CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of United States Provisional patent application USSN 61/561 ,290 filed November 18, 20 1, the entire contents of which is hereby incorporated by reference. FIELD OF THE INVENTION

The present invention relates to a lipoteichoic acid (LTA) and uses thereof. More specifically, the invention relates to a Clostridium difficile lipoteichoic acid and its use as a vaccine to combat Clostridium difficile and as a diagnostic antigen.

BACKGROUND OF THE INVENTION Clostridium difficile is a Gram-positive anaerobe that is the cause of enteric disease in many animal species including humans. In humans, C. difficile associated diarrhea (CDAD) is a commonly diagnosed cause of hospital-associated and antimicrobial- associated diarrhea. With the emergence of the hypervirulent NAP1/027 strains in hospitals globally, a sharp increase in mortality rates has been observed (Kaier and Frank, Antimicrob Agents Chemother 2009, 53 (10), 4574-4575). While previous reports of C. difficile epidemics were restricted to single institutions or wards, more recently reports of a wider distribution of outbreaks are increasing (Bignardi et al, J Hosp Infect 2008, 70 (1), 96-98). Infection with C. difficile can lead to severe diarrhea, abdominal pain and further complications such as pseudomembranous colitis, inflammation and ulceration of the lining of the intestinal wall.

Current practice for the treatment of CDAD is the administration of antibiotics. Metronidazole, vancomycin, and fidaxomicin are among the most commonly-used antibiotics for treatment of CDAD. However, these approaches can only be used once the patient has contracted CDAD, and may be inefficient in the face of a drug-resistant bacterium. Additionally, the relapse rate of successfully treated patients is approximately 20%.

In light of the emergence and increasing severity of CDAD, there has been a significant increase in the number of research articles on C. difficile detection and characterization of virulence factors and toxins. However, to date little attention has been paid to the surface carbohydrate-containing molecules produced by this emerging pathogen. An early study by Poxton and Cartmill, J. Gen Micro 1982, 128, 1365-1370, described the characterization of two cell surface antigens extracted from the bacterial cell surface. Twenty years ago, the identification of a capsular polysaccharide (CPS)-like structure by electron microscopy was reported (Baldassarri et al, Microbiologica 1991 , 14 (4), 295- 300) followed by a detailed characterization of a C. difficile CPS (Ganeshapillai et al, Carbohydr. Res. 2008, 343 (4), 703-710). A recent publication demonstrated that the fiagellin protein from a number of C. difficile clinical isolates was glycosylated with a novel O-linked glycan (Twine et al, 2009, 191 (22), 7050-7062). In general however, the surface polysaccharides of the genus Clostridium are relatively poorly understood. Although there is information relating to C. perfringens CPS structures (Kalelkar er al, 1997, 299 (3), 119-128), the Clostridium genus is diverse genetically and it is unlikely that surface polysaccharides are conserved across the genus.

With respect to CPS of C. difficile, the work of Ganeshapillai, supra showed that a ribotype 027 strain produced two polysaccharides; the first polysaccharide (PSI) was a branched pentaglycosyl phosphate repeat unit composed of [→4-a-L-Rhap-(1→3)-p-D- Glcp-(1- 4)-[a-L-Rhap-(1→3]-a-D-Glcp-(1→2)-a-D-Glcp-(1→P- ] while the second polysaccharide (PSII) consisted of a hexaglycosyl phosphate repeat unit with the structure [→6)- -D-Glcp-(1→3)- -D-GalpNAc-(1^4)-a-D-Glcp-(1→4)-[p-D-Glcp(1→3]-p- D-GalpNAc-(1->3)-a-D-Manp-(1→P→]. The authors also confirmed the presence of the latter structure on the surface of two other C. difficile isolates; however, they also acknowledged that further investigations regarding the use of the structures in immune response were warranted.

Others (Oberli er al, Chem Biol, 2011 , 18 (5), 580-588; Danieli er al, Org Letters. 2011 , 13 (3), 378-381 ; Monteiro er al, WO 2009/033268) have-investigated vaccines that target the PSII CPS. Oberli, supra, and Danieli, supra, both use a synthetic monomeric structure to target the CPS; however, this may not provide a good mimic of the natural epitopes present on the polymers on the pathogen. Monteiro shows limited cross- reactivity of the PSII polysaccharide. To date, no further vaccines have been reported against C. difficile surface polysaccharides.

Another strategy is a therapeutic approach against the C. difficile toxin. This involves the use of antibodies (e.g., monoclonal antibodies) or antibody fragments (e.g., single- domain antibodies) specific for the toxin (for example, Hussack et al, 2011 JBC 286 (11 ), pp. 8961-8976). However, this anti-toxin strategy does not kill the bacteria, but rather only neutralizes the toxin, leaving the bacteria intact.

Thus, it is clear to those of skill in the art that there remains a profound need to establish a conserved and broadly cross-reactive, immunogenic antigen in order to develop a safe and effective vaccines for conferring immunity to patients at risk for developing C. difficile infections.

SUMMARY OF THE INVENTION

The present invention relates to a lipoteichoic acid (LTA) and uses thereof. More specifically, the invention relates a Clostridium difficile lipoteichoic acid and its use as a vaccine to combat Clostridium difficile.

The present invention provides an isolated LTA comprising a structure of Formula I

wherein is selected from NH ₂ and NHAc; each R ₂ is independently selected from NH ₂ and NHAc; and n is an integer between about 1 and 20. In a preferred embodiment, n is 12-16. The isolated LTA may have a degree of acetylation of the LTA in the range of about 65 to 100%. In a preferred embodiment, the degree of acetylation may be in the range of 65-75% or of about 70%. The isolated LTA of the invention may have a percentage of de-acetylation in the LTA between about 25 and 35%, or of about 30%. In the LTA as described above, the carbohydrate residues may be further substituted by D-alanine (D-ala), phosphorylcholine, or by other sugars such as glucose, galactose, N- acetylglucosamine, N-acetylgalactosamine and ribitol (Weidenmaier & Peschel, Nat. Rev. Microbiol. 2008 v6 p 276-287). The core unit of the isolated LTA of the present invention may comprise three glucose (Glcp) residues and a glycerol (Gro) residue. The Gro residue of the core unit may be esterified by one or more than one fatty acid. In a preferred embodiment, the Gro residue is esterified by two fatty acids. In one non-limiting example, the core unit may comprise the structure of Formula II

wherein at least one of R ₃ and R ₄ is independently selected from a C14:0, C:16:0 C16:1 C18:0, or C18:1 fatty acid, or any combination thereof, in embodiments wherein the Gro residue of the core unit is esterified by only one fatty acid, one of COR ₃ or COR ₄ is replaced by H.

In one embodiment of the invention, the isolated LTA of the present invention may comprise the structure of Formula III

wherein is selected from NH ₂ and NHAc; each R ₂ is independently selected from NH ₂ and NHAc; n is an integer between about 1 and 20; and at least one of R ₃ and R ₄ is independently selected from a C14:0, C:16:0 C16:1 C18.0 or C18:1 fatty acid, or any combination thereof. In embodiments wherein the Gro residue of the core unit is esterified by only one fatty acid, one of COR ₃ or COR ₄ is replaced by H. In a preferred embodiment, n is 12-16.

In another specific, non-limiting example of the invention, the isolated LTA of the present invention may comprise the structure of Formula IV.

wherein n is an integer between 1 and 20 and at least one of R ₃ and R ₄ is independently selected from a C14:0, C:16:0 C16:1 C18:0 or C18:1 fatty acid, or any combination thereof. In embodiments wherein the Gro residue of the core unit is esterified by only one fatty acid, one of COR ₃ or COR ₄ is replaced by H. In a preferred embodiment, n is 12-16.

The isolated LTA as described herein may be linked to a carrier molecule. The carrier molecule may be selected from the group consisting of a peptide, a protein, a membrane protein, a carbohydrate moiety, or one or more liposomes loaded with any of the previous carrier molecules. Examples of suitable carrier molecules include flagellin, human serum albumin (HSA), tetanus toxoid (TT), diphtheria toxoid (CRM or DT), Exotoxoid A, protein D, cholera toxin B subunit.

The present invention also encompasses a C. difficile vaccine comprising one or more than one isolated LTA as described herein. The C. difficile vaccine may further comprise an adjuvant. Examples of suitable adjuvants include attenuated viral and bacterial vectors and the AMVAD adjuvant (Patel et al, 2007 Vaccine 25: 8622-8636).

The present invention also provides a composition comprising the isolated LTA as described herein and a pharmaceutically acceptable diluent, carrier, or excipient. The present invention further provides a method of conferring immunity against C. difficile comprising administering an effective amount of the isolated LTA, the C. difficile vaccine, or the composition as described herein to a subject in need thereof.

The present invention further provides a method of detecting the presence of C. difficile using the isolated LTA described herein.

Additional aspects and advantages of the present invention will be apparent in view of the following description. The detailed description and examples, while indicating preferred embodiments of the invention, are given by way of illustration only, as various changes and modifications within the scope of the invention will become apparent to those skilled in the art in light of the teachings of this invention.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features of the invention will now be described by way of example, with reference to the appended drawings, wherein:

FIGURES 1A and 1B show results of whole cell HR-MAS NMR analysis of C. difficile isolates. For each isolate, the cells from one plate of confluent growth were killed in 2% phenol prior to analysis. As reference, the high resolution spectra of purified PS-II and O-deacylated LTA are shown on the bottom. The anomeric resonances are labelled according to the structures for the capsular polysaccharide and LTA in Figure 3.

FIGURE 2A shows the NMR spectra of PS-II for C. difficile CM-26. The proton spectrum and H- ¹³ C HSQC correlation spectrum with the anomeric resonances labelled A-F show the presence of PS-II shown in FIGURE 3. FIGURE 2B shows the NMR spectra of lipoteichoic acid (LTA) from C. difficile CM-26. 1 ). The proton spectrum and H- ¹³ C HSQC correlation spectrum of the O-deacylated LTA with the anomeric resonances labelled for the L-M and L'-M' repeating units, the terminal unit L ^r , and the core unit X-Y- Z. 2). The proton spectrum of the N-acetylated O-deacylated polymer showing the disappearance of L' and M' resonances due to N-acetylation of the GlcpN(1→3) residue (L'). 3). The proton spectrum of the dephosphorylated N-acetylated oligosaccharides OS-I and OS-II from the repeating units (L-M) and from the core unit (X-Y-Z). FIGURE 3 shows the capsule and lipoteichoic acid structures observed from C. difficile 630 and CM-26 strains. Residues are labelled according to the assignment of the resonances in Figures 1 and 2 and the NMR data in Table 2. For the O-deacylated LTA a minor component (30%) consisted of aGlcpN(1→3) instead of aGlcpNAc-(1-3) in the repeat unit.

FIGURE 4 shows an extracted mass spectrum of the LTA from C. difficile. Separation conditions: bare fused-silica (90 cm x 50 μΐη i.d., 375 μΐτι o.d.), 15 mM ammonium acetate, pH 7.0, +20 kV, 300 mbar. Ionization voltage: +5200 V. Orifice voltage: +350 V.

FIGURE 5 shows CE-MS/MS analyses (positive ion mode, orifice voltage 350 V) of the LTA from C. difficile. FIGURE 5A shows the extracted MS/MS spectrum of precursor ions at m/z 858.0, while FIGURE 5B shows the extracted MS/MS spectrum of precursor ions at m/z 696.0. The precursor ions were generated by increasing the orifice voltage to +350 V. N ₂ as collision gas; 40 eV (laboratory frame reference).

