AUTHOR=Esposito Giuseppe , Nobile Nicola , Gigli Stefano , Seguella Luisa , Pesce Marcella , d’Alessandro Alessandra , Bruzzese Eugenia , Capoccia Elena , Steardo Luca , Cuomo Rosario , Sarnelli Giovanni 

TITLE=Rifaximin Improves Clostridium difficile Toxin A-Induced Toxicity in Caco-2 Cells by the PXR-Dependent TLR4/MyD88/NF-κB Pathway

JOURNAL=Frontiers in Pharmacology

VOLUME=7

YEAR=2016

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2016.00120

DOI=10.3389/fphar.2016.00120

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold><italic>Clostridium difficile</italic> infections (CDIs) caused by <italic>Clostridium difficile</italic> toxin A (TcdA) lead to severe ulceration, inflammation and bleeding of the colon, and are difficult to treat.</p><p><bold>Aim:</bold> The study aimed to evaluate the effect of rifaximin on TcdA-induced apoptosis in intestinal epithelial cells and investigate the role of PXR in its mechanism of action.</p><p><bold>Methods:</bold> Caco-2 cells were incubated with TcdA and treated with rifaximin (0.1-10 μM) with or without ketoconazole (10 μM). The transepithelial electrical resistance (TEER) and viability of the treated cells was determined. Also, the expression of zona occludens-1 (ZO-1), toll-like receptor 4 (TLR4), Bcl-2-associated X protein (Bax), transforming growth factor-β-activated kinase-1 (TAK1), myeloid differentiation factor 88 (MyD88), and nuclear factor-kappaB (NF-κB) was determined.</p><p><bold>Results:</bold> Rifaximin treatment (0.1, 1.0, and 10 μM) caused a significant and concentration-dependent increase in the TEER of Caco-2 cells (360, 480, and 680% vs. TcdA treatment) 24 h after the treatment and improved their viability (61, 79, and 105%). Treatment also concentration-dependently decreased the expression of Bax protein (-29, -65, and -77%) and increased the expression of ZO-1 (25, 54, and 87%) and occludin (71, 114, and 262%) versus TcdA treatment. The expression of TLR4 (-33, -50, and -75%), MyD88 (-29, -60, and -81%) and TAK1 (-37, -63, and -79%) were also reduced with rifaximin versus TcdA treatment. Ketoconazole treatment inhibited these effects.</p><p><bold>Conclusion:</bold> Rifaximin improved TcdA-induced toxicity in Caco-2 cells by the PXR-dependent TLR4/MyD88/NF-κB pathway mechanism, and may be useful in the treatment of CDIs.</p>