METHODS Confluent HT29 (non–mucus-producing) and HT29-MTX (mucus-producing) intestinal epithelial cells (IECs) with and without transcytosed SIgA were exposed to C. difficile toxin A (6 hours), and IEC toxin internalization, permeability (fluorescein isothiocyanate dextran), and necrosis (propidium iodide staining) were determined. In other experiments, colostral SIgA was added to the apical surface of IEC, and cleavage was determined by measurement of intact SIgA and secretory component fractions by enzyme-linked immunosorbent assay. Tumor necrosis factor α and interleukin 6 were measured from basal chamber culture supernatants by enzyme-linked immunosorbent assay.

RESULTS Toxin A uptake and subsequent enterotoxic effects on IEC were decreased by both the mucus layer and SIgA. Similar findings were noted with the effects of toxin A on IEC monolayer permeability, cytoskeleton changes, and proinflammatory cytokine release. The combination of the mucus layer and SIgA afforded the best protection against the adverse effects on IEC by toxin A. It seems that the mucus layer was also protective against SIgA cleavage, resulting in reduced protease activity by HT29 cells exposed to toxin A.

CONCLUSION Both intestinal mucus and SIgA were important in limiting C. difficile–associated disease severity in this model. A synergistic effect of mucus and IgA was also noted and may be due to protection of SIgA from proteolytic cleavage.

From the Department of Surgery, Wayne State University, Detroit, Michigan.

Submitted: December 6, 2012; Revised: December 27, 2012; Accepted: December 27, 2012.

This study was presented at the 71st annual meeting of the American Association for the Surgery of Trauma, September 12–15, 2012, in Kauai, Hawaii.

Address for reprints: Lawrence N. Diebel, MD, Department of Surgery, 6C University Health Center, 4201 Saint Antoine, Detroit, MI 48201; email:

© 2013 Lippincott Williams & Wilkins, Inc.