FIGURE 6 shows the structure of the major lipoteichoic acid (LTA) from C. difficile. Glycerol (Gro) is esterified either to C ₁₄ , C ₁₆ , or C ₁₈ , saturated or mono-unsaturated fatty acids indicated by R. A molecular model of the LTA with three repeat units and a Ci ₆ saturated fatty acid is shown.

FIGURE 7 shows the titration of the polyclonal sera derived from rabbit immunisations with killed whole cells from strains 630 and R20291 against purified LTA and PS-II antigens

FIGURE 8 shows the NMR spectra of the LTA from C. difficile strain 630 before (FIGURE 8A) and after (FIGURE 8B) O-deacylation and after both O-deacylation and linker incorporation (FIGURE 8C).

FIGURE 9 shows MALDI-TOF mass spectroscopy analyses of HSA (FIGURE 9A), HSA- BMPH (FIGURE 9B), and HSA-BMPH-SH-LTA conjugate (FIGURE 9C).

FIGURE 10 shows MALDI-TOF mass spectroscopy analyses of HSA (FIGURE 10A), HSA-BrAc (FIGURE 10B), and HSA-BrAc-SH-LTA conjugate (FIGURE 10C). DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to a lipoteichoic acid (LTA) and uses thereof. More specifically, the invention relates to a Clostridium difficile LTA and its use as a vaccine to combat Clostridium difficile. Lipoteichoic acids are often zwitterionic cell wall polymers most commonly composed of polyglycerol phosphate chains linked to a glycolipid anchor found on the surface of Gram positive bacteria. They are a major constituent of the cell wall of Gram-positive bacteria. While the exact function of teichoic acid is currently not clear, it has been shown that absence of LTA causes severe morphological defects, resulting in bacteria that are only viable under certain growth conditions (Grundling & Schneewind, PNAS 2007, 104:8478- 8483). The structure of LTA varies significantly between different classes and species of bacteria. In particular, LTA is known to vary in the length of the chains and the location and type of substituents. Substituents can include amino acids, sugars such as D-glucose, and amino sugars such as N-acetyl-D-glucosamine and N-acetyl-D-galactosamine. In US 2006/0002939, mice immunized with whole strain Staphylococcus epidermidis produced a wide range of antibodies some of which bound to commercially purchased LTA. However, the structure of the LTA was not known.

The inventors of the present application have isolated and characterized a novel LTA from C. difficile. The inventors cultured 39 different strains of C. difficile (see Table 1). Of these 39 strains, the following 11 strains were subjected to a survey of surface carbohydrate diversity using whole-cell high resolution magic angle spinning (HR-MAS) NMR:

630, BI-7, BI-1 , QCD32g58, CM26, CM56, 06Cd-130, 955289, D0835450, D0503439 and D0632920. Of the 11 strains surveyed, including genome-sequenced strain 630 and a clinical isolate from an outbreak in Manitoba, Canada in 2000 (CM-26), a highly conserved anomeric region was observed.

Following hot water extraction of the cells and one and two-dimensional NMR experiments, a non-lipidated polysaccharide (PS-II) was confirmed to be identical to the hexaglycosyl phosphate repeating block of [→6)-P-Glc-(1- 3)-p-GalNAc-(1→4)-a-Glc- (1→4)-[p-Glc(1→3]-p-GalNAc-(1→3)-a-Man-(1→P→] (PSII) reported previously (Figure 2A).

A second, novel, conserved glycan polymer, was also observed in the 11 strains. This glycan polymer, an LTA, was isolated following a phenol extraction from strains 630, VP110463 and C -26. The LTA was lipid-linked either to C ₁₄ , Ci ₆ , or Ci8, saturated or mono-unsaturated fatty acids. It was also visible by HR-MAS NMR (Figure 1 ) indicating that it is a major conserved component of the cell surface carbohydrates. A complete structural analysis was performed on the novel LTA, which enabled determination of its structure. The LTA described herein comprises a repeating unit -[6-a-GlcNAc(1→3]-a- GlcNAc-((1- 2)-GroA)-6→P-»]) that is connected to a lipid anchor via a core unit.

The predominant component of the LTA was an a-linked GlcNAc-GlcNAc-glyceric acid repeating unit linked through a 6-6 phosphodiester bridge between C-6 of the two GlcNAc residues (6-P-6). This portion of the structure was previously found in cell- envelope polysaccharide antigens of the Gram-positive organism, Peptostreptococcus anaeorobius following extraction from intact cells by autoclave or alkaline treatment (Storz et al, J. Carbohydrate Res. 1990, 207, 101-120). However, the entire structure of the novel LTA has never been previously reported. The inventors of the presently claimed invention have identified, in addition to the repeat unit, the terminal residue and the core unit (see Figure 3). A minor component of the LTA from C. difficile comprising approximately 30% GlcN-GlcNAc-GroA in place of GlcNAc-GlcNAc-GroA was also observed. The core unit contained the β-linked Glc-Glc-Glc-Gro with glycerol esterified by fatty acids.

The LTA identified herein is quite distinct to the reported structures of LTA from other Gram-positive organisms within the Phylum Firmicutes (low GC). However, the structural studies completed to date on LTAs have primarily focused on organisms from the class Bacilli within this Phylum (Henneke et al, J Immunol. 2005, 174 (10), 6449-6455; Morath ef al 2002, 70 (2), 938-944;Behr er a/, Eur. J Biochem. 1992, 207 (3), 1063-1075; Han et al, Infect Immun. 2003 Oct;71 (10):5541-8(e.gf. Bacillus, Streptococcus, Staphylococcus, Lactobacillus, Staphylococcus spp) while the present invention focuses on an LTA from C. difficile, which is a member of the class Clostridia. A previous report on C. innocuum had demonstrated that the LTA contained a Gal-Gro-P repeating unit (Fischer, Bacterial Cell Wall Ghuysen and Hakenbeck (eds) Elsevier Science B.V.1994,) which is different from the repeating unit of the LTA of the present invention. Given that the LTA was present in all 11 tested strains, and based on immunological studies reported further herein, the inventors of the present application have determined that the distinct structure of the LTA is representative of the C. difficile species. The present invention provides an isolated LTA comprising a structure of Formula I

which may, alternatively, be written as follows:

L ^r M N

-GlcR _r (l? 3)- -GlcNAc-(l? 2)-GroA

I L M N

6-P-[? 6- -GlcR ₂ -(l? 3)- -GlcNAc-(l? 2)-GroA

6-P-l ^J n? 6-Core Unit wherein is selected from NH ₂ and NHAc; each R ₂ within the repeating unit is independently selected from NH ₂ and NHAc; and n is an integer between about 1 and 20. In a preferred embodiment, n is 12-16. The entire polymer may have a degree of acetylation in the range of about 60-100%, preferably 65-75% or about 70%, due to acetylation of the combination of and R ₂ .

In the repeating unit, as described above, n is an integer between about 1 and 20. For example, and without wishing to be limiting in any manner, n may be about 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 14, 15, 16, 17 ,18, 19, or 20. In a non-limiting example, n may be about 12 to 16. Thus, the molecular weight of the LTA as described above will vary based on the value of n. For example, and without wishing to be limiting in any manner, the molecular weight of the LTA may be between about 5 and 10 kDa. In a non-limiting example, the molecular weight of the LTA may be about 8-12 kDa. For example, the OS- I repeating unit may be as shown in Figure 3, where the residues are labelled L-M-N.

The repeating unit may be capped by a terminal unit. The terminal unit in the LTA as described herein and shown in Formula I is noted as L ^T -M-N, which is the same as the repeating unit, except that a terminal GlcpNAc or GlcN is present. For example, the terminal unit may be as shown in Figure 3, where the residues are labelled L ^T -M-N.

As described above, each R ₂ within the repeating unit of the isolated LTA of the present invention may be the same or different. For example, and strictly for the purpose of illustration, when n=3, each of the three R ₂ of the repeating unit is independently selected from NH ₂ and NHAc. Thus, in this illustration, the repeating unit may comprise 0, , 2, or 3 NH ₂ at position R ₂ . Similarly, Ri of the terminal unit of the isolated LTA of the present invention is selected independently from R ₂ and may be the same as or different from any given R ₂ . The selection of the R ₁ and R ₂ groups results in a degree of acetylation of the LTA polymer. By "degree of acetylation", it is meant the percentage of LTA that comprises NHAc at the and R ₂ positions combined. This degree of acetylation may be between about 60% and 90%, or between about 65% and 75%; for example, the degree of acetylation may be about 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 , 72, 73, 74, 75, 76, 77, 78, 79, 80, 81 , 82, 83, 84, 85, 86, 87, 88 , 89, or 90%, or any value in between. In one non-limiting example, the proportion of GlcNAc in the LTA may be approximately 70%.

Stated alternatively, the degree of deacetylation in the LTA may be between about 10% and 40%, or between about 25% and 35%; for example, the proportion of GlcN may be about 10, 1 1 , 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 , 32, 33, 34, 35, 36, 37, 38, 39, or 40%, or any value therein between. By "degree of deacetylation", it is meant the percentage of LTA that comprises NH at the R and R ₂ positions combined. In one non-limiting example, the degree of deacetylation (i.e., GlcN) in the LTA may be approximately 30%. In the LTA of the present invention, the residues within the repeating and terminal units may be further substituted. For example, and without wishing to be limiting, the residues may be further substituted by D-alanine (D-AIa), phosphorylcholine, or by sugars such as D-glucose or amino sugars such as N-acetyl-D-glucosamine. This type of substitution is well-known to those of skill in the art (see, for example, Ghuysen, J.M., Bacterial Cell Wall (Elsevier Science B.V., 1994, Amsterdam at page 201). The repeating unit is also connected to a core unit. The core unit may be a glucose trisaccharide, which may link the repeating unit to a lipid anchor. Such a core unit of the isolated LTA described herein may comprise three glucose (Glcp) residues and a glycerol (Gro) residue. Structures of Glcp and Gro residues are well-known to those of skill in the art. In one specific example, the glucose trisaccharide of the isolated LTA may comprise the structure of Formula II

or

8-Glc-(l ? 6) 8-Glc-(l ? 6)-8-Glc-(l ? l)-Gro

X Y Z as shown in Figure 3, where the carbohydrate residues are labelled X-Y-Z. The core unit may have a molecular weight of approximately 500 Da.

The Gro residue of the core unit as described above may be esterified by one or more than one fatty acid. It is known that many different fatty acids are found in Clostridium (Elsden et al, 980, J. Gen Microbio. 1980: 115-123). In one example, the Gro residue is esterified by two fatty acids. By the expression, "one or more than one fatty acid", it is meant that the fatty acid may be a single type of fatty acid, or a mixture of fatty acids; for example, and without wishing to be limiting in any manner, at least one of R ₃ and R ₄ in the structure of Formula II above is independently selected from a C14.0, C:16:0, C 6:1 , C18:0 or C18:1 fatty acid, or any combination thereof. In embodiments wherein the Gro residue of the core unit is esterified by only one fatty acid, one of COR ₃ or COR ₄ is replaced by H.

By the term "connected", also referred to herein as "linked", it is meant that the repeating unit is covalently linked to the core unit. The covalent linkage may be a direct covalent linkage between residues or may be via a functional group, for example but not limited to a phosphodiester bridge. A phosphodiester bridge (or bond) joins the carbons of two carbohydrate residues to a phosphate group over two ester bonds.

