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Clostridioides difficile is a bacterial species well known for its ability to cause C. difficile
infection (also known as CDI). The investigation of the role of this species in the human
gut has been so far dominated by a disease-centred perspective, focused on studying
C. difficile in relation to its associated disease.
In this context, the first aim of this thesis was to combine publicly available
metagenomic data to analyse the microbial composition of stool samples from patients
diagnosed with CDI, with a particular focus on identifying a CDI-specific microbial
signature.
However, similarly to many other bacterial species inhabiting the human gut, C.
difficile association with disease is not valid in absolute terms, as C. difficile can be
found also among healthy subjects. Further aims of this thesis were to 1) identify
potential C. difficile reservoirs by screening a wide range of habitats, hosts, body sites
and age groups, and characterize the biotic context associated with C. difficile
presence, and 2) investigate C. difficile within-species diversity and its toxigenic
potential across different age groups.
The first part of the thesis starts with the description of the concepts and
definitions used to identify bacterial species and within-species diversity, and then
proceeds to provide an overview of the bacterial species at the centre of my
investigation, C. difficile. The first Chapter includes a detailed description of the
discovery, biology and physiology of this clinically relevant species, followed by an
overview of the diagnostic protocols used in the clinical setting to diagnose CDI.
The second part of the thesis describes the methodology used to investigate
the questions mentioned above, while the third part presents the results of such
investigative effort. I first show that C. difficile could be found in only a fraction of the
CDI samples and that simultaneous colonization of multiple enteropathogenic species
able to cause CDI-like clinical manifestations is more common than previously
thought, raising concerns about CDI overdiagnosis. I then show that the CDIassociated
gut microbiome is characterized by a specific microbial signature,
distinguishable from the community composition associated with non-CDI diarrhea.
Beyond the nosocomial and CDI context, I show that while rarely found in adults, C.
difficile is a common member of the infant gut microbiome, where its presence is
associated with multiple indicators typical of a desirable healthy microbiome
development.
In addition, I describe C. difficile extensive carriage among asymptomatic
subjects, of all age groups and a potentially novel clade of C. difficile identified
exclusively among infants.
Finally, I discuss the limitations, challenges and future perspectives of my
investigation.
With the technological advances of the last decade, it is now feasible to analyze microbiome samples, such as human stool specimens, using multi-omic techniques. Given the inherent sample complexity, there exists a need for sample methods which preserve as much information as possible about the biological system at the time of sampling. Here, we analyzed human stool samples preserved and stored using different methods, applying metagenomics as well as metaproteomics. Our results demonstrate that sample preservation and storage have a significant effect on the taxonomic composition of identified proteins. The overall identification rates, as well as the proportion of proteins from Actinobacteria were much higher when samples were flash frozen. Preservation in RNAlater overall led to fewer protein identifications and a considerable increase in the share of Bacteroidetes, as well as Proteobacteria. Additionally, a decrease in the share of metabolism-related proteins and an increase of the relative amount of proteins involved in the processing of genetic information was observed for RNAlater-stored samples. This suggests that great care should be taken in choosing methods for the preservation and storage of microbiome samples, as well as in comparing the results of analyses using different sampling and storage methods. Flash freezing and subsequent storage at −80 °C should be chosen wherever possible.