Abstract
Clostridioides difficile is a major cause of health care–associated diarrhea. Severity ranges from mild to life-threatening, but this variability remains poorly understood. Microbiologic diagnosis of C. difficile infection (CDI) is straightforward but offers little insight into the patient’s prognosis or into pathophysiologic determinants of clinical trajectory. The aim of this study was to discover host-derived, CDI-specific fecal biomarkers involved in disease severity. Subjects without and with CDI diarrhea were recruited. CDI severity was based on Infectious Diseases Society of America/Society for Healthcare Epidemiology of America criteria. We developed a liquid chromatography tandem mass spectrometry approach to identify host-derived protein biomarkers from stool and applied it to diagnostic samples for cohort-wise comparison (CDI-negative vs. nonsevere CDI vs. severe CDI). Selected biomarkers were orthogonally confirmed and subsequently verified in a CDI mouse model. We identified a protein signature from stool, consisting of alpha-2-macroglobulin (A2MG), matrix metalloproteinase-7 (MMP-7), and alpha-1-antitrypsin (A1AT), that not only discriminates CDI-positive samples from non-CDI ones but also is potentially associated with disease severity. In the mouse model, this signature with the murine homologs of the corresponding proteins was also identified. A2MG, MMP-7, and A1AT serve as biomarkers in patients with CDI and define novel components of the host response that may determine disease severity.
Highlights
Clostridioides difficile, an anaerobic, Gram-positive, spore-forming bacterium transmitted by the fecal-oral route, is the leading cause of health care–associated diarrhea [1]
C. difficile infection (CDI) severity was based on Infectious Diseases Society of America/Society for Healthcare Epidemiology of America criteria
We identified a protein signature from stool, consisting of alpha-2-macroglobulin (A2MG), matrix metalloproteinase-7 (MMP-7), and alpha-1-antitrypsin (A1AT), that discriminates CDI-positive samples from non-CDI ones and is potentially associated with disease severity
Summary
Clostridioides difficile, an anaerobic, Gram-positive, spore-forming bacterium transmitted by the fecal-oral route, is the leading cause of health care–associated diarrhea (incidence: 4.3–7.9/10,000 patient days) [1]. The grade of severity can be assessed by various systems, including the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) criteria [3], in which severe disease is marked by hypotension, shock, ileus, megacolon, colectomy, admission to the intensive care unit, or death The basis for this variability in clinical course remains incompletely understood. Epidemiologic studies have identified risk factors for CDI, including use and duration of antibiotics, increasing age [4], and compromised immune status [1, 3] These factors are not sufficiently granular to inform on an individual’s prognosis, nor are they therapeutically actionable once disease is established. Identification of such biomarkers may provide insight into pathogenesis and determinants of disease outcome that are potentially tractable
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