In one specific, non-limiting example, the LTA of the present invention may comprise the structure of Formula III

Or, the structure of Formula III may be written as follows:

LJ M N

<-GlcR _r (l ? 3)-<-GlcNAc-(l ? 2)-GroA

I L M N

6-P-[? 6-<-GlcR (l ? 3)-<-GlcNAc-(l ? 2)-GroA

6-P-] ? 6-<-Glc-(l ? 6)-<-Glc-(l ? 6)-<-Glc-(l ? l )-Gro

X Y Z wherein Ri is selected from NH ₂ and NHAc; each R ₂ within the repeating unit is independently selected from NH ₂ and NHAc; n is an integer between 1 and 20; and at least one of R ₃ and R ₄ is independently selected from a C14:0, C:16:0 C16: 1 C18:0 or C18: 1 fatty acid, or any combination thereof. In embodiments wherein the Gro residue of the core unit is esterified by only one fatty acid, one of COR ₃ or COR ₄ is replaced by H. The entire polymer may have a degree of acetylation in the range of about 60- 00%, or between about 65% and 75%, or about 70% due to acetylation of the combination of Ri and R ₂ . Individual features of the LTA are as described herein.

The present invention also encompasses embodiments wherein all and R ₂ within a LTA polymer are NHAc, as well as LTA polymers wherein all and R ₂ are NH ₂ . In one specific, non-limiting example, the isolated LTA of the present invention may be as shown in Figure 3, where it is labelled "LTA".

In a specific, non-limiting example of the invention, the isolated LTA of the present invention may comprise the structure of Formula IV.

wherein n is an integer between 1 and 20 and at least one of R ₃ and R ₄ is independently selected from a C14:0, C:16:0 C16:1 C18:0 or C18:1 fatty acid, or any combination thereof. In embodiments wherein the Gro residue of the core unit is esterified by only one fatty acid, one of COR ₃ or COR ₄ is replaced by H. In a preferred embodiment, n is 12-16. The LTA as described herein may be obtained by any suitable method. For example, the LTA may be natural, obtained by isolation from C. difficile strain(s), or may be synthesized using methods known to those of skill in the art (Kusumoto et al, 1996, J Synth Org Chem Jpn 54: 976-987; Marcus et al, Angew. Chem. Int. Ed 2010 49:2585- 2590; Stadelmaier et al, Angew. Chem. Int. Ed. 2003 42: 916-920). The present invention further encompasses conjugates comprising the isolated LTA described herein. The conjugates may comprise the novel LTA as described above linked to a carrier molecule. The carrier molecule may be any suitable molecule known in the art. For example, and without wishing to be limiting in any manner, the carrier molecule may be a peptide, a protein, a membrane protein, a carbohydrate moiety, or one or more liposomes loaded with any of the previously recited types of carrier molecules or with the LTA itself. For example, and without wishing to be limiting in any manner, the carrier molecule may be flagellin, human serum albumin (HSA), tetanus toxin (TT), diphtheria toxoid (CRM or DT), exotoxin A, protein D, cholera toxin B subunit, or other suitable carrier protein/peptide (for example see Dagan et al, Vaccine, 2010, 28(34), 5513-5523 for a review of suitable carrier molecules). In a further non-limiting example, the carrier molecule may be a liposome, for example an archaeosome (Krishnan et al, Infect and Imm: 2000 68 54-63), loaded with any of the molecules noted above; this renders the construct well-suited as a delivery agent for mucosal vaccines. The carrier molecule may be linked to the LTA by any suitable method known in the art. For example, and without wishing to be limiting, the carrier molecule may be linked to the LTA by a covalent bond or ionic interaction, either directly or via a linker. The linkage may be achieved through a chemical cross-linking reaction, for example a thiol linkage. The carrier protein may be conjugated to the LTA as described above via any suitable group; for example and without wishing to be limiting in any manner, the carrier protein may be conjugated to a GlcN residue at position L, resulting from F and/or R ₂ = NH ₂ within the structure. Methods for linking LTA to a carrier molecule would be well-known to a person of skill in the art (Cox et al, 2010 Glycoconj J. 27: 401-407). Methods of preparing glycoconjugate vaccines are well described in the prior art and these methods are widely known and practiced by those of skill in the art (see, for example Pace, D, 2012, Exp Opin Biol Ther. EPub Ahead of Print, Sept 20, 2012.

The present invention also provides compositions or formulations comprising the compounds described herein, including the isolated LTA described herein and/or conjugates comprising the isolated LTA. Additionally, the present invention provides a C. difficile vaccine comprising the isolated LTA described herein and/or conjugates comprising the isolated LTA as described herein.

The inventors of the present application have found that the vaccines of the present invention produce sera in mammals which are reactive with each of the 39 strains of C. difficile cultured. Accordingly, the vaccines of the present invention are effective against the entire C. difficile species. The inventors of the present application have also found that, unlike many isolated carbohydrate compounds, the isolated LTA of the present invention is an effective immunological agent which produces an IgG response (see Table 7). An IgG response has significant prophylactic benefit since the host will retain antibodies in its system and be able to mount an immunological response against subsequent exposure to the pathogen. Accordingly, while the production of a conjugate may provide enhanced immunogenicity, it is possible to produce an effective vaccine using isolated LTA alone. This feature of the present invention has benefit for vaccine manufacturers, who may find enhanced efficiency in using the isolated LTA without conjugation. The vaccines of the present invention demonstrated high titres when administered to mice and rabbits, indicating that vaccines of the invention are useful against C. difficile.

The compositions, formulations, or vaccines may further comprise pharmaceutically acceptable diluents, carriers, or excipients. By the term "pharmaceutically acceptable", it is meant that the diluent, carrier, or excipient is compatible with the compound of the present invention, and is not deleterious to the recipient of the composition.

The diluent, carrier, or excipient may be any suitable diluent, carrier, or excipient known in the art, and must be compatible with other ingredients in the composition and with the method of delivery of the compositions, formulations, or vaccines. The composition may be in any suitable form; for example, the compositions, formulations, or vaccines may be provided in suspension form, powder form (for example, but not limited to lyophilised or encapsulated), capsule or tablet form. For example, and without wishing to be limiting, when the compositions, formulations, or vaccines are provided in suspension form, the carrier may comprise water, saline, a suitable buffer, or additives to improve solubility and/or stability; reconstitution to produce the suspension is effected in a buffer at a suitable pH to ensure the viability of the antibody or fragment thereof. Dry powders may also include additives to improve stability and/or carriers to increase bulk/volume; for example, and without wishing to be limiting, the dry powder composition may comprise sucrose or trehalose. In a specific, non-limiting example, the compositions, formulations, or vaccines may be so formulated as to deliver the LTA to the gastrointestinal tract of the subject. Thus, the compositions, formulations, or vaccines may comprise encapsulation, time-release, or other suitable technologies for delivery of the LTA. It would be within the competency of a person of skill in the art to prepare suitable compositions, formulations, or vaccines comprising the present compounds (see, for example, Rappuoli, R. And Bagnoli, F. eds, Vaccine Design, Innovative Approaches and Novel Strategies, (Caister Academic Press: 2011 , Norfolk UK).

The composition, formulation, or vaccine as described above may also comprise an adjuvant. The adjuvant may increase the specificity of the immune response, or may increase the level of immune response. In some instances, the adjuvant may be the carrier molecule (for example but not limited to cholera toxin B subunit, liposome, etc); in other instances, the adjuvant may be an unrelated molecule known to increase the response of the immune system (for example but not limited to attenuated bacterial or viral vectors, AMVAD (Patel et al, 2007, Vaccine, 25: 8622-8636). Other suitable adjuvants are well-known to those of skill in the art. In one example, the adjuvant may be an adjuvant / carrier protein that generates a strong mucosal immune response such as an attenuated virus or bacteria, or aluminum salts. Another suitable adjuvant is known as MF59, which contains 2,6, 10,15, 19,23-Hexamethyltetracosa-2,6,10,14,18,22-hexaene, also known as squalene, which can be obtained from shark liver oil or certain plant sources.

The present invention also provides a method of conferring immunity against C. difficile comprising administering an effective amount of the isolated LTA of the present invention or a composition comprising the isolated LTA, or a conjugate comprising the LTA of the present invention to a subject in need thereof. Any suitable method of delivery may be used. For example, and without wishing to be limiting in any manner, the LTA or the composition of the present invention may be delivered enteraliy or parentally (orally, nasally, rectally intravenously, subcutaneous, intraperitoneally, transdermally, etc.). For example, and without wishing to be limiting, the LTA or composition of the present invention may be delivered via a route that achieves a strong mucosal immune response. Those of skill in the art would be familiar with such methods of delivery. Accordingly, the LTA of the present invention and as described above can be used to confer immunity against C. difficile, or could be used to prepare a medicament for conferring immunity against C. difficile. Sera produced by rabbits administered whole cells of C. difficile was shown to comprise antibodies, of which a large portion were antibodies to LTA. This sera was also shown to be opsonic, or exhibit opsonic activity, for C. difficile. More specifically, these sera promote attachment of the C. difficile to a phagocyte and thereby enhance phagocytosis, which results in death of the C. difficile cells. Opsonic activity is a measure of the ability of sera to kill cells and therefore provides a measure of the ability of a vaccine to generate an immunogenic response with is lethal to the pathogen. The present invention will be further illustrated in the following examples. However, it is to be understood that these examples are for illustrative purposes only and should not be used to limit the scope of the present invention in any manner.

Example 1: Cell culture

The C. difficile isolates examined herein are shown in Table 1. All strains are from distinct outbreaks and display unique typing profiles. Isolates were grown on brain heart infusion (BHI) broth and solid media supplemented with 0.5 g L ^" cysteine-HCI, 5 mg L ^"1 hemin, 1 mg L ^" vitamin and 1 mg L ^"1 resazurin. Bacteria were grown under anaerobic conditions in a miniMACs workstation (Microbiology International, Frederick, MD) at 37°C. Table 1. C. difficile strains.

QCD32g58 BI/NAP1/027, Quebec, Canada 2004

955289 A ⁺ B ⁺ , CdtB ⁺

D0835450 A ⁺ B ⁺ , CdtB ^" , intestinal swab, swine, Prairie Diagnostic

Services, Saskatoon, SK

D0632920 A ^' B ^" CdtB ^" , mesocolon isolate, swine, Prairie Diagnostic

Services, Saskatoon, SK.

D0724491 Porcine colon isolate, Prairie Diagnostic Services, Saskatoon,

SK

CM-121 A ⁺ B\ Manitoba, Canada, (20 cases) 2000

29975 A-B+ Manitoba, Canada (16 cases) 1998

05-2694 A ⁺ B ⁺ , Manitoba, Canada, (7 cases) 2005

M 13876 Sherbrooke.QC, 2004

M16256 Sherbrooke, QC, 2004

M23257 Sherbrooke, QC, 2004

M26195 Sherbrooke, QC, 2004

M46846 Sherbrooke, QC, 2004

M6510 Sherbrooke, QC, 2005

M7465 Sherbrooke, QC, 2005

M9349 Sherbrooke, QC, 2005

M6317 Sherbrooke, QC, 2005

M 13340 Sherbrooke, QC, 2005 R20291 A ⁺ B ⁺ , NAP1/027, UK, 2005

CD196 A ⁺ B ⁺ , NAP1/027, France, 1985

M68 A ⁺ B ⁺ , 017, Ireland, 2006

CF5 A ⁺ B ⁺ , 017, Belgium, 1995

CD20 023, UK, 2007

BI-6 A ⁺ B ⁺ , USA, 2003

BI-11 A ⁺ B ⁺ , USA, 2001

BI-14 A ⁺ B ⁺ , USA, 2004

001-01 UK, 2008

106-01 UK, 2007

M120 A ⁺ B ⁺ , 078,2007

BI-9 001.NAP2

Liv022 UK , 2009

Liv024 UK.2009

TL174 UK, 2009

TL176 UK, 2009

TL178 Ireland, 2009

VP110463 ATCC 43255, 087

To analyse LTA by HR-MAS (Example 2) a single agar plate was streaked for confluent growth and incubated for 12h. Cells were scraped from BHI plate and killed for 4h with 2% phenol prior to analysis. Cells were washed extensively (x4) in sterile PBS, followed by washes in PBS/D ₂ 0. The washed cell pellets were re-suspended in 40 μΙ_ D ₂ 0 containing 0.015% TPS (internal standard).

