title: Bacteriophage Combinations Significantly Reduce Clostridium difficile Growth In Vitro and Proliferation In Vivo.
abstract: The microbiome dysbiosis caused by antibiotic treatment has been associated with both susceptibility to and relapse of Clostridium difficile infection (CDI). Bacteriophage (phage) therapy offers target specificity and dose amplification in situ, but few studies have focused on its use in CDI treatment. This mainly reflects the lack of strictly virulent phages that target this pathogen. While it is widely accepted that temperate phages are unsuitable for therapeutic purposes due to their transduction potential, analysis of seven C. difficile phages confirmed that this impact could be curtailed by the application of multiple phage types. Here, host range analysis of six myoviruses and one siphovirus was conducted on 80 strains representing 21 major epidemic and clinically severe ribotypes. The phages had complementary coverage, lysing 18 and 62 of the ribotypes and strains tested, respectively. Single-phage treatments of ribotype 076, 014/020, and 027 strains showed an initial reduction in the bacterial load followed by the emergence of phage-resistant colonies. However, these colonies remained susceptible to infection with an unrelated phage. In contrast, specific phage combinations caused the complete lysis of C. difficile in vitro and prevented the appearance of resistant/lysogenic clones. Using a hamster model, the oral delivery of optimized phage combinations resulted in reduced C. difficile colonization at 36 h postinfection. Interestingly, free phages were recovered from the bowel at this time. In a challenge model of the disease, phage treatment delayed the onset of symptoms by 33 h compared to the time of onset of symptoms in untreated animals. These data demonstrate the therapeutic potential of phage combinations to treat CDI.
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, England, United Kingdom.
authors.forename: Janet Y
authors.initials: JY
authors.lastname: Nale
authors.affiliation: Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Janice
authors.initials: J
authors.lastname: Spencer
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, England, United Kingdom.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Hargreaves
authors.affiliation: Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Buckley
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, England, United Kingdom.
authors.forename: Przemysław
authors.initials: P
authors.lastname: Trzepiński
authors.affiliation: Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom Gillian.Douce@glasgow.ac.uk mrjc1@le.ac.uk.
authors.forename: Gillian R
authors.initials: GR
authors.lastname: Douce
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, England, United Kingdom Gillian.Douce@glasgow.ac.uk mrjc1@le.ac.uk.
authors.forename: Martha R J
authors.initials: MR
authors.lastname: Clokie
mesh_terms: D000818:Animals; D001427:Bacterial Toxins / Q000378:metabolism; D001435:Bacteriophages / Q000145:classification / Q000235:genetics / Q000502:physiology*; D016360:Clostridioides difficile / Q000254:growth & development / Q000472:pathogenicity* / Q000821:virology*; D003015:Clostridium Infections / Q000821:virology; D004195:Disease Models, Animal; D005260:Female; D058507:Host Specificity; D008647:Mesocricetus; D010802:Phylogeny; D021521:Ribotyping; D013171:Spores, Bacterial / Q000821:virology
chemical_list: D001427:Bacterial Toxins; C488583:Clostridium difficile lethal toxin B