Skip to main content
Top
Published in: BMC Infectious Diseases 1/2009

Open Access 01-12-2009 | Research article

Truncation in the tcdC region of the Clostridium difficilePathLoc of clinical isolates does not predict increased biological activity of Toxin B or Toxin A

Authors: Ruth Murray, Dave Boyd, Paul N Levett, Michael R Mulvey, Michelle J Alfa

Published in: BMC Infectious Diseases | Issue 1/2009

Login to get access

Abstract

Background

The increased severity of disease associated with the NAP1 strain of Clostridium difficile has been attributed to mutations to the tcdC gene which codes for a negative regulator of toxin production. To assess the role of hyper-production of Toxins A and B in clinical isolates of Clostridium difficile, two NAP1-related and five NAP1 non-related strains were compared.

Methods

Sequencing was performed on tcdC, tcdR, and tcdE to determine if there were differences that might account for hyper-production of Toxin A and Toxin B in NAP1-related strains. Biological activity of Toxin B was evaluated using the HFF cell CPE assay and Toxin A biological activity was assessed using the Caco-2 Trans-membrane resistance assay.

Results

Our results confirm that Toxin A and Toxin B production in NAP1-related strains and ATCC 43255 occurs earlier in the exponential growth phase compared to most NAP1-nonrelated clinical isolates. Despite the hyper-production observed in ATCC 43255 it had no mutations in tcdC, tcdR or tcdE. Analysis of the other clinical isolates indicated that the kinetics and ultimate final concentration of Toxin A and B did not correlate with the presence or lack of alterations in tcdC, tcdR or tcdE.

