Thus, we postulate that compared with monocytes, there are markedly fewer number of receptors for toxin A on the surface of lymphocytes, leading to lower level of fluorescence because of internalization of a much smaller number of toxin A488 molecules during culture at 37 °C. It is also Galunisertib possible that the differences between monocytes and lymphocytes reflect the non-phagocytic capacity of the latter cells. Our studies also suggest, for the first time, differences in the nature of receptors on

the surface of neutrophils and monocytes. Unlike monocytes, toxin A488-associated fluorescence in neutrophils was greater when exposed to the labelled toxin on ice than at 37 °C. Binding of selleck compound toxin A to hamster and rabbit intestinal brush-border

membranes has also previously been reported to be higher at 4 °C than at 37 °C [17, 35, 36]. In hamster brush-border membranes, toxin A is believed to bind to the carbohydrate sequence Galα1-3Galβ1-4GlcNAc [17], but the binding site on human cells remains to be fully characterized. Because of greater toxin A488-associated fluorescence on ice than at 37 °C, our studies imply the presence of distinct carbohydrate sequences in receptors for toxin A on the surface on neutrophils, but not monocytes. Characterization of receptors for C. difficile toxins will enable further studies to investigate potential new therapeutic agents that may interfere with toxin–receptor interactions. Intracellularly, toxin A monoglucosylates the Rho

family of proteins, which precedes destruction of the actin cytoskeleton [37]. In epithelial cells, loss of the actin cytoskeleton is associated with cell rounding, detachment and cell death by apoptosis [24–26, 38]. Mechanisms of resistance to toxin A-mediated cell death may include not only low level of uptake of the toxin (because of limited N-acetylglucosamine-1-phosphate transferase number of receptors) but also differences in intracellular activities of the toxin once internalized by the cells. It is possible that the greater sensitivity to C. difficile toxin-mediated monocyte/macrophage cell death may determine the development of mucosal inflammation. Thus, our previous studies have shown significant reduction in macrophage cell counts in colonic biopsies of patients with C. difficile-associated diarrhoea [39]. The relative resistance of lymphocytes to the effects of toxin A may enable them to survive long enough to mount specific immune responses to the toxins. Thus, mucosal and circulating antibodies to C. difficile toxins have been detected in patients following C. difficile infection, and a number of studies have reported that the antibody levels (or mucosal antibody secreting cells) are related to the development and nature of clinical disease [39–43]. K. Solomon was funded by Dr Hadwen Trust.