For broth-grown cells, 500ml cultures were inoculated to a starting OD ₆₀ o of 0.1 using cells grown for 18h on BHI agar plate. Flasks were incubated in anaerobic hood without shaking until OD ₆ oo was .5-2.0 and then harvested by centrifugation.

Other Clostridia species (non C. difficile) that were examined are detailed in Table 2

Table 2. Other Clostridia species

Example 2: Whole cell HR-MAS NMR

Whole, killed C. difficile isolate cells (from Example 1 ) were subjected to high resolution magic angle spinning (HR-MAS) NMR analysis to initially compare the surface polysaccharide profile of C. difficile isolates in a high-throughput manner. HR-MAS NMR provides a quick and rapid method to assess the surface glycoconjugates. C. difficile cells from one plate of confluent growth of each isolate were killed in 2% phenol for 4 h prior to NMR analysis. HR-MAS NMR experiments were performed using a Varian Inova 500 MHz spectrometer equipped with a Varian nano-NMR probe as previously described (St. Michael et al, 2002, Young et al, 2002). Spectra from 40 μΙ_ samples were spun at 3 kHz and recorded at ambient temperature (21°C) with the suppression of the HOD signal at 4.8 ppm. Proton spectra of bacterial cells were acquired with a Carr-Purcell-Meiboom-Gill (CPMG) pulse sequence (90-(τ-180-τ) _η - acquisition) to remove broad lines arising from lipids and solid-like material. The total duration of the CPMG pulse (η*2τ) was 1 ms with τ set to (1/MAS spin rate). The methyl resonance of 3-(trimethylsilyl)propionic-2,2,3,3-d ₄ acid (TPS) (0.015% in D ₂ 0) at 0.00 ppm was used as internal reference in H spectra. The high resolution spectra of purified PS-II and O-deacylated LTA were used as references.

The anomeric region of the ¹ H spectrum of strain 630 was compared to 10 different strains of either clinical or environmental sources (Figures 1A and B). The ¹ H spectra indicated the presence of highly conserved capsular polysaccharide (PSII) and a conserved and structurally novel lipotechoic acid (LTA) in all the strains examined. Several anomeric resonances were observed and these correlated to the published chemical shifts for the anomeric resonances (Figure 1 ) of the polysaccharide composed of a hexaglycosyl phosphate repeat unit reported by Ganeshapillai supra. In addition to anomeric signals correlating to the capsular polysaccharide structure, a number of additional conserved resonances were observed for each strain.

Example 3: Isolation and purification of surface polysaccharides

In order to initially confirm the presence of the hexaglycosyl phosphate polysaccharide and to investigate the structure corresponding to the additional signals in HR-MAS NMR experiments (Example 2), and subsequently to prepare the structurally characterised LTA for glycoconjugation, three strains (630, VPI 0463 and CM-26) were chosen for large scale growth, polysaccharide extraction, characterization of the isolated polysaccharides and provision of LTA for glycoconjugation.

In order to ensure that the polysaccharides extracted were from vegetative cells, cultures of strains 630, VPI10463,and CM-26 (Example 1 ) were harvested at late logarithmic phase (OD ₆₀₀ 1.5-2.0). The bacterial cells were harvested (8200 xg, 4°C, 20 min), killed with the addition of phenol to 4% washed with 10 mM phosphate buffered saline, pH 7.4, and subjected to modified hot water-phenol extraction. Briefly, the cells were first extracted in boiling water for 30 min and the resulting solution separated by low-speed centrifugation; the supernatant was dialyzed against tap water and lyophilized. Contaminating proteins and nucleic acids were removed by precipitation with trichloroacetic acid, followed by dialysis against water. The water-soluble material was separated by anion exchange chromatography on a HiTrap Q column using a H ₂ 0-1 M NaCI gradient to give a polysaccharide fraction (PS-II).

The remaining cells were subjected to extraction with 45% phenol (68°C, 30 min). The water phase was separated from the phenol phase and cell debris by centrifugation. The phenol phase and cell debris was then re-extracted with more water and treated as per above. The two water phases were combined and dialyzed against tap water until phenol-free, then lyophilized. The dried sample was dissolved in water to give a 1-2% solution (w/v) and treated with deoxyribonuclease I (DNase) (0.01 mg/ml) and ribonuclease (RNase) (0.01 mg/ml) for 3 hrs at 37°C, then treated with proteinase K (0.01 mg/ml) for 3hrs. The sample was then dialysed against tap water for 17hrs and lyophilized. The resulting crude polysaccharide sample was purified by anion exchange chromatography as described above. The LTA fraction was O-deacylated with 14% ammonia in 10% methanol (50°C, 3h), yielding a deacylated polysaccharide. The solution was rotary evaporated to dryness, re-dissolved in water, and gel-purified on a Sephadex G-25 column (Amersham), eluting with water.

The following three methodologies were utilised for structural analyses.

Liberated fatty acids were analyzed as fatty acid methyl esters (FAMEs) as previously described (lchihara & Fukubayashi, 2010 J. Lipid Res, 51 : 635-40). When required, samples were re-N-acetylated by treatment with acetic anhydride and subsequent column chromatography. Similarly, if required re-N-acetylated samples were de-O-acetylated by treatment with mild base and purified by subsequent column chromatography as required.

Carbohydrate samples were dephosphorylated by treatment with 48% HF (Sigma Aldridge, Oakville, ON) for 48 hrs at 4°C. The HF was evaporated under stream of nitrogen and the residue re-dissolved in water and lyophilized. Example 4: Structural analysis of the LTA

The polysaccharide fractions (PS-II, LTA) obtained in Example 3 were subject to gas chromatography, nuclear magnetic resonance (NMR) and mass spectroscopy experiments in order to identify monosaccharides and determine the polysaccharide structure.

Monosaccharides were identified by GC on a Shimadzu GC-14 gas chromatograph equipped with flame ionization detector and Zebron ZB-5 capillary column (30 m x 0.25 mm), with hydrogen as carrier gas, using a temperature gradient 170°C (3 min), 260°C at 5°C min ^"1 . Prior to analysis, polysaccharides were hydrolyzed with 4 M TFA (1 10°C, 3 h) and converted to alditol acetates by conventional methods. Methylation analysis was performed. Methylated glycerophosphorylated glucans were dephosphorylated prior to alditol acetate derivatization. Partially methylated alditol acetates were analyzed by GC and GC-MS. GC-MS experiments were performed on a Varian Saturn 2000 system, equipped with DB-17 (30 m x 0.25 mm) fused-silica column using a temperature gradient of 180°C (2 min) to 240 °C at 2°C min ^"1 ; equipped with a ion-trap mass spectral detector. Polysaccharides and standards of L-glyceric acid with R- and S-2-butanol were mixed with acetyl chloride (0.3 mL of 2-BuOH, 0.03 mL of AcCI) and heated for 3 h at 90°C, dried under air stream, acetylated with Ac20-Py (1 h, 90°C), dried and analyzed by GC- MS on Varian Saturn 2000 MSD on DB17 column at 140°C isothermally. NMR spectra were acquired using a Varian INOVA 500 MHz spectrometer employing standard software at 25-45°C using a 5 mm indirect detection probe with the ¹ H coil nearest to the sample (Brisson et al, 2002). Samples were dissolved in D ₂ 0 using acetone as internal reference (2.23 ppm for ¹ H and 31.5 ppm for ¹³ C). Polysaccharide samples were analyzed using standard pulse sequences DQCOSY, TOCSY (mixing time 120 ms), NOESY (mixing time 400 ms), HSQC and HMBC (100 ms long range transfer delay). ¹ H- ³¹ P HMQC and HMQC-TOCSY were run with ¹ H- ³¹ P coupling set to 11 Hz, TOCSY mixing time 100 ms. Molecular models were generated using the Insightll software.

Structural analysis of the capsular polysaccharide (PS-II) using NMR (DQCOSY, TOCSY, NOESY, ¹ H- ¹³ C HSQC, ¹ H- ¹³ C HMBC, ¹ H- ³¹ P HMQC, ¹ H- ³ P HMQC-TOCSY), data not shown, led to the complete assignment of all signals and the structure presented (Figure 2A and 3) on the basis of signal position, coupling constants, NOE and HMBC correlations. However, due to the overlap of signals of H-2 and H-3 of residue A, it was not possible to determine its identity. This monosaccharide was linked to a phosphate, which followed from ¹ H- ³¹ P correlation spectrum. Dephosphorylation of the PS-II with 45% HF gave a pentasaccharide (OS-aq), representing the repeating unit of this polysaccharide. Residue A was present at the reducing end of the OS-aq in a- and β-configurations, where vicinal coupling constants corresponded to manno- configuration (data not shown). NMR data were in close agreement with that published by Ganeshapillai et al (2008) confirming that the structure of PS-II isolated from 630 and CM26 was identical to that previously reported for three other strains of C. difficile, 'Ganeshapillai et al, 2008). No evidence for a distinct rhamnose-containing polysaccharide (PS-I), identified in the study by Ganeshapillai et al 2008, was observed for C. difficile strains 630 and CM26 examined presently.

The proton NMR spectrum of the phenol-extracted LTA showed strong signals of fatty acids at 0.83 and 1.35 ppm. Fatty acid analysis of this mixture showed the presence of C14:0 (minor), C16:0, C16:1 , C18:0 and C18:1 acids. After O-deacylation to remove fatty acids, major anomeric signals (L, M) and minor signals (U, M\ L ^T , X, Y, Z) were observed in the ¹ H ^"13 C HSQC correlation spectrum (Figure 2B-1 ), which permitted complete NMR structural analysis using the same methods as outlined above. The novel LTA contained a repeating unit comprising two GlcpNAc residues (L-M) connected by an a(1-3) linkage and D-glyceric acid (GroA) as an aglycon. The repeating units were connected by a 6-6 phosphodiester bridge (6-P-6) between C-6 of residue L and C-6 of residue M. This portion of the structure was previously found in cell-envelope polysaccharide antigens of the Gram positive organism, Peptostreptococcus anaeorobius (Storz et al, 1990). The terminal unit L ^T , which is the non-reducing GlcpNAc(1-3) residue, with no phosphate at C-6 was also detected.

A minor component, GlcpN, labelled U was observed due to substitution of the N-acetyl group at C-2 for N. De-acetylation at C2 resulted in the high field shift of H-2 at 3.37 ppm (L') compared to 3.94 ppm for H-2 (L). Different chemical shifts were also observed for the anomeric and H-3 resonances of residues L and L'. The presence of GlcpN also affected the resonances of the other GlcpNAc residue in the repeat unit, labelled M' (Table 2). Based on integration of the proton anomeric resonances, it was determined that -30% of residues at position L in the LTA polymer were GlcpN. This was confirmed by N-acetylation, which led to disappearance of resonances for units L' and M' (Figure 2B-2). Dephosphorylation of LTA produced the disaccharide OS-I (Figures 2B-3, and 3) consistent with a 6-6 phosphodiester bridge joining the repeating units.

