IE20020097A1 - A vaccine - Google Patents

Abstract

A vaccine for the treatment of prophylaxis of C. difficile associated disease comprises a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment of mutant or variant thereof which is immunogenic in humans. The gene encodes a C. difficile surface layer protein, SlpA or variant or homologue thereof. The peptide/polypeptide is a C. difficile surface layer protein, SlpA or variant or homologue thereof. The vaccine may comprise a chimeric nucleic acid sequence.

Description

The invention relates to vaccines to provide immunological protection against C. difficile infection.

Background Clostridium difficile is a common nosocomial pathogen and a major cause of morbidity and mortality among hospitalised patients throughout the world [Kelly et al., 1994]. Outbreaks of C. difficile have necessitated ward and partial hospital closure. With the increasing elderly population and the changing demographics of the population, C. difficile is set to become a major problem in the 21st century. The spectrum of C. difficile diseases range from asymptomatic carriage to mild diarrhoea to fulminant pseudomembranous colitis. Host factors rather than bacterial factors appear to determine the response to C. difficile [Cheng et al., 1997; McFarland et al., 1991; Shim et al., 1998].

Reports indicate that hypogammaglobulinaemia in children appears to predispose to the development of disease due to C. difficile and that therapy with intravenously administered gamma globulin can be associated with the clinical resolution of chronic relapsing colitis due to C. difficile disease [Leung et al., 1991; Pelmutter et al., 1985]. A study by Mulligan et al. [1993] found elevated levels of immunoglobulins reactive with C. difficile in asymptomatic carriers as opposed to symptomatic patients. Recently it has been shown that patients who became colonised with C. difficile who had relatively low levels of serum IgG antibody against toxin A had a much greater risk of developing C. difficile diarrhoea [Kyne et al., 2000].

It is clear that any advance in the understanding of C. difficile disease and methods of preventing or treating C. difficile diarrhoea (CDD) and other related diseases will OPEN TO PUBLIC INSPECTION UNDER SECTION 28 AND RULE 23 JNL No. ...........5| be of major therapeutic potential.

TRI002/C Statements of Invention According to the invention there is provided a vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans.

The invention also provides a vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising a C. difficile gene or C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof to which immunoreactivity is detected in individuals who have recovered from C. difficile infection.

Preferably the gene encodes a C. difficile surface layer protein, SlpA or variant or homologue thereof.

Preferably the peptide/polypeptide is a C. difficile surface layer protein, SlpA or variant or homologue thereof.

Most preferably the vaccine comprises a chimeric nucleic acid sequence. Preferably the chimeric nucleic acid sequence is derived from the 5' end of the gene, encoding the mature N-terminal moiety of SlpA from C. difficile.

In one embodiment of the invention the vaccine comprises a chimeric peptide/polypeptide. Preferably the amino acid sequence of the chimeric peptide/polypeptide is derived from the mature N-terminal moiety of SlpA from C. difficile.

Preferably the vaccine of the invention contains an amino acid sequence SEQ ID No.l or a derivative or fragment or mutant or variant thereof.

IE Ο 2 Ο Ο 9 7 TRI002/C Preferably the vaccine contains an amino acid sequence SEQ ID No.2 or a derivative or fragment or mutant or variant thereof.

In one embodiment of the invention the vaccine contains a nucleotide sequence SEQ 5 ID No.3 or a derivative or fragment or mutant or variant thereof; a nucleotide sequence SEQ ID No.4 or a derivative or fragment or mutant or variant thereof; a nucleotide sequence SEQ ID No.5 or a derivative or fragment or mutant or variant thereof; a nucleotide sequence SEQ ID No.6 or a derivative or fragment or mutant or variant thereof; a nucleotide sequence SEQ ID No.7 or a derivative or fragment or mutant or variant thereof; a nucleotide sequence SEQ ID No.8 or a derivative or fragment or mutant or variant thereof; a nucleotide sequence SEQ ID No.9 or a derivative or fragment or mutant or variant thereof or a nucleotide sequence SEQ ID No. 10 or a derivative or fragment or mutant or variant thereof.

