Increase in Incidence of Clostridium Difficile infection in aged models and the need for novel vaccines for the prevention of disease

Abstract

Abstract Clostridium difficile associated disease (CDAD) constitutes a large majority of nosocomial diarrhea cases and is mediated by the effects of two secreted toxins, toxin A (TcdA) and toxin B (TcdB). Key toxin-neutralizing epitopes have been discovered within the carboxy-terminal receptor-binding domain (RBD) of the toxins, which has generated interest in developing the RBD as a vaccine target. The elderly mount an impaired humoral response to C. difficile toxins leading to more severe and recurrent disease; however, it has yet to be determined what underlying mechanisms lead to lower anti-toxin titers, thus higher incidence of severe and recurrent disease. While numerous platforms have been studied, very few data describe the potential of DNA vaccination against CDAD. We created highly optimized plasmids encoding the RBD from TcdA and TcdB and immunized C57BL/6 mice and rhesus macaques intramuscularly followed by in vivo electroporation. In these animal models, vaccination induced significant levels of anti-RBD antibodies within the serum and feces that could neutralize toxins in an in vitro cytotoxicity assay. Moreover, mice that were actively immunized with the DNA vaccine or given passive transfer of immunized non-human primate sera were protected from a lethal intraperitoneal challenge of purified C. difficile toxins. Finally, immunized mice were significantly protected following orogastric challenge with strains of C. difficile spores that were homologous (VPI 10463; n=10/10) and heterologous (hypervirulent UK1; n=4/8) strains to our vaccine antigens. These data demonstrate the robust immunogenicity and efficacy of a TcdA/B RBD-based DNA vaccine in preclinical models of acute toxin-associated disease.