Table 3. NMR data for O-deacylated LTA. Proton and ¹³ C chemical shifts (ppm).

The structure of the component X-Y-Z and glycerol could also be deduced from the NMR data (Table 3). All resonances could be assigned with the exception of H/C-2 signals of glycerol, which were not identified due to low intensity and signal overlap. Residues X-Y- Z and glycerol were found to correspond to the structure -P-6)-p-Glcp-(1-6)-p-Glcp-(1-6)- p-Glcp-(1-1)-Gro. Glycerol was originally esterified with fatty acids and removed after O- deacylation. The terminal glucose is phosphorylated and is substituted by GlcpNAc of the repeating unit (L-M) through a 6-6 phosphodiester bridge. The oligosaccharide OS-II derived from dephosphorylation of LTA (Figures 2B-3) is also consistent with the structures shown in Figure 3. Integration of the major anomeric resonances for L, M and the minor ones for L ^T , X, Y, and Z (Figure 2B-2) indicated repeating units with a degree of polymerization less than 10. Analysis of HR-MAS spectra of strain CM-26 and comparison with the ¹ H spectrum of purified deacylated LTA allowed for the assignment of the LTA signals observed in Figure 1. The sequence of sugars within the LTA was confirmed by mass spectrometry. A Prince CE system (Prince Technologies, The Netherlands) was coupled to a 4000 Q-Trap mass spectrometer (Applied Biosystems/MDS Sciex, Canada). A sheath solution (isopropanol-methanol, 2:1 ) was delivered at a flow rate of 1.0 uL/min. Separations were obtained on about 90 cm length bare fused-silica capillary using 15 mM ammonium acetate in deionized water, pH 9.0. The 5 kV of electrospray ionization voltage was used for positive ion mode. Tandem mass spectra were obtained using enhance production ion scan mode (EPI) with a scan rate of 4000 Da/s, in which the precursor ions were generated with an orifice voltage of +380 V. Because of its large molecular mass, a high orifice voltage (+ 350 V) was used to promote in-source collision-induced dissociation to facilitate its analysis with CE-MS (Fig. 4).The results were in complete agreement with the proposed structure (Table4). The most abundant ion at m/z 574.8 corresponds to a single repeating unit (P,L,M,N). The ions correlated to a double repeating unit were detected at m/z 1 149.3. Table 4. CE-MS data and corresponding fragment compositions of the LTA from C. difficile. Monoisotopic mass units were used for calculation of m/z based on proposed composition as follows: Glc, 162.05; GlcNAc, 203.08; Gro, 88.08; P (phosphate), 79.97. L ^T , L and M represent GlcNAc. L' is for GlcN and N is for glyceric acid (GroA).

Ion ([IV +ΗΓ) Fragment composition

Observed Calculated

204.3 204.1 GlcNAc

284.1 284.1 P+GlcNAc

372.0 372.1 P+GlcNAc+ GroA (PMN)

433.2 433.1 P+2GlcNAc-3H ₂ 0 (PLM)

450.9 451.1 P+2GlcNAc-2H ₂ 0 (PLM)

468.9 469.1 P+2GlcNAc-H ₂ 0 (PLM)

534.0 534.2 P+GlcNAc+GroA+GIc (MNP-GIc)

539.1 539.4 P+2GlcNAc+GroA-2H ₂ 0 (PLMN)

556.8 557.4 P+2GlcNAc+GroA-H ₂ 0 (PLMN)

574.8 575.4 P+2GlcNAc+GroA (PLMN)

696.0 696.3 P+GlcNAc+GroA+2Glc (MNP-Glc-GIc)

723.9 724.3 P+3GlcNAc+GroA-3H ₂ 0 (L' MNPL)

777.9 778.3 P+3GlcNAc+GroA (L'MNPL)

858.0 858.2 2P+3GlcNAc+GroA (PLMNPL)

1007.1 1007.3 2P+4GlcNAc+GroA-3H ₂ 0 (LMPLMN)

1025.1 1025.3 2P+4GlcNAc+GroA-3H ₂ 0 (LMPLMN)

1043.1 1043.3 2P+4GlcNAc+GroA-H ₂ 0 (LMPLMN)

1107.3 1107.4 2P+3GlcNAc+GlcN+2GroA (LMPL'MN) 1149.3 1149.4 I 2P+4GlcNAc+2GroA (PLMN)

The sequence of sugars within theLTA was also corroborated by mass spectrometry (performed as described above). The presence of ions at m/z 534.0 and 696.0 indicated two glucose residues attached to MNP. In combination with evidence from the NMR experiment, it was thus concluded that the fatty acids and the core is linked through the glucose residues.

The product-ion spectra obtained from the second generation ions at m/z 858.0 and 696.0 are presented in Figure 5A and 5B, respectively. The series of fragments correspond to the proposed structure for the LTA (Figure 6). Observation of sequential loss of the residues Glc, N, Glc, P and GlcNAc (Fig. 5B) confirms again that two glucose residues are linked to the repeat unit. The assignments for other fragment ions are given in Table 4.

Example 5: Production of polyclonal antisera to bacterial cells.

In order to determine if the purified LTA was recognised as an immunogen in the context of the intact bacterial cell, polyclonal antisera to formalin killed whole cells of C. difficile strains 630 and R20291 was produced. For strain 630, a New Zealand white rabbit (1.5- 2kg) was immunised with 2 x 0.25ml subcutaneous injections containing 2x10 ⁹ bacterial cells mixed 1 :1 with incomplete Freunds adjuvant (IFA) and boosted three times (D28, 56 and D77) with an identical antigen preparation. For strain R20291 another New Zealand white rabbit (1.5-2kg) rabbit was immunised with 2 x 0.25ml subcutaneous injections containing 2 x10 ⁹ bacterial cells mixed 1 :1 in incomplete Freunds adjuvant (IFA) and boosted two times (D28, D56) with the identical antigen preparation.

Fig. 7 illustrates the ELISA determination of recognition of LTA and polysaccharide capsule (PS-II) with titration of post-immune rabbit sera following immunization with bacterial cells. ELISA values after 60 min at OD ₄₀₅ nm are detailed on the y-axis and dilutions are shown on the x-axis. Plates were coated with 1 ug of LTA or 1 ug of PS-II per well.

The polyclonal antisera raised to C. difficile 630 and R20291 cells revealed a good titer towards LTA (630 sera diluted 1 :800 gave an OD of 2.5; R20291 sera diluted 1 :800 gave an OD of 1.4) and a lower titer towards PS-II (630 (1 :100) OD = 0.7; R20291 (1 :100) OD = 0.4)

The polyclonal sera raised to the Cd 630 strain whole cells was then tested for its ability to recognise a variety of other C. difficile strains and other Clostridial species (Table 5). Table 5. ELISA determination of recognition of whole cells of C. difficile strains and other Clostridial species (as indicated) with post-immune CD630 rabbit polyclonal sera (D105). ELISA values after 60 min. at OD ₄₀ 5nm are detailed. Dilutions are shown in parentheses.

CM121 1.331

CM56 1.798

O6CD130 1.851

29975 1.997

M13876 1.573

M 16256 1.579

B1-1 1.621

052694 1.822

B1-7 1.616

M26195 1.999

M23257 1.296

M46846 1.483

LIV022 1.135

TL178 1.184

LIV024 1.252

TL 76 1.173

CD305 0.909

CF5 1.332 6510 1.249

TL174 1.290 68 0.910

M6317 1.056

M7465 1.108

M9349 1.001

M 13340 1.135

VPI 10463 1.618

D0724491 0.879

D0835450 1.202

955289 1.070

C. perfringens 0.286

C. sporogenes 0.241

C. barati 0.853

C. butyricum 1.361

C. subterminale 1.629

C. bifermentans 1.723

C. botuiinum type I A6 0.416

C. botuiinum type II E Russ 0.129

Example 6: Preparation of conjugates from purified LTA

(i) Human serum albumin (HSA) and maleimide (BMPH) linker The glycoconjugate to assess the immunogenic potential of the LTA was prepared as described below.

O-deacylation: Purified LTA (Example 3) was treated with 14% NH ₄ OH in 10% MeOH at 50°C for 3 h. The solution was rotary evaporated to dryness, re-dissolved in water, and gel-purified on a Sephadex G-25 column (Amersham), eluting with water. The product fraction was collected and lyophilised to prepare O-deacylated LTA (LTA-OH). The extent and specificity of O-deacylation was monitored by NMR (as described in Example 4), as evidenced by the loss of the signals for the CH ₂ residues at 0.5 to 1.5 ppm (Fig. 8A and B). Attachment of linker molecule: LTA-OH (4 mg/ml) was dissolved in 200 mM sodium phosphate at pH 7.5 and a 3x molar equivalent of N-succinimidyl-S-acetylthiopropionate (SATP, Pierce) dissolved in 100μΙ of DMSO (BDH Chemicals) was added. The reaction was left at 22°C for 2 h in the dark. The sample was then purified using a Sephadex G- 25 column, eluting with water and the product peak was lyophilised. The product was monitored by NMR as described in Example 4. NMR revealed the acquisition of a singlet at 2.4 ppm corresponding to the methyl protons of the acetate protecting group consistent with attachment of the linker molecule and the concomitant decrease in the anomeric resonance of the free amino sugar targeted by the linker (Fig. 8C).

Activation of protein carrier: In order to conjugate the protein carrier molecule HSA to the thiol-tagged LTA, it was necessary to modify the carboxyl groups on the HSA protein (15mg) by treatment with an 600x molar excess of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC, Pierce) and a 80 x molar excess of Ν-(β- maleimidopropionic acid) hydrazide trifluoroacetic acid salt (BMPH, Pierce) dissolved in 3ml of 100mM 2-(N-morpholino) ethanesulfonic acid (MES, Aldrich) at pH 5.2 at 4°C for 16 h. The sample was purified on a Sephadex G-25 column, eluting with 100mM sodium phosphate pH 6.8. The product peak was concentrated to approximately 0.5ml using an Amicon ultra-15 10 kDa MMCF spin column and stored at 4°C.

The activated protein was characterised by MALDI-TOF MS. Briefly, matrix-assisted laser desorption ionization- time of flight (MALDI-TOF) mass spectra were obtained using a Voyager DE-STR mass spectrometer (Applied BioSystems, Foster City, CA, U.S.A.). The instrument was operated in positive, linear ion mode under delayed extraction conditions (200 ns) using an accelerating voltage of 25 000 V. Each spectrum is the average of approximately 100 laser shots. The matrix used was 3,5-dimethoxy- 4hydroxy cinnamic acid (sinapinic acid), prepared at a concentration of 10 g/pl in 30 % acetonitrile and 0.1 % formic acid (v/v). These solutions were spotted directly on the MALDI target in a :3 ratio with matrix. MALDI-TOF of activated HSA showed that -25 carboxyl residues had been activated with BMPH as evidenced by a mass increase of -4.6 kDa (Fig. 9B) over inactivated HSA (Fig. 9A).