Conclusion

Our data do not support a direct role for alterations in the tcdC gene as a predictor of hyperproduction of Toxin A and B in NAP1-related strains.
Appendix
Available only for authorised users
Literature
1.
go back to reference Poutanen SM, Simor AE: Clostridium difficile – associated diarrhea in adults. Can Med Assoc J. 2004, 171: 51-58. 10.1503/cmaj.1031189.CrossRef Poutanen SM, Simor AE: Clostridium difficile – associated diarrhea in adults. Can Med Assoc J. 2004, 171: 51-58. 10.1503/cmaj.1031189.CrossRef
2.
go back to reference Pepin J, Valiquette L, Alary M-E, Villemure P, Pelletier A, Forget K, Pepin K, Chouinard D: Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004, 17: 466-472.CrossRef Pepin J, Valiquette L, Alary M-E, Villemure P, Pelletier A, Forget K, Pepin K, Chouinard D: Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004, 17: 466-472.CrossRef
3.
go back to reference Voth DE, Ballard JD: Clostridium difficile Toxins: Mechanism of action and role I disease. Clin Microbiol Rev. 2005, 18: 247-263. 10.1128/CMR.18.2.247-263.2005.CrossRefPubMedPubMedCentral Voth DE, Ballard JD: Clostridium difficile Toxins: Mechanism of action and role I disease. Clin Microbiol Rev. 2005, 18: 247-263. 10.1128/CMR.18.2.247-263.2005.CrossRefPubMedPubMedCentral
4.
go back to reference Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, Frost E, McDonald LC: Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005, 366: 1079-1084. 10.1016/S0140-6736(05)67420-X.CrossRefPubMed Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, Frost E, McDonald LC: Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005, 366: 1079-1084. 10.1016/S0140-6736(05)67420-X.CrossRefPubMed
5.
go back to reference McDonald L, Killgore GE, Thompson A, Owens RC, Kazakova SV, Sambol SP, Johnson S, Gerding DN: An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005, 353: 2433-2441. 10.1056/NEJMoa051590.CrossRefPubMed McDonald L, Killgore GE, Thompson A, Owens RC, Kazakova SV, Sambol SP, Johnson S, Gerding DN: An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005, 353: 2433-2441. 10.1056/NEJMoa051590.CrossRefPubMed
6.
go back to reference Akerlund T, Svenungsson B, Lagergren A, Burman LG: Correlation of disease severity with fecal toxin levels in patients with Clostridium difficile-associated diarrhea and distribution of PCR ribotypes and toxin yields in vitro of corresponding isolates. J Clin Microbiol. 2006, 44: 353-358. 10.1128/JCM.44.2.353-358.2006.CrossRefPubMedPubMedCentral Akerlund T, Svenungsson B, Lagergren A, Burman LG: Correlation of disease severity with fecal toxin levels in patients with Clostridium difficile-associated diarrhea and distribution of PCR ribotypes and toxin yields in vitro of corresponding isolates. J Clin Microbiol. 2006, 44: 353-358. 10.1128/JCM.44.2.353-358.2006.CrossRefPubMedPubMedCentral
7.
go back to reference Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Micaud S, Bourgault AM, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson TJ, Horn R, Rene P, Monczaky Dascal A: A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005, 353: 2442-2449. 10.1056/NEJMoa051639.CrossRefPubMed Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Micaud S, Bourgault AM, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson TJ, Horn R, Rene P, Monczaky Dascal A: A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005, 353: 2442-2449. 10.1056/NEJMoa051639.CrossRefPubMed
8.
go back to reference Pepin J, Valiquette L, Cossette B: Mortality attributable to nosocomial Clostridium difficile-associated disease furing an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005, 173: 1-9.CrossRef Pepin J, Valiquette L, Cossette B: Mortality attributable to nosocomial Clostridium difficile-associated disease furing an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005, 173: 1-9.CrossRef
9.
go back to reference Miller MA, Hyland M, Ofner-Agostini M, Gourdeau M, Ishak M: Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol. 2002, 23: 137-140. 10.1086/502023.CrossRefPubMed Miller MA, Hyland M, Ofner-Agostini M, Gourdeau M, Ishak M: Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol. 2002, 23: 137-140. 10.1086/502023.CrossRefPubMed
