Differential Effects of TcdB1 and TcdB2 in C. difficile disease

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ABSTRACT The most recent reports indicate Clostridioides difficile is the cause of over 400,000 cases of gastrointestinal illness and nearly 30,000 deaths annually. A major factor in the virulence of C. difficile is TcdB, an intracellular bacterial toxin that glucosylates small GTPases in targeted cells. Our studies focus on determining the critical differences in TcdB1 and TcdB2, the two major variants of TcdB. TcdB1 is produced by historical strains of C. difficile and TcdB2 is produced by hypervirulent/epidemic strains of C. difficile. Understanding how these two forms of TcdB, which share 92% identity, differ in critical steps in intoxication and immunogenicity provides insight into underlying differences in virulence between historical and epidemic strains of C. difficile. Several studies, including many from our group, have found that TcdB1 and TcdB2 differ in their interactions with target cells, tropism, cytotoxicity, and immunogenicity. The objective of our work is to identify and characterize the underlying molecular and cellular details of the factors accounting for these differences in TcdB1 and TcdB2 activity. To continue this line of investigation, three specific aims to i) Determine the underlying differences in the molecular mechanism of TcdB1 and TcdB2 receptor binding and cell penetration, ii) Determine if TcdB2 subverts antigen presentation and limits humoral immunity to co-administered vaccine antigen TcdB2Δ1769-1787, and iii) Construct and test strains of C. difficile expressing mutants of TcdB1 and TcdB2 will be pursued. These studies will provide further insight into the differences in TcdB1 and TcdB2, determine the contribution of TcdB to ineffective immune memory leading to relapse, and test hypotheses related to specific TcdB functional activities in the context of C. difficile infection. Overall, the findings from this work will enhance our understanding of C. difficile disease at multiple levels and provide information needed to prevent and treat this serious human illness.