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di Masi A, Leboffe L, Polticelli F, Tonon F, Zennaro C, Caterino M, Stano P, Fischer S, Hägele M, Müller M, Kleger A, Papatheodorou P, Nocca G, Arcovito A, Gori A, Ruoppolo M, Barth H, Petrosillo N, Ascenzi P, Di Bella S. Human Serum Albumin Is an Essential Component of the Host Defense Mechanism Against Clostridium difficile Intoxication. J Infect Dis 2019; 218:1424-1435. [PMID: 29868851 DOI: 10.1093/infdis/jiy338] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/01/2018] [Indexed: 01/05/2023] Open
Abstract
Background The pathogenic effects of Clostridium difficile are primarily attributable to the production of the large protein toxins (C difficile toxins [Tcd]) A (TcdA) and B (TcdB). These toxins monoglucosylate Rho GTPases in the cytosol of host cells, causing destruction of the actin cytoskeleton with cytotoxic effects. Low human serum albumin (HSA) levels indicate a higher risk of acquiring and developing a severe C difficile infection (CDI) and are associated with recurrent and fatal disease. Methods We used a combined approach based on docking simulation and biochemical analyses that were performed in vitro on purified proteins and in human epithelial colorectal adenocarcinoma cells (Caco-2), and in vivo on stem cell-derived human intestinal organoids and zebrafish embryos. Results Our results show that HSA specifically binds via its domain II to TcdA and TcdB and thereby induces their autoproteolytic cleavage at physiological concentrations. This process impairs toxin internalization into the host cells and reduces the toxin-dependent glucosylation of Rho proteins. Conclusions Our data provide evidence for a specific HSA-dependent self-defense mechanism against C difficile toxins and provide an explanation for the clinical correlation between CDI severity and hypoalbuminemia.
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Affiliation(s)
| | - Loris Leboffe
- Department of Sciences, Roma Tre University, Roma, Italy
| | - Fabio Polticelli
- Department of Sciences, Roma Tre University, Roma, Italy.,National Institute of Nuclear Physics, Roma Tre Section, Roma, Italy
| | - Federica Tonon
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristina Zennaro
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Marianna Caterino
- Department of Molecular Medicine and Medical Biotechnology, University of Napoli "Federico II", Napoli, Italy.,Associazione Culturale DiSciMuS RCF, Casoria, Napoli, Italy
| | - Pasquale Stano
- Department of Sciences, Roma Tre University, Roma, Italy
| | - Stephan Fischer
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | - Marlen Hägele
- Department of Internal Medicine I, University of Ulm Medical Center, Germany
| | - Martin Müller
- Department of Internal Medicine I, University of Ulm Medical Center, Germany
| | - Alexander Kleger
- Department of Internal Medicine I, University of Ulm Medical Center, Germany
| | - Panagiotis Papatheodorou
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, University of Freiburg, Freiburg, Germany
| | - Giuseppina Nocca
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Sacred Heart, Roma, Italy.,Institute of Chemistry of Molecular Recognition, CNR, Roma, Italy
| | - Alessandro Arcovito
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of Sacred Heart, Roma, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Margherita Ruoppolo
- Department of Molecular Medicine and Medical Biotechnology, University of Napoli "Federico II", Napoli, Italy.,Associazione Culturale DiSciMuS RCF, Casoria, Napoli, Italy.,CEINGE Biotecnologie Avanzate, Napoli, Italy
| | - Holger Barth
- Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany
| | - Nicola Petrosillo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases "L. Spallanzani", Roma, Italy
| | - Paolo Ascenzi
- Department of Sciences, Roma Tre University, Roma, Italy
| | - Stefano Di Bella
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases "L. Spallanzani", Roma, Italy
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