10.
go back to reference Soehn F, Wagenknecht-Wiesner A, Leukel P, Kohl M, Weidmann M, von eichel-Streiber C, Braun : Genetic rearrangements in the pathogenicity locus of Clostridium difficile strain 8864 – implications for transcription, expression and enzymatic activity of toxins A and B. Mol Gen Genet. 1998, 258: 222-232. 10.1007/s004380050726.CrossRefPubMed Soehn F, Wagenknecht-Wiesner A, Leukel P, Kohl M, Weidmann M, von eichel-Streiber C, Braun : Genetic rearrangements in the pathogenicity locus of Clostridium difficile strain 8864 – implications for transcription, expression and enzymatic activity of toxins A and B. Mol Gen Genet. 1998, 258: 222-232. 10.1007/s004380050726.CrossRefPubMed
11.
go back to reference Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J: Clostridium difficile – associated diarrhea and colitis. Infect Control and Hosp Epidemiol. 1995, 16: 459-477.CrossRef Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J: Clostridium difficile – associated diarrhea and colitis. Infect Control and Hosp Epidemiol. 1995, 16: 459-477.CrossRef
12.
go back to reference Spigaglia P, Mastrantonio P: Comparative analysis of Clostridium difficile clinical isolates belonging to different genetic lineages and time periods. J Med Microbiol. 2004, 53: 1129-1136. 10.1099/jmm.0.45682-0.CrossRefPubMed Spigaglia P, Mastrantonio P: Comparative analysis of Clostridium difficile clinical isolates belonging to different genetic lineages and time periods. J Med Microbiol. 2004, 53: 1129-1136. 10.1099/jmm.0.45682-0.CrossRefPubMed
13.
go back to reference Stabler RA, Gerding DN, Songer JG, Drudy D, Brazier JS, Trinh HT, Whitney AA, Hinds J, Wren BW: Comparative phylogenomics of Clostridium difficile reveals clade specificity and microevolution of hypervirulent strains. J Bacteriol. 2006, 188: 7297-7305. 10.1128/JB.00664-06.CrossRefPubMedPubMedCentral Stabler RA, Gerding DN, Songer JG, Drudy D, Brazier JS, Trinh HT, Whitney AA, Hinds J, Wren BW: Comparative phylogenomics of Clostridium difficile reveals clade specificity and microevolution of hypervirulent strains. J Bacteriol. 2006, 188: 7297-7305. 10.1128/JB.00664-06.CrossRefPubMedPubMedCentral
14.
go back to reference Cloud J, Kelly CP: Update on Clostridium difficile associated disease. Current Opinion in Gastroenterology. 2007, 23: 4-9.PubMed Cloud J, Kelly CP: Update on Clostridium difficile associated disease. Current Opinion in Gastroenterology. 2007, 23: 4-9.PubMed
15.
go back to reference Hubert B, Loo VG, Bourgault AM, Poirier L, Dascal A, Fortin E, Dionne M, Lorange M: A portrait of the geographic dissemination of the Clostridium difficile North American Pulsed-Field Type 1 strain and the epidemiology of C. difficile-associated disease in Quebec. CID. 2007, 44: 238-44. 10.1086/510391.CrossRef Hubert B, Loo VG, Bourgault AM, Poirier L, Dascal A, Fortin E, Dionne M, Lorange M: A portrait of the geographic dissemination of the Clostridium difficile North American Pulsed-Field Type 1 strain and the epidemiology of C. difficile-associated disease in Quebec. CID. 2007, 44: 238-44. 10.1086/510391.CrossRef
17.
go back to reference Chernak E, Johnson CC, Weltman A, Wiggs L, Killgore G, Thompson A, LeMaile-Williams M, Lewis FM: Severe Clostridium difficile-associated disease in populations previously at low risk – Four States 2005. MMWR. 2005, 54: 1201-1205. Chernak E, Johnson CC, Weltman A, Wiggs L, Killgore G, Thompson A, LeMaile-Williams M, Lewis FM: Severe Clostridium difficile-associated disease in populations previously at low risk – Four States 2005. MMWR. 2005, 54: 1201-1205.
18.
go back to reference Geric B, Rupnik M, Gerding DN, Grabnar M, Johnson S: Distribution of Clostridium difficile variant toxintypes and strains with binary toxin genes among clinical isolates in an American hospital. J MedMicrobiol. 2004, 53: 887-894. Geric B, Rupnik M, Gerding DN, Grabnar M, Johnson S: Distribution of Clostridium difficile variant toxintypes and strains with binary toxin genes among clinical isolates in an American hospital. J MedMicrobiol. 2004, 53: 887-894.