Conjugation reaction: The thiol protecting group of the carbohydrate (5 mg/ml) was removed using 100 mM hydroxylamine hydrochloride (JT Baker) in 100 mM sodium phosphate pH 6.8 at 22-24°C for 1.5 h under nitrogen. The sample was purified on a Sephadex G-25 column, eluting with 100mM sodium phosphate pH 6.8. The eluted product was collected directly into the maleimide-activated protein. The mixture was left to react at 22-24°C for 3 h in the dark under nitrogen while rocking. This mixture was then left for 16h at 4°C and concentrated to -1 ml as described above. The concentrate was washed and concentrated a further four times using Dulbecco's PBS (Gibco) containing 10 mM sodium citrate (Sigma). The final concentrate was stored at 4°C. The glycoconjugate was characterised by MALDI-TOF MS as described above. Results (Fig. 9C) suggested that -5 carbohydrate molecules had been attached per carrier protein, and revealed a mass increase of - 31.5 kDa overall that corresponds to 5 units of -6.5 kDa for each carbohydrate unit attached. This indicated that the LTA polymer attached to HSA was approximately 15 repeat units in length.

(ii) Human serum albumin (HSA) and bromoacetyl (BrAc) linker

A glycoconjugate to assess the immunogenic potential of the LTA was prepared wherein the carrier protein was human serum albumin (HSA) and the linker on the protein was based on bromoacetyl (BrAc). The LTA was activated as is or following O-deacylation and the linker was based on thiol (SATP).

O-deacylation and linker attachment: The purified LTA was O-deacylated as described above. Purified LTA and O-deacylated LTA had a SATP linker attached as described above. Activation of protein carrier: In order to conjugate the protein carrier molecule HSA to the thiol-tagged LTA or LTA-OH, it was necessary to modify the amino groups on the HSA protein (15mg) by dissolving it in 4ml of 100mM sodium phosphate at pH 8 and adding a 200X molar excess of bromoacetic acid N-hydroxysuccinimide ester (Sigma) in 200 μΙ of DMSO (BDH Chemicals). The reaction was left for 17hrs at 4 °C then purified, concentrating the sample 4X with 10ml of 100mM sodium phosphate at pH6.8 in an Amicon ultra-15 30 kDa MMCF spin column and stored at 4°C.

The activated protein was characterised by MALDI-TOF MS as described above. MALDI-TOF of activated HSA showed that -38 amino residues had been activated with bromoacetic acid N-hydroxysuccinimide ester.

Conjugation reaction: The thiol protecting group of the carbohydrates (5 mg/ml) were removed as described above and the conditions for the conjugation reaction were the same as described above. The glycoconjugate was characterised by MALDI-TOF MS as described above. Results (Fig. 10) suggested that 1 or 2 or more carbohydrate molecules from the LTA-OH had been attached per carrier protein, and revealed a mass increase of ~ 7.5 kDa for each carbohydrate unit attached. This indicated that the LTA polymer attached to HSA was approximately 15 repeat units in length. The MALDI-TOF MS analysis was not as definitive for the LTA conjugate but did indicate an increase in mass from the activated protein as a result of conjugation and this was corroborated by SDS-PAGE where the conjugate was recognised by polyclonal sera raised to whole C. difficile cells (Example 5). (iii) Exoprotein A (ExoA) and maleimide (BMPH) linker

The glycoconjugate to assess the immunogenic potential of the LTA was prepared wherein the carrier protein was Exoprotein A (ExoA) and the linker on the protein was based on maleimide (BMPH). The LTA was O-deacylated and was the linker was based on thiol (SATP). O-deacylation and linker attachment: The purified LTA was O-deacylated and a SATP linker attached as described above.

Activation of protein carrier: In order to conjugate the protein carrier molecule ExoA to the thiol-tagged LTA, it was necessary to modify the carboxyl groups on the ExoA protein (15mg) as described above for the HSA protein. The activated protein was characterised by MALDI-TOF MS as described above. MALDI-TOF of activated ExoA showed that -24 carboxyl residues had been activated with BMPH.

Conjugation reaction: The glycoconjugate was prepared as described above for the HSA-BMPH activated conjugation reaction and characterised by MALDI-TOF MS as described above. Results suggested that carbohydrate molecules had been attached per carrier protein and this was corroborated by SDS-PAGE where the conjugate migrated significantly less than the activated protein and was recognised by polyclonal sera raised to whole C. difficile cells (Example 5). Example 7: Immunisation an Analysis of Derived Sera

(i) Conjugate of Example 6(i)

In order to test the immunogenicity of the glycoconjugate, mice and rabbits were immunised with a prime and two booster doses of the glycoconjugate of Example 6 (i), which had been prepared from BMPH activated HSA and thiol activated de-O-acylated LTA.

Three New Zealand white rabbits (1.5 - 2 kg) were immunised subcutaneously with the glycoconjugate. Each rabbit received 50 pg of HSA-BMPH-SH-de-O-LTA conjugate (RCDV1-3) as 2 x 0.5ml per immunisation with incomplete Freunds adjuvant for the prime immunisation and boosts. The rabbits were boosted on days 28 and 56; sera were recovered following trial bleed on day 42 and terminal heart puncture on day 70. Two rabbits also received control immunisations, which consisted of the O-deacylated carbohydrate (50 pg per rabbit (RCDC4-5)) admixed with the same amount of protein (HSA) as in the glycoconjugate and appropriate adjuvant, with the same boosting and sera recovery schedule. Five Balb/C mice (6-8 weeks old) were also immunised intra-peritoneally with the HSA- BMPH-SH-de-O-LTA conjugate (MCDV1 -5): two with 10 and three with 5 pg of conjugated carbohydrate per immunisation with Sigma adjuvant for the prime immunisation and boosts. The mice were boosted on days 21 and 42; sera were recovered following trial bleed on day 35 and terminal heart puncture on day 56. Additionally, eight mice received control immunisations, which comprised two mice (MCDC 6-7) receiving O-deacylated carbohydrate (10 pg per mouse) admixed with the same amount of protein (HSA) as in the glycoconjugate, two mice (MCDC 10-11 ) receiving purified LTA (10 pg per mouse) admixed with the same amount of protein (HSA) as in the glycoconjugate, two mice (MCDC 8-9) receiving O-deacylated carbohydrate (10 pg per mouse) alone and two mice (MCDC 12-13) receiving native LTA (10 pg per mouse) alone, all with the same boosting and sera recovery schedule.

Whole cell ELISA was performed to determine whether sera recognized whole cells from various strains of C. difficile. Briefly, wells of Nunc Maxisorp EIA plates were coated with 100 μΙ of formalin-killed bacteria (optical density at 620 nm [OD620] of 0.080) in H ₂ 0 for 18 h in a 37°C drying oven and then brought to 22-24°C before use. Plates were blocked with 1 % bovine serum albumin (BSA)-PBS for 1 h at 22-24°C, wells were washed with PBS-0.05 % Tween 20 (PBS-T), and incubated with sera for 3 h at 22-24°C. Following washing with PBS-T, alkaline phosphatase-labeled goat anti-mouse IgG (or goat anti- rabbit Ig) (Cedarlane Laboratories) diluted 1 :1 ,000 (mice) 1 :3,000 (rabbits) in 1 % BSA- PBS was added for 1 h at 22-24°C. The plates were then washed and developed with Phosphatase Substrate System (Kirkegaard and Perry Laboratories). After 60 min OD was measured at A ₄₀ 5nm using a microtiter plate reader.

Rabbit sera were initially titrated against the homologous strain, C. difficile 630 which revealed good titers for sera from each conjugate immunised rabbit (Table 4). These conjugate sera were subsequently shown to be broadly cross reactive against all strains of C. difficile tested (Table 4) with end-point titers ranging from 1 :2000 to 1 :3000, compared to the two control rabbits that had end-point titers of 1 :200 to 1 :400, whereas sera from rabbits that received admixed de-O-acylated LTA with HSA (RCDC4-5) did not recognise the C. difficile strains. Three of the five mice that received the conjugate and intriguingly two of the control mice recognised whole cells from C. difficile strain 630. The two control mice (mice #'s 11 and 13) which gave an IgG response to C. difficile strain 630 whole cells were immunised with LTA admixed with HSA (#11) or LTA alone (#13). The positive mice sera, including mice #'s 11 & 13 were subsequently shown to be broadly cross reactive against all strains of C. difficile that were tested (Table 6). The reactivity of the rabbit sera was also tested against a number of other Clostridial species (Table 6) and the conjugate sera (RCDV1-3) was shown to display strong cross reactivity against C. butyricum C. subterminales, and C. bifermentans but only limited or no reactivity with C. perfringens, C. sporogenes, C. barati and C. botulinum type I and type II strains. Similarly to the testing of the C. difficile strains, sera from rabbits that received admixed de-O-acylated LTA with HSA (RCDC4-5) did not recognise the other Clostridial species

Table 6. ELISA determination of recognition of whole cells from C. difficile strains and other Clostridial species (as indicated) with post-immune rabbit sera (D70) and post- immune mice sera (D56) following immunisations with glycoconjugate. ELISA values after 60 min. at OD ₀ 5nm are detailed. Cells were killed with formalin, washed with water and resuspended at the same OD prior to plating. Dilutions are shown in parentheses.

B1-14 0.862 1.308 0.902 0.276 0.328

B1-11 1.038 1.496 1.090 0.297 0.342

B1-9 1.210 1.867 1.309 0.341 0.388

B1 -6 0.777 0.982 0.670 0.187 0.212

CM121 0.429 0.848 0.418 0.229 0.216

CM56 0.584 1.076 0.663 0.234 0.246

O6CD130 0.848 0.357 0.988 0.310 0.269

29975 0.629 0.238 0.770 0.242 0.231

M 13876 0.616 0.985 0.788 0.203 0.217

M16256 0.755 1.017 0.755 0.166 0.185

B1 -1 0.688 1.157 0.857 0.265 0.281

052694 0.827 1.164 0.873 0.220 0.223

B1 -7 0.707 1.222 0.845 0.168 0.219

M26195 0.682 1.217 0.895 0.265 0.255

M23257 0.645 0.939 0.577 0.190 0.246

M46846 0.582 0.898 0.81 1 0.202 0.178

LIV022 0.298 0.548 0.352 0.135 0.186

TL178 0.415 0.633 0.502 0.124 0.158

LIV024 0.601 0.765 0.744 0.166 0.201

TL176 0.512 0.643 0.493 0.127 0.141 CD305 0.218 0.395 0.347 0.132 0.173

CF5 0.661 1.008 0.772 0.182 0.187

M6510 0.420 0.588 0.445 0.101 0.154

TL174 0.353 0.576 0.442 0.105 0.149

M68 0.252 0.479 0.329 0.069 0.078

M6317 0.344 0.648 0.416 0.075 0.084

M7465 0.448 0.711 0.529 0.102 0.121

M9349 0.365 0.626 0.488 0.083 0.102

M 13340 0.539 0.749 0.518 0.095 0.099

VPI 10463 0.779 1.173 0.698 0.127 0.145

D0724491 0.318 0.330 0.169 0.191 0.509

D0835450 0.446 0.692 0.424 0.139 0.674

955289 0.366 0.556 0.304 0.123 0.463

C. perfringens 0.255 0.703 0.233 0.196 0.224

C. sporogenes 0.180 0.1 16 0.146 0.140 0.162

C. barati 0.292 0.318 0.256 0.146 0.252

C. butyricum 0.606 0.898 0.586 0.124 0.183

C. subterminale 0.779 1.261 0.827 0.189 0.197

C. bifermentans 0.791 1.154 0.749 0.141 0.209

C. botulinum I A6 0.166 0.213 0.174 0.132 0.261 C. botulinum II E 0.076 0.057 0.047 0.083 0.087

Russ

(ii) Conjugate of Example 6(ii)

In order to test the immunogenicity of the glycoconjugate, mice and rabbits were immunised with a prime and two booster amounts of the glycoconjugate of Example 6 (ii) which had been prepared from BrAc activated HSA and thiol activated LTA and thiol activated de-O-acylated LTA.

