1. Immune response against Clostridioides difficile and translation to therapy
- Author
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Sahil Khanna and Kanika Sehgal
- Subjects
0301 basic medicine ,genetic structures ,030106 microbiology ,diarrhea ,Review ,C difficile ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Immunity ,Medicine ,Clostridioides difficile Infection: Approaching a Difficult Menace ,030212 general & internal medicine ,bezlotoxumab ,business.industry ,pathogenesis ,Gastroenterology ,Translation (biology) ,Clostridium difficile ,immunity ,Diarrhea ,Bezlotoxumab ,Immunology ,medicine.symptom ,business ,Clostridioides - Abstract
The pathogenesis of Clostridioides difficile infection (CDI) has largely been attributed to the action of two major toxins – A and B. An enhanced systemic humoral immune response against these toxins has been shown to be protective against recurrent CDI. Over the years, fully human monoclonal antibodies against both of these toxins have been developed in an attempt to counter the increasing incidence of recurrent CDI. Clinical trials conducted to evaluate the efficacy of anti-toxin A monoclonal antibody, actoxumab, and anti-toxin B monoclonal antibody, bezlotoxumab, demonstrated that bezlotoxumab substantially lowered the rate of recurrent infection, while actoxumab did not. A significant therapeutic benefit was appreciated in patients with at least one high-risk factor for recurrence, including, age ⩾65 years, immunocompromised state, prior CDI and severe CDI. In light of toxins A and B being immunogenic, vaccine trials are underway with the aim to prevent primary infection.
- Published
- 2021