19.
go back to reference Geric B, Johnson S, Gerding DN, Brabnar M, Rupnik M: Frequency of binary toxin genes among Clostridium difficile strains that do not produce large clostridial toxins. J Clin Microbiol. 2003, 41 (11): 5227-5232. 10.1128/JCM.41.11.5227-5232.2003.CrossRefPubMedPubMedCentral Geric B, Johnson S, Gerding DN, Brabnar M, Rupnik M: Frequency of binary toxin genes among Clostridium difficile strains that do not produce large clostridial toxins. J Clin Microbiol. 2003, 41 (11): 5227-5232. 10.1128/JCM.41.11.5227-5232.2003.CrossRefPubMedPubMedCentral
20.
go back to reference MacCannell DR, Louie TJ, Gregson DB, Laverdiere M, Labbe A-C, Laing F, Henwick S: Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada. J Clin Microbiol. 2006, 44: 2147-2152. 10.1128/JCM.02563-05.CrossRefPubMedPubMedCentral MacCannell DR, Louie TJ, Gregson DB, Laverdiere M, Labbe A-C, Laing F, Henwick S: Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada. J Clin Microbiol. 2006, 44: 2147-2152. 10.1128/JCM.02563-05.CrossRefPubMedPubMedCentral
21.
go back to reference Stare B, Delmee M, Rupnik M: Variant Forms of the binary toxin CDT locus and tcdC gene in Clostridium difficile strains. J Med Microbiol. 2007, 56: 329-335. 10.1099/jmm.0.46931-0.CrossRefPubMed Stare B, Delmee M, Rupnik M: Variant Forms of the binary toxin CDT locus and tcdC gene in Clostridium difficile strains. J Med Microbiol. 2007, 56: 329-335. 10.1099/jmm.0.46931-0.CrossRefPubMed
22.
go back to reference Chang S-Y, Song K-P: ADP-riobsylating binary toxin genes of Clostridium difficile strain CCUG 20309. DNA Sequence. 2001, 12: 115-120. 10.3109/10425170109047564.CrossRefPubMed Chang S-Y, Song K-P: ADP-riobsylating binary toxin genes of Clostridium difficile strain CCUG 20309. DNA Sequence. 2001, 12: 115-120. 10.3109/10425170109047564.CrossRefPubMed
23.
go back to reference Goncalves C, Decre D, Barbut F, Burghoffer B, Petit J-C: Prevalence and characterization of a binary toxin (Actin-specific ADP-ribosyltransferase) from Clostridium difficile. J Clin Microbiol. 2004, 42: 1933-1939. 10.1128/JCM.42.5.1933-1939.2004.CrossRefPubMedPubMedCentral Goncalves C, Decre D, Barbut F, Burghoffer B, Petit J-C: Prevalence and characterization of a binary toxin (Actin-specific ADP-ribosyltransferase) from Clostridium difficile. J Clin Microbiol. 2004, 42: 1933-1939. 10.1128/JCM.42.5.1933-1939.2004.CrossRefPubMedPubMedCentral
24.
go back to reference Terhes G, Urban E, Soki J, Hamid KA, Nagy E: Community-acquired Clostridium difficile diarrhea caused by binary toxin, Toxin A and Toxin B gene-positive isolates in Hungary. J Clin Microbiol. 2004, 42: 4316-4318. 10.1128/JCM.42.9.4316-4318.2004.CrossRefPubMedPubMedCentral Terhes G, Urban E, Soki J, Hamid KA, Nagy E: Community-acquired Clostridium difficile diarrhea caused by binary toxin, Toxin A and Toxin B gene-positive isolates in Hungary. J Clin Microbiol. 2004, 42: 4316-4318. 10.1128/JCM.42.9.4316-4318.2004.CrossRefPubMedPubMedCentral
25.
go back to reference Spigaglia P, Mastrantonio P: Molecular analysis of the pathogenicity locus and polymorphism in the putative negative regulator of toxin production (TcdC) among Clostridium difficile clinical isolates. J Clin Microbiol. 2002, 40: 3470-3475. 10.1128/JCM.40.9.3470-3475.2002.CrossRefPubMedPubMedCentral Spigaglia P, Mastrantonio P: Molecular analysis of the pathogenicity locus and polymorphism in the putative negative regulator of toxin production (TcdC) among Clostridium difficile clinical isolates. J Clin Microbiol. 2002, 40: 3470-3475. 10.1128/JCM.40.9.3470-3475.2002.CrossRefPubMedPubMedCentral
26.
go back to reference Lemee L, Dhalluin A, Testelin S, Mattrat M.-A, Maillard K, Lemeland J-F, Pons J-L: Multiplex PCR targeting tpi (triose phosphate isomerase), tcdA (toxin A), and tcdB (toxin B) genes for toxigenic culture of Clostridium difficile. J Clin Microbiol. 2004, 42: 5710-5714. 10.1128/JCM.42.12.5710-5714.2004.CrossRefPubMedPubMedCentral Lemee L, Dhalluin A, Testelin S, Mattrat M.-A, Maillard K, Lemeland J-F, Pons J-L: Multiplex PCR targeting tpi (triose phosphate isomerase), tcdA (toxin A), and tcdB (toxin B) genes for toxigenic culture of Clostridium difficile. J Clin Microbiol. 2004, 42: 5710-5714. 10.1128/JCM.42.12.5710-5714.2004.CrossRefPubMedPubMedCentral