Six New Zealand white rabbits (1.5 - 2 kg) were immunised subcutaneously with the glycoconjugates. Three rabbits received 50 pg of HSA-BrAc-SH-LTA conjugate (RCLV1- 3) and three rabbits received 50 pg of HSA-BrAc-SH-de-O-LTA conjugate (RCOV1 -3) as 2 x 0.5ml per immunisation with incomplete Freunds adjuvant for the prime immunisation and boosts. The rabbits were boosted on days 28 and 56; sera were recovered following trial bleed on day 42 and terminal heart puncture on day 70. Four rabbits also received control immunisations, which consisted of the LTA (2 rabbits RCLC4-5) or the O- deacylated LTA (2 rabbits RCOC4-5) (50 pg per rabbit) admixed with the same amount of protein (HSA) as in the glycoconjugate and appropriate adjuvant, with the same boosting and sera recovery schedule.

Ten Balb/C mice (6-8 weeks old) were also immunised intra-peritoneally with the glycoconjugates. Five mice received the HSA-BrAc-SH-LTA conjugate (MCLV 1-5) with 5 pg of conjugated carbohydrate per immunisation and five mice received the HSA- BrAc-SH-de-O-LTA conjugate (MCOV 1-5) with 5 pg of conjugated carbohydrate per immunisation with Sigma adjuvant for the prime immunisation and boosts. The mice were boosted on days 21 and 42; sera were recovered following trial bleed on day 35 and terminal heart puncture on day 56. Additionally, six mice received control immunisations, which comprised three mice receiving O-deacylated LTA (5 pg per mouse (MCOV6-8)) admixed with the same amount of protein (HSA) as in the glycoconjugate and three mice receiving the native LTA (5 pg per mouse (MCLV6-8)) admixed with the same amount of protein (HSA) as in the glycoconjugate, all with the same boosting and sera recovery schedule.

Whole cell ELISA was performed to determine whether sera recognized whole cells from various strains of C. difficile as described above.

Rabbit sera were initially titrated against the homologous strain, C. difficile 630, which revealed good titers for sera from each LTA conjugate immunised rabbit (RCLV1-3) and generally weaker titers for the de-0 LTA conjugate immunised rabbits (RCOV1-3). Intriguingly the control rabbits that received LTA admixed with HSA (RCLC4-5) also recognised the C. difficile 630 whole cells. The sera that were generated to LTA containing immunogens, either conjugated or free LTA, were subsequently shown to be broadly cross reactive against all strains of C. difficile tested (Table 7). Generally speaking the de-O-LTA conjugate derived sera (RCOV1-3) and the de-O-LTA admixed with HSA derived sera (RCOC4-5) recognised the majority of the C. difficile cells at lower titers than the LTA immunogen derived sera.

The reactivity of the rabbit sera was also tested against a number of other Clostridial species (Table 7). Serum from rabbits immunised with either LTA conjugate (RCLC1-3) or LTA admixed with HSA (RCLC4-5) all generated antibodies which reacted against C. butyricum C. subterminales and C. bifermentans but not with C. perfringens, C. sporogenes C. barati and C. botulinum type I and type II strains.

Table 7. ELISA determination of recognition of whole cells from C. difficile strains and other Clostridial species (as indicated) with post-immune rabbit sera (D70) following immunisations with glycoconjugate. ELISA values after 60 min. at OD ₄₀₅ nm are detailed. Dilutions are shown in parentheses.

CM56 0.406 1.363 0.319 0.909 0.311

O6CD130 0.657 1.708 0.486 0.743 0.265

29975 0.633 1.580 0.840 0.737 0.286

M 13876 0.454 1.31 1 0.270 0.865 0.308

M 16256 0.468 1.291 0.315 0.895 0.342

B1-1 0.592 1.601 0.317 0.908 0.297

052694 0.397 1.429 0.284 0.878 0.318

B1-7 0.497 1.450 0.341 0.764 0.295

M26195 0.437 1.633 0.340 0.867 0.302

M23257 0.439 1.112 0.272 0.618 0.274

M46846 0.425 1.036 0.687 0.444 0.212

LIV022 0.310 0.989 0.247 0.460 0.161

TL178 0.336 0.895 0.230 0.363 0.137

LIV024 0.438 1.013 0.234 0.466 0.193

TL176 0.289 0.850 0.508 0.384 0.159

CD305 0.893 0.180 0.227 0.603 0.207

CF5 1.244 0.403 0.417 0.670 0.206

M6510 1.032 0.307 0.683 0.600 0.222

TL174 0.960 0.146 0.318 0.679 0.305

M68 0.222 0.717 0.303 0.363 0.136 M6317 0.254 1.004 0.203 0.322 0.137

M7465 0.335 1.003 0.250 0.326 0.146

M9349 0.249 0.948 0.170 0.287 0.108

M 13340 0.263 1.048 0.21 1 0.289 0.125

VPI 10463 0.419 1.442 0.287 0.744 0.242

D0724491 0.232 0.578 0.267 0.659 0.276

D0835450 0.305 1.135 0.280 0.674 0.270

955289 0.240 0.799 0.224 0.654 0.249

C. perfringens 0.268 0.392 0.268 0.824 0.341

C. sporogenes 0.166 0.314 0.195 0.873 0.324

C. barati 0.349 0.438 0.293 0.760 0.479

C. butyricum 0.319 1.212 0.292 0.639 0.285

C. subterminale 0.447 1.548 0.288 0.777 0.292

C. bifermentans 0.484 1.497 0.358 0.692 0.272

C. botulinum A6 0.342 0.410 0.212 0.742 0.301

C. botulinum II E 0.064 0.121 0.112 0.490 0.143 Russ

Cd630 1.263 2.577 2.376 1.348 2.649

QCD 0.303 0.866 0.817 0.495 0.769

R20291 0.202 0.638 0.532 0.360 0.704

M120 0.092 0.465 0.550 0.330 0.501

CM26 0.389 0.885 0.826 0.662 0.954

106-01 0.235 1.031 0.794 0.464 1.166

Cd196 0.491 2.067 1.627 0.803 2.176

001-01 0.539 2.202 1.844 1.088 2.409

Cd20 0.611 2.251 1.855 1.145 2.409

B1 -14 0.610 1.349 1.181 0.830 1.253

B1-11 0.776 1.821 1.620 0.997 1.629

B1-9 0.336 0.800 0.775 0.636 1.132

B1-6 0.552 1.185 1.044 0.763 1.415

CM121 0.280 0.676 0.986 0.500 0.779

CM56 0.471 1.314 1.254 0.843 1.487

O6CD130 0.528 1.336 1.203 0.923 1.235

29975 0.839 1.519 1.444 0.866 1.328

M 13876 0.463 1.226 1.255 0.738 0.969

M 16256 0.449 1.107 1.150 0.678 1.242

B1 -1 0.388 1.205 1.231 0.753 1.075 052694 0.479 1.320 1.152 0.864 1.343

B1-7 0.484 1.012 0.947 0.768 1.014

M26195 0.401 1.480 1.378 0.831 1.586

M23257 0.479 1.015 0.876 0.582 1.142

M46846 0.735 1.174 1.108 0.590 0.936

LIV022 0.171 0.755 0.704 0.298 0.697

TL178 0.257 0.936 0.760 0.364 0.857

LIV024 0.340 0.981 0.901 0.606 1.012

TL176 0.302 1.004 0.925 0.490 0.841

CD305 0.136 0.573 0.449 0.239 0.503

CF5 0.616 1.000 0.923 0.609 1.073

M6510 0.512 1.014 1.005 0.492 0.937

TL174 0.308 0.872 0.658 0.461 0.912

M68 0.131 0.408 0.405 0.249 0.489

M6317 0.191 0.758 0.637 0.337 0.702

M7465 0.290 0.721 0.686 0.485 0.851

M9349 0.164 0.674 0.595 0.363 0.766

M 13340 0.285 0.763 0.729 0.505 0.833

VPI 10463 0.387 1.256 1.150 0.696 1.144

D0724491 0.200 0.422 0.427 0.258 0.557 D0835450 0.228 0.889 0.884 0.398 0.834

955289 0.168 0.655 0.595 0.276 0.693

C. perfringens 0.503 0.328 0.507 0.541 0.365

C. sporogenes 0.163 0.313 0.300 0.247 0.310

C. barati 0.237 0.261 0.218 0.337 0.530

C. butyricum 0.331 1.101 0.971 0.584 1.025

C. subterminale 0.473 1.268 1.132 0.833 1.264

C. bifermentans 0.432 1.235 1.075 0.756 1.318

C. botulinum A6 0.120 0.374 0.209 0.237 0.506

C. botulinum E 0.057 0.1 11 0.088 0.097 0.155 Russ

(iii) Conjugate of Example 6(iii)

In order to test the immunogenicity of the glycoconjugate, mice and rabbits were immunised with a prime and two booster amounts of the glycoconjugate of Example 6 (iii) which had been prepared from BMPH activated ExoA and thiol activated de-O- acylated LTA.

Three New Zealand white rabbits (1.5 - 2 kg) were immunised subcutaneously with the glycoconjugates receiving 25 μg of ExoA-BMPH-SH-de-O-LTA conjugate (RCXV 1 -3) as 2 x 0.5ml per immunisation with incomplete Freunds adjuvant for the prime immunisation and boosts. The rabbits were boosted on days 28 and 56; sera were recovered following trial bleed on day 42 and terminal heart puncture on day 70. Two rabbits also received control immunisations, which consisted of the O-deacylated LTA (50 pg per rabbit (RCXC 4-5)) admixed with the same amount of protein (ExoA) as in the glycoconjugate and appropriate adjuvant, with the same boosting and sera recovery schedule. Five Balb/C mice (6-8 weeks old) were also immunised intra-peritoneally with the glycoconjugates (MCXV 1 -5) receiving the ExoA-BMPH-SH-de-O-LTA conjugate with 5 \sg of conjugated carbohydrate per immunisation with Sigma adjuvant or the prime immunisation and boosts. The mice were boosted on days 21 and 42; sera were recovered following trial bleed on day 35 and terminal heart puncture on day 56. Additionally, three mice received control immunisations, which comprised of receiving O- deacylated LTA (5 pg per mouse (MCXC 6-8)) admixed with the same amount of protein (ExoA) as in the glycoconjugate, all with the same boosting and sera recovery schedule.

Whole cell ELISA was performed to determine whether sera recognized whole cells from various strains of C. difficile as described above.

Rabbit sera were initially titrated against the homologous strain, C. difficile 630 which revealed good titers for sera from each conjugate immunised rabbit (RCXV1 -3) (Table 8). These sera were subsequently shown to be broadly cross reactive against all strains of C. difficile tested (Table 8) compared to the two control rabbits (RCXC4-5) which only received the de-O-acylated LTA admixed with ExoA.

All of the five mice that received the conjugate (MCXV1 -5) and none of the control mice (MCXC6-8) recognised whole cells from C. difficile strain 630. The positive mice sera were subsequently shown to be broadly cross reactive against all strains of C. difficile that were tested (Table 8). The reactivity of the rabbit sera was also tested against a number of other Clostridial species (Table 8) and only the LTA conjugate antisera (RCXV1 -3) was shown to display strong cross reactivity against C. butyricum, C. subterminales and C. bifermentans. No reactivity was observed with C. perfringens, C. sporogenes C. barati and C. botulinum type I and type II strains with the conjugate serum. Control sera from rabbits which received the de-O-acylated LTA admixed with ExoA (RCXC 4-5) did not exhibit any cross reactivity with other Clostridial species.

