Successful Treatment of Relapsing Clostridium Difficile Colitis With Lactobacillus Gg

Gorbach, S. L.; Chang, Te‐Wen; Goldin, Barry R.

doi:10.1016/s0140-6736(87)92646-8

Cited by 397 publications

(155 citation statements)

References 7 publications

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“…Following the initial reported health benefit of L. rhamnosus GG in 1987 (36), strain GG has become one of the most comprehensively studied probiotic cultures in use today (2,3). However, a detailed understanding of the molecular mechanisms governing the interplay between the human host and strain GG has been hindered and largely undiscovered because of insufficient genomic information on L. rhamnosus GG.…”

Section: Discussionmentioning

confidence: 99%

Comparative genomic analysis of Lactobacillus rhamnosus GG reveals pili containing a human- mucus binding protein

Kankainen

Paulín

Tynkkynen

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

631

901

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To unravel the biological function of the widely used probiotic bacterium Lactobacillus rhamnosus GG, we compared its 3.0-Mbp genome sequence with the similarly sized genome of L. rhamnosus LC705, an adjunct starter culture exhibiting reduced binding to mucus. Both genomes demonstrated high sequence identity and synteny. However, for both strains, genomic islands, 5 in GG and 4 in LC705, punctuated the colinearity. A significant number of strain-specific genes were predicted in these islands (80 in GG and 72 in LC705). The GG-specific islands included genes coding for bacteriophage components, sugar metabolism and transport, and exopolysaccharide biosynthesis. One island only found in L. rhamnosus GG contained genes for 3 secreted LPXTG-like pilins (spaCBA) and a pilin-dedicated sortase. Using anti-SpaC antibodies, the physical presence of cell wall-bound pili was confirmed by immunoblotting. Immunogold electron microscopy showed that the SpaC pilin is located at the pilus tip but also sporadically throughout the structure. Moreover, the adherence of strain GG to human intestinal mucus was blocked by SpaC antiserum and abolished in a mutant carrying an inactivated spaC gene. Similarly, binding to mucus was demonstrated for the purified SpaC protein. We conclude that the presence of SpaC is essential for the mucus interaction of L. rhamnosus GG and likely explains its ability to persist in the human intestinal tract longer than LC705 during an intervention trial. The presence of mucus-binding pili on the surface of a nonpathogenic Gram-positive bacterial strain reveals a previously undescribed mechanism for the interaction of selected probiotic lactobacilli with host tissues.genome ͉ probiotics ͉ adhesion ͉ pilus ͉ lactic acid bacteria

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Section: Discussionmentioning

confidence: 99%

Comparative genomic analysis of Lactobacillus rhamnosus GG reveals pili containing a human- mucus binding protein

Kankainen

Paulín

Tynkkynen

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

631

901

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“…Several strains of lactobacilli have been tested as treatments for CDAD. Three case series, involving a total of 41 patients with recurrent CDAD, investigated treatment with Lactobacillus rhamnosus GG (Gorbach et al, 1987;Biller et al, 1995;Bennett et al, 1996). No further recurrences were seen in 50-84 % of patients.…”

Section: Probioticsmentioning

confidence: 99%

Alternative treatments for Clostridium difficile disease: what really works?

McFarland

2005

Journal of Medical Microbiology

141

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Vancomycin and metronidazole have been used for treating Clostridium difficile-associated disease (CDAD) for the past 25 years, but approximately 20 % of patients develop recurrent disease. The increasing incidence of nosocomial outbreaks, cases of recurrent CDAD and other complications (toxic megacolon, ileus, sepsis) has fuelled the search for different types of treatments. As the understanding of the pathogenesis of this disease has matured, newer treatment strategies that take advantage of these mechanisms have been developed. This review will describe such treatments and examine the evidence for each strategy.

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“…Second, 60-day retention in this study was arduous for many of the frail, elderly participants, and was often further complicated by concomitant cognitive dysfunction. Also, most study participants were presenting with a first recurrence of CDAD, unlike the patients with recalcitrant disease who were previously reported in case series of successful adjunctive LGG treatment (Gorbach et al, 1987;Bennett et al, 1996). Lastly, the participants were conservatively chosen to be at low risk for infectious complications from the study probiotic.…”

Section: Probiotics For Recurrent Clostridium Difficile Diseasementioning

confidence: 99%