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Open AccessArticle

Enhanced Humoral Immune Responses against Toxin A and B of Clostridium difficile is Associated with a Milder Disease Manifestation

1
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
2
Department of Geriatric Rehabilitation, Tel-Aviv Sourasky medical Center, Tel Aviv 6423906, Israel
3
Division of Epidemiology, and the National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
4
Clinical Microbiology Laboratory, Tel-Aviv Sourasky medical Center, Tel Aviv 6423906, Israel
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(10), 3241; https://doi.org/10.3390/jcm9103241
Received: 12 September 2020 / Revised: 23 September 2020 / Accepted: 30 September 2020 / Published: 10 October 2020
(This article belongs to the Special Issue Clostridium difficile Infection: Unmet Needs and Unsolved Questions)
The role of the humoral immune response to Clostridium difficile in modulating the severity of C. difficile infection (CDI) is unclear. We compared the levels of serum immunoglobulin G (IgG) and immunoglobulin A (IgA) against toxin A (TcdA) and toxin B (TcdB) of C. difficile between CDI and control patients and according to disease severity. The levels of IgG and IgA antibodies against TcdA and TcdB were measured in sera from patients with CDI (n = 50; 19 had severe CDI) and control patients (n = 52), using ELISA. Patients with CDI had higher levels of IgG antibodies against TcdA and TcdB than controls (p = 0.001 and p = 0.04, respectively). Higher IgG levels against TcdA and TcdB were found in patients with mild vs. severe CDI 7–14 days after the diagnosis (p = 0.004 and 0.036, respectively). A factor analysis included both IgA and IgG levels against both toxins into one composite variable, which was of higher values in patients with mild vs. severe CDI (p = 0.026). In conclusion, the systemic humoral immune responses against TcdA and TcdB might modulate the severity of CDI. These preliminary findings provide a basis for future large-scale studies and support the development and evaluation of active and passive immunotherapies for CDI management. View Full-Text
Keywords: immunoglobulin G; immunoglobulin A; Clostridium difficile; toxin A; toxin B; disease severity; sero-epidemiology immunoglobulin G; immunoglobulin A; Clostridium difficile; toxin A; toxin B; disease severity; sero-epidemiology
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Na’amnih, W.; Carmeli, Y.; Asato, V.; Goren, S.; Adler, A.; Cohen, D.; Muhsen, K. Enhanced Humoral Immune Responses against Toxin A and B of Clostridium difficile is Associated with a Milder Disease Manifestation. J. Clin. Med. 2020, 9, 3241.

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