27.
go back to reference Rupnik M, Dupuy B, Fairweather NF, Gerding DN, Johnson S, Just I, Lyerly DM, Popoff MR, Rood JI, Sonenshein AL, Thelestam M, Wren BW, Wilkins TD, von Eichel-Streiber C: Revised nomenclature of Clostridium difficile toxins and associated genes. J Med Microbiol. 2005, 54: 113-117. 10.1099/jmm.0.45810-0.CrossRefPubMed Rupnik M, Dupuy B, Fairweather NF, Gerding DN, Johnson S, Just I, Lyerly DM, Popoff MR, Rood JI, Sonenshein AL, Thelestam M, Wren BW, Wilkins TD, von Eichel-Streiber C: Revised nomenclature of Clostridium difficile toxins and associated genes. J Med Microbiol. 2005, 54: 113-117. 10.1099/jmm.0.45810-0.CrossRefPubMed
28.
go back to reference Stubbs S, Rupnik M, Gibert M, Brazier J, Duerden B, Popoff M: Production of actin-specific ADP-ribosyltransferase (binary toxin) by strains of Clostridium difficile. FEMS Microbiology Letters. 2000, 186: 307-312. 10.1111/j.1574-6968.2000.tb09122.x.CrossRefPubMed Stubbs S, Rupnik M, Gibert M, Brazier J, Duerden B, Popoff M: Production of actin-specific ADP-ribosyltransferase (binary toxin) by strains of Clostridium difficile. FEMS Microbiology Letters. 2000, 186: 307-312. 10.1111/j.1574-6968.2000.tb09122.x.CrossRefPubMed
29.
go back to reference Alfa MJ, Swan B, VanDekerkhove B, Pang P, Harding GKM: The diagnosis of Clostridium difficile-associated diarrhea: comparison of Triage C. difficile panel, EIA for Tox A/B and cytotoxin assays. Diagnostic Microbiology and Infectious Disease. 2002, 43: 257-263. 10.1016/S0732-8893(02)00413-3.CrossRefPubMed Alfa MJ, Swan B, VanDekerkhove B, Pang P, Harding GKM: The diagnosis of Clostridium difficile-associated diarrhea: comparison of Triage C. difficile panel, EIA for Tox A/B and cytotoxin assays. Diagnostic Microbiology and Infectious Disease. 2002, 43: 257-263. 10.1016/S0732-8893(02)00413-3.CrossRefPubMed
30.
go back to reference Du T, Alfa MJ: Translocation of Clostridium difficile toxin B across polarized Caco-2 cell monolayers is enhanced by toxin A. Canadian Journal of Infectious Disease. 2004, 15: 2-CrossRef Du T, Alfa MJ: Translocation of Clostridium difficile toxin B across polarized Caco-2 cell monolayers is enhanced by toxin A. Canadian Journal of Infectious Disease. 2004, 15: 2-CrossRef
31.
go back to reference Grasset E, Pinto M, Dussaulx E, Zweibaum A, Desjeux J: Epithelial properties of human colonic carcinoma cell line Caco-2: Electrical parameters. Am J Physiol. 1984, 247: C260-7.PubMed Grasset E, Pinto M, Dussaulx E, Zweibaum A, Desjeux J: Epithelial properties of human colonic carcinoma cell line Caco-2: Electrical parameters. Am J Physiol. 1984, 247: C260-7.PubMed
32.
go back to reference Alfa MJ, Kabani A, Lyerly D, Moncrief S, Neville LM, Al-Barrak A, Harding GKH, Dyck B, Olekson K, Embil JM: Characterization of a toxin A-negative, toxinB-positive strain of Clostridium difficile responsible for a nosocomial outbreak of Clostridium difficile-associated diarrhea. J Clin Microbiol. 2000, 38: 2706-2714.PubMedPubMedCentral Alfa MJ, Kabani A, Lyerly D, Moncrief S, Neville LM, Al-Barrak A, Harding GKH, Dyck B, Olekson K, Embil JM: Characterization of a toxin A-negative, toxinB-positive strain of Clostridium difficile responsible for a nosocomial outbreak of Clostridium difficile-associated diarrhea. J Clin Microbiol. 2000, 38: 2706-2714.PubMedPubMedCentral
33.
go back to reference Rupnick M, Braun V, Soehn F, Janc M, Hofsetter M, Laufenberg-Feldmann R, von Eichel-Streiber C: Characterization of polymprphisms in the toxin A and B genes of Clostridium difficile. FEMS Microbiology Letters. 1997, 148: 197-202. 10.1111/j.1574-6968.1997.tb10288.x.CrossRef Rupnick M, Braun V, Soehn F, Janc M, Hofsetter M, Laufenberg-Feldmann R, von Eichel-Streiber C: Characterization of polymprphisms in the toxin A and B genes of Clostridium difficile. FEMS Microbiology Letters. 1997, 148: 197-202. 10.1111/j.1574-6968.1997.tb10288.x.CrossRef
