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      Lauric Acid Is an Inhibitor of Clostridium difficile Growth in Vitro and Reduces Inflammation in a Mouse Infection Model

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          Abstract

          Clostridium difficile is a Gram-positive, spore-forming anaerobic human gastrointestinal pathogen. C. difficile infection (CDI) is a major health concern worldwide, with symptoms ranging from diarrhea to pseudomembranous colitis, toxic megacolon, sepsis, and death. CDI onset and progression are mostly caused by intestinal dysbiosis and exposure to C. difficile spores. Current treatment strategies include antibiotics; however, antibiotic use is often associated with high recurrence rates and an increased risk of antibiotic resistance. Medium-chain fatty acids (MCFAs) have been revealed to inhibit the growth of multiple human bacterial pathogens. Components of coconut oil, which include lauric acid, have been revealed to inhibit C. difficile growth in vitro. In this study, we demonstrated that lauric acid exhibits potent antimicrobial activities against multiple toxigenic C. difficile isolates in vitro. The inhibitory effect of lauric acid is partly due to reactive oxygen species (ROS) generation and cell membrane damage. The administration of lauric acid considerably reduced biofilm formation and preformed biofilms in a dose-dependent manner. Importantly, in a mouse infection model, lauric acid pretreatment reduced CDI symptoms and proinflammatory cytokine production. Our combined results suggest that the naturally occurring MCFA lauric acid is a novel C. difficile inhibitor and is useful in the development of an alternative or adjunctive treatment for CDI.

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          Most cited references65

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          Clostridium difficile infection

          Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis - the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota.
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            Bile salts and glycine as cogerminants for Clostridium difficile spores.

            Spore formation by Clostridium difficile is a significant obstacle to overcoming hospital-acquired C. difficile-associated disease. Spores are resistant to heat, radiation, chemicals, and antibiotics, making a contaminated environment difficult to clean. To cause disease, however, spores must germinate and grow out as vegetative cells. The germination of C. difficile spores has not been examined in detail. In an effort to understand the germination of C. difficile spores, we characterized the response of C. difficile spores to bile. We found that cholate derivatives and the amino acid glycine act as cogerminants. Deoxycholate, a metabolite of cholate produced by the normal intestinal flora, also induced germination of C. difficile spores but prevented the growth of vegetative C. difficile. A model of resistance to C. difficile colonization mediated by the normal bacterial flora is proposed.
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              Clostridium difficile colitis: pathogenesis and host defence.

              Clostridium difficile is a major cause of intestinal infection and diarrhoea in individuals following antibiotic treatment. Recent studies have begun to elucidate the mechanisms that induce spore formation and germination and have determined the roles of C. difficile toxins in disease pathogenesis. Exciting progress has also been made in defining the role of the microbiome, specific commensal bacterial species and host immunity in defence against infection with C. difficile. This Review will summarize the recent discoveries and developments in our understanding of C. difficile infection and pathogenesis.
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                Author and article information

                Contributors
                Journal
                Front Microbiol
                Front Microbiol
                Front. Microbiol.
                Frontiers in Microbiology
                Frontiers Media S.A.
                1664-302X
                17 January 2018
                2017
                : 8
                : 2635
                Affiliations
                [1] 1Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University , Tainan, Taiwan
                [2] 2Center of Infectious Disease and Signaling Research, National Cheng Kung University , Tainan, Taiwan
                [3] 3Department of Earth Sciences, National Cheng Kung University , Tainan, Taiwan
                [4] 4Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University , Tainan, Taiwan
                [5] 5Department of Internal Medicine, National Cheng Kung University Hospital , Tainan, Taiwan
                [6] 6Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare , Tainan, Taiwan
                [7] 7Graduate Institute of Clinical Medicine, National Cheng Kung University Hospital , Tainan, Taiwan
                [8] 8Center of Infection Control, National Cheng Kung University Hospital , Tainan, Taiwan
                [9] 9Department of Medicine, College of Medicine, National Cheng Kung University , Tainan, Taiwan
                [10] 10Microbiota-Host Interactions and Clostridia Research Group, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas, Universidad Andrés Bello , Santiago, Chile
                Author notes

                Edited by: Michael Jay Sadowsky, University of Minnesota, United States

                Reviewed by: Wiep Klaas Smits, Leiden University, Netherlands; Christopher Staley, University of Minnesota, United States

                *Correspondence: I-Hsiu Huang, ihsiuhuang@ 123456mail.ncku.edu.tw

                These authors have contributed equally to this work.

                This article was submitted to Antimicrobials, Resistance and Chemotherapy, a section of the journal Frontiers in Microbiology

                Article
                10.3389/fmicb.2017.02635
                5776096
                29387044
                d34a1551-72c2-4128-9658-9b5647a26d46
                Copyright © 2018 Yang, Chen, Rathod, Jiang, Tsai, Hung, Ko, Paredes-Sabja and Huang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 30 July 2017
                : 18 December 2017
                Page count
                Figures: 8, Tables: 3, Equations: 2, References: 72, Pages: 16, Words: 0
                Funding
                Funded by: Ministry of Science and Technology, Taiwan 10.13039/501100004663
                Award ID: 106-2321-B-006 -008
                Award ID: 103-2320-B-006-028-MY2
                Categories
                Microbiology
                Original Research

                Microbiology & Virology
                clostridium difficile,medium-chain fatty acid,lauric acid,alternative therapy,natural product

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