Table 8. ELISA determination of recognition of whole cells from C. difficile strains and other Clostridial species (as indicated) with post-immune rabbit sera (D70) and post- immune mice sera (D56) following immunisations with glycoconjugate. ELISA values after 60 min. at OD ₄₀ 5nm are detailed. Dilutions are shown in parentheses. C. difficile Conjugate Rabbit Sera (1 :200) Strain RCXV1 RCXV2 RCXV3 RCXC4 RCXC5

Cd630 0.997 1.008 0.877 0.106 0.229

QCD 1.265 1.194 1.009 0.075 0.152

R20291 1.353 1.319 1.109 0.061 0.132

M120 1.041 1.034 0.878 0.056 0.127

CM26 1.435 1.234 1.015 0.069 0.145

106-01 1.350 1.303 1.148 0.063 0.152

Cd196 1.694 1.507 1.469 0.159 0.819

001-01 1.540 1.456 1.454 0.122 0.661

Cd20 1.803 1.659 1.463 0.192 0.754

B1-14 1.508 1.432 1.208 0.115 0.151

B1-11 1.668 1.552 1.330 0.140 0.209

B1 -9 1.586 1.369 1.261 0.132 0.162

B1-6 1.813 1.682 1.646 0.130 0.177

CM121 1.138 1.158 0.980 0.040 0.122

CM56 1.569 1.449 1.322 0.125 0.240

O6CD130 1.442 1.392 1.365 0.083 0.291

29975 1.687 1.526 1.494 0.156 0.308

M 13876 1.423 1.339 1.275 0.121 0.119 M16256 1.417 1.375 1.330 0.120 0.120

B1 -1 1.742 1.628 1.563 0.118 0.158

052694 1.582 1.593 1.462 0.140 0.187

B1 -7 1.726 1.646 1.614 0.122 0.578

M26195 1.542 1.460 1.361 0.223 0.128

M23257 1.592 1.618 1.693 0.176 0.702

M46846 1.779 1.591 1.437 0.163 0.601

LIV022 1.495 1.468 1.298 0.178 0.122

TL178 1.372 1.232 1.1 16 0.055 0.050

LIV024 1.760 1.431 1.393 0.101 0.161

TL176 1 .551 1.342 1.218 0.117 0.079

CD305 0.679 0.711 0.626 0.025 0.040

CF5 1.620 1.481 1.326 0.084 0.124

M6510 1.327 1.084 1.024 0.072 0.110

TL174 1.330 1.193 1.000 0.040 0.039

M68 1.044 1.045 0.870 0.057 0.144 6317 1.283 1.290 1.023 0.062 0.070

M7465 1.456 1.200 1.125 0.088 0.086

M9349 1.352 1.245 1.148 0.074 0.068

M 13340 1.443 1.359 1.160 0.098 0.169 VPI 10463 2.043 1.734 1.358 0.116 0.134

D0724491 0.917 0.949 0.813 0.153 0.153

D0835450 1.375 1.232 1.081 0.135 0.104

955289 1.214 1.215 1.064 0.178 0.097

C. perfringens 0.216 0.957 0.307 0.157 0.171

C. sporogenes 0.137 0.153 0.202 0.128 0.149

C. barati 0.230 0.272 0.411 0.178 0.176

C. butyricum 1.818 1.672 1.549 0.104 0.129

C. subterminale 1.884 1.697 1.458 0.131 0.134

C. bifermentans 1 .674 1.466 1.309 0.129 0.140

C. botulinum A6 0.138 0.191 0.290 0.111 0.152

C. botulinum E 0.053 0.064 0.096 0.045 0.047 Russ

M120 0.182 0.638 0.703 0.356 0.283 0.025 0.040 0.064

CM26 0.418 1.296 1.013 0.665 0.638 0.026 0.070 0.122

Example 8: Immunofluorescence at bacterial cell surface.

In order to determine if antibodies in immune serum could access LTA epitopes on bacterial cell surface, immunofluorescence on live C. difficile vegetative cells was performed.

C. difficile was cultured to mid-log phase in BHI broth without shaking in a Mini acs anaerobic chamber at 37°C. The cells were centrifuged to remove the broth, re- suspended in PBS, then 10 μΙ was air dried onto glass coverslips. The bacteria were heat fixed to the coverslip by passing though a bunsen flame 5-6 times, then were blocked with 5% milk-PBS for 30 minutes at room temperature. The cells were incubated for 45 minutes at room temperature in 50 μΙ of either the pre- or post-immune anti-LTA serum at a dilution of 1 :100 in PBS. The coverslips were washed with PBS then incubated for 45 minutes at room temperature with 50 μΙ goat anti-rabbit IgG Alexafluor 488 FITC antibody (Invitrogen, Eugene, Oregon, USA) at a 1 :1000 dilution. The coverslips were washed with PBS, mounted with Vectashield-DAPI (Vector Laboratories, Burlington, Canada) then examined with a Zeiss microscope (Axiovert 200M).

Results of immunofluorescence experiments using pre or post immune serum from rabbits RCDV2, RCLV2 and RCXV2 with live whole cells of C. difficile are shown in Table 9. The accessibility to the cell surface and cross reactivity to vegetative cells of strains 630, R20291 and QCD32g58 is demonstrated by the binding activity of the post immune serum. No fluorescence was observed with any of the strains when pre-immune serum was used. This illustrates that the derived sera is specifically recognising a conserved accessible epitope on the surface of live C. difficile vegetative cells.

Table 9. Cell surface reactivity of LTA conjugate sera by immunofluorescence imaging C. difficile RCDV2 RCLV2 RCXV2 strain

Pre Post Pre immune Post Pre immune Post

(cell type) immune immune immune immune

630 + + +

(vegetative)

QCD32g58 + + + (vegetative)

R20291 + + + (vegetative)

630 (spore) - + ND ND +

R20291 + ND ND + (spore)

*ND not determined, - cells no reactivity, + cells reactive.

Example 9 Immunofluorescence of C. difficile spores

In order to determine if antibodies in immune serum would react with C. difficile spore surface, immunofluorescence on C. difficile spores was performed as described in Example 8.

C. difficile was cultured on BHI agar plates in a MiniMacs anaerobic chamber at 37°C for 7 days to allow spore formation. Spores were purifiedby heat inactivating any vegetative cells for 20 minutes at 60°C then by multiple washes in ice cold H ₂ 0. Once purified, 10 μΙ of spores was air dried onto glass coverslips. The bacterial spore preparation was heat fixed to the coverslip by passing though a bunsen flame 5-6 times, then were blocked with 5% milk-PBS for 30 minutes at room temperature. The cells were incubated for 45 minutes at room temperature in 50 μΙ of either the pre- or post-immune anti-LTA serum at a dilution of 1 :100 in PBS. The coverslips were washed with PBS then incubated for 45 minutes at room temperature with 50 μΙ goat anti-rabbit IgG Alexafluor 488 FITC antibody (Invitrogen, Eugene, Oregon, USA) at a 1 :1000 dilution. The coverslips were washed with PBS, mounted with Vectashield-DAPI (Vector Laboratories, Burlington, Canada) then examined with a Zeiss microscope (Axiovert 200M). Results are shown in Table 9. Spores are shown to bind with the RCDV2 and RCXV2 immune sera. No binding was observed when pre-immune serum was used. This may allow the use of immune LTA sera as a means to identify spores of C. difficile.

Example 10 Opsonophagocytic activity against C. difficile cells

In order to determine if antibodies in immune serum had opsonizing activity and facilitated uptake by phagocytic cells, opsonophagocytic assays were performed with a THP-1 monocyte cell line.

THP-1 cell culture conditions

THP-1 monocyte cells were grown in RPMI-1640 with 2mM L-glutamine, 10% FBS and gentamicin. Cells are propagated at a density between 1x10 ⁵ cells/ml and 1 x10 ⁶ cells/ml, with media changes every 3-4 days. For differentiation, cells are suspended in media at a density of 5x10 ⁵ cells/ml, containing 200nM Phorbol myristate acetate (PMA). For experiments in a 24-well plate, 0.5ml of cell suspension is added per well, for a total of 2.5x10 ⁵ cells/well. THP-1 cells are allowed to differentiate for 24 hours, at which time the PMA containing media is removed and replaced with fresh RPMI-1640 + 10% FBS and allowed to rest for a further 24 hours before use in the opsonophagocytosis assay.

Bacterial opsonisation

C. difficile 630 cells were grown in BHI supplemented broth to an OD ₆₀₀ of 1.0. Bacteria (5ml) were harvested by centrifugation and washed with 5ml PBS and resuspended to cell concentration of 1x10 ⁸ cells/ml. For opsonization, 0.5 ml of cell suspension was mixed with 500ul serum (heat inactivated) at appropriate dilution in PBS (1 :10 or 1 :100) and incubated in anaerobic chamber for 30 min. This suspension was either used directly in opsonophagocytosis assay or the opsonised bacteria were collected by centrifugation and resuspended in PBS and then used in the assay. Serum used - CD1 , unrelated antisera, RCXV2.

Opsonophagocytic assay

To determine opsonophagocytic activity, THP-1 cells at concentration of 2.5 x 10 ⁵ cells/well (24 well tissue culture plate) were washed with 3 x1 ml PBS to remove undifferentiated cells and then THP-1 cells were incubated with opsonised bacterial suspension for 30min at 37°C under aerobic conditions. The THP monolayer was then washed 3 x 1 ml PBS. THP cells were lysed by addition of 1 ml of cold dH ₂ 0 and mixing by pipetting. Serial dilutions of each well were prepared in PBS and samples plated on Braziers agar and incubated 24h in anaerobic chamber and bacterial colonies counted to determine the opsonizing activity of each serum.

Table 10. Opsonising activity of C. difficile 630 (CD1 ) whole cell rabbit polyclonal antisera

Fluorescence imaging of bacteria captured by opsonophagocytosis. THP monocytes were cultured on coverslips in 24 well plates. After completion of the opsonophagocytic assay as described above the wells were washed three times with 1 ml PBS then were fixed with 3% formalin at 4°C overnight. Then each well was washed with PBS, and the coverslips removed and incubated at room temperature with 1 :100 dilution of rabbit polyclonal antiserum to C. difficile 630 cells in PBS for 45 minutes. The coverslips were washed with PBS then incubated with 1 :1000 dilution of Alexafluor 488 anti rabbit IgG (Invitrogen) in PBS at room temperature for 45 minutes. The coverslips were washed in PBS then permeabilised with 0.1% Triton in PBS for 15 minutes at room temperature followed by washing in PBS and incubation in a 1 :100 dilution of rabbit polyclonal antiserum to C. difficile 630 cells at room temperature for 45 minutes. After washing in PBS, the coverslips were incubated in a 1 :800 dilution of Alexafluor 594 anti rabbit IgG (Invitrogen) in PBS for 45 minutes at room temperature then washed in PBS and mounted onto slides with Vectashield + DAPI (Vector Laboratories) and examined with Axiovert 200M (Zeiss) microscope. Internalised and surface bound bacteria were identified by differential staining (red internalised, green surface associated). Higher numbers of bacteria were shown by immunofluorescence to associate with and be internalised by THP monocytes when CD1 antiserum was used (1 :100) when compared to the unrelated antiserum control.

The embodiments and examples described herein are illustrative and are not meant to limit the scope of the invention as claimed. Variations of the foregoing embodiments, including alternatives, modifications and equivalents, are intended by the inventors to be encompassed by the claims. Furthermore, the discussed combination of features might not be necessary for the inventive solution.