34.
go back to reference Hundsberger T, Braun V, Weidmann M., Leukel P, Sauerborn M, von Eichel-Streiber C: Transcription analysis of the genes tcdA-E of the pathogenicity locus of Clostridium difficile. Eur J Biochem. 1997, 244 (3): 735-742. 10.1111/j.1432-1033.1997.t01-1-00735.x.CrossRefPubMed Hundsberger T, Braun V, Weidmann M., Leukel P, Sauerborn M, von Eichel-Streiber C: Transcription analysis of the genes tcdA-E of the pathogenicity locus of Clostridium difficile. Eur J Biochem. 1997, 244 (3): 735-742. 10.1111/j.1432-1033.1997.t01-1-00735.x.CrossRefPubMed
35.
go back to reference Curry SR, March JW, Muto CA, O'Leary MM, Pasculle AW, Harrison LH: tcdC Genotypes associated with severe TcdC truncation in an epidemic clone and other strains of Clostridium difficile. J Clin Microbiol. 2007, 45: 215-221. 10.1128/JCM.01599-06.CrossRefPubMed Curry SR, March JW, Muto CA, O'Leary MM, Pasculle AW, Harrison LH: tcdC Genotypes associated with severe TcdC truncation in an epidemic clone and other strains of Clostridium difficile. J Clin Microbiol. 2007, 45: 215-221. 10.1128/JCM.01599-06.CrossRefPubMed
36.
go back to reference Karlsson S, Dupuy B, Mukherjee K, Norin E, Burman Lars G, Akerlund T: Expression of Clostridium difficile Toxins A and B and their Sigma Factor TcdD is controlled by temperature. Infect Immun. 2003, 71: 1784-1793. 10.1128/IAI.71.4.1784-1793.2003.CrossRefPubMedPubMedCentral Karlsson S, Dupuy B, Mukherjee K, Norin E, Burman Lars G, Akerlund T: Expression of Clostridium difficile Toxins A and B and their Sigma Factor TcdD is controlled by temperature. Infect Immun. 2003, 71: 1784-1793. 10.1128/IAI.71.4.1784-1793.2003.CrossRefPubMedPubMedCentral
37.
go back to reference Matamouros S, England P, Dupuy B: Clostridium difficile toxin expression is inhibited by the novel regulator TcdC. Mol Microbiol. 2007, "Postprint;" doi: 10:1111/j.1365-2958.2007.05739.x. Matamouros S, England P, Dupuy B: Clostridium difficile toxin expression is inhibited by the novel regulator TcdC. Mol Microbiol. 2007, "Postprint;" doi: 10:1111/j.1365-2958.2007.05739.x.
38.
go back to reference Teichert M, Tatge H, Schoentaube J, Just I, Gerhard R: Application of mutated Clostridium difficile Toxin a for determination of glycosyltransferase-dependent effect. Infect Immun. 2006, 74: 6006-6010. 10.1128/IAI.00545-06.CrossRefPubMedPubMedCentral Teichert M, Tatge H, Schoentaube J, Just I, Gerhard R: Application of mutated Clostridium difficile Toxin a for determination of glycosyltransferase-dependent effect. Infect Immun. 2006, 74: 6006-6010. 10.1128/IAI.00545-06.CrossRefPubMedPubMedCentral
39.
go back to reference Freeman J, Baines SD, Saxton K, Wilcos MH: Effect of metronidazole on growth and toxin production by epidemic Clostridium difficile PCR ribotypes 01 and 027 in a human gut model. J Antimicrobial Chemotherapy. 2007 Freeman J, Baines SD, Saxton K, Wilcos MH: Effect of metronidazole on growth and toxin production by epidemic Clostridium difficile PCR ribotypes 01 and 027 in a human gut model. J Antimicrobial Chemotherapy. 2007
40.
go back to reference O'Connor JR, Lyras D, Farrow KA, Adams V, Powell DR, Hinds J, Cheung JK, Rood JI: Construction and analysis of chromosomal Clostridium difficile mutants. Molec Microbiol. 2006, 61: 1335-1351. 10.1111/j.1365-2958.2006.05315.x.CrossRef O'Connor JR, Lyras D, Farrow KA, Adams V, Powell DR, Hinds J, Cheung JK, Rood JI: Construction and analysis of chromosomal Clostridium difficile mutants. Molec Microbiol. 2006, 61: 1335-1351. 10.1111/j.1365-2958.2006.05315.x.CrossRef
Metadata
Title
Truncation in the tcdC region of the Clostridium difficilePathLoc of clinical isolates does not predict increased biological activity of Toxin B or Toxin A
Authors
Ruth Murray
Dave Boyd
Paul N Levett
Michael R Mulvey
Michelle J Alfa
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2009
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-9-103

Other articles of this Issue 1/2009

BMC Infectious Diseases 1/2009 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.