Preferably the vaccine of the invention is in combination with at least one other C. difficile sub-unit.

The invention provides a vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising the mature N-terminal moiety of a surface layer protein, SlpA of C. difficile or variant or homologue thereof which is immunogenic in humans.

Most preferably the N-terminal moiety of SlpA contains an amino acid sequence SEQ ID No. 1.

In one embodiment of the invention the N-terminal moiety of SlpA contains an amino acid sequence SEQ ID No. 2.

The invention also provides a vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising an immunodominant epitope derived TRI002/C from a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans.

Preferably the vaccine of the invention comprises a pharmaceutically acceptable 5 carrier. Most preferably the vaccine is in combination with a pharmacologically suitable adjuvant. Ideally the adjuvant is interleukin 12. Altemativley the adjuvant may be a heat shock protein.

In one embodiment of the invention the vaccine comprises at least one other pharmaceutical product.

The pharmaceutical product may be an antibiotic, selected from one or more metronidazole, amoxycillin, tetracycline or erythromycin, clarithromycin or tinidazole.

In one embodiment of the invention the pharmaceutical product comprises an acidsuppressing agent such as omeprazole or bismuth salts.

The vaccine of the invention may be in a form for oral administration, intranasal administration, intravenous administration or intramuscular administration.

In one embodiment of the invention the vaccine includes a peptide delivery system.

The invention also provides an immunodominant epitope derived from a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof. Preferably the C. difficile peptide/polypeptide contains an amino acid sequence SEQ ID No.l or SEQ ID No.2 or a derivative or fragment or mutant or variant thereof.

In one embodiment of the invention the C. difficile peptide/polypeptide contains an amino acid sequence SEQ ID No.3 or SEQ ID No.4 or SEQ ID No.5 or SEQ ID No.6 or SEQ ID No.7 or SEQ ID No.8 or SEQ ID No. 9 or SEQ ID No. 10 or a derivative or fragment or mutant or variant thereof.

IE Ο 2 Ο Ο 9 7 TRI002/C The invention further provides a chimeric nucleic acid sequence derived from the 5' end of the sip A gene encoding the mature N-terminal moiety of SlpA from C. difficile which is immunogenic in humans.

The invention also provides a chimeric peptide/polypeptide wherein the amino acid sequence of the chimeric peptide/polypeptide is derived from the mature N-terminal moiety of SlpA from C. difficile.

The invention provides a C. difficile peptide comprising SEQ ID No. 1 or SEQ ID No. 2 or SEQ ID No. 3 or SEQ ID No. 4 or SEQ ID No. 5 or SEQ ID No. 6 or SEQ ID No. 7 or SEQ ID No. 8 or SEQ ID No. 9 or SEQ ID No. 10.

One aspect of the invention provides for the use of a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans in the preparation of a medicament for use in a method for the treatment or prophylaxis of C. difficile infection or C. difficile associated disease in a host.

Preferably the medicament which is prepared is a vaccine of the invention.

The invention also provides a method for preparing a vaccine for prophylaxis or treatment of C. difficile associated disease, the method comprising; obtaining a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans; and forming a vaccine preparation comprised of said gene or peptide/polypeptide or derivative or fragment or mutant or variant, which is suitable for administration to a host and which when administered raises an immune response.

TRI002/C Preferably the C. difficile peptide/polypeptide contains an amino acid sequence SEQ ID No.l or SEQ ID No.2 or a derivative or fragment or mutant or variant thereof.

Most preferably the C. difficile gene contains an amino acid sequence SEQ ID No.3 5 or SEQ ID No.4 or SEQ ID No.5 or SEQ ID No.6 or SEQ ID No.7 or SEQ ID No.8 or SEQ ID No.9 or SEQ ID No. 10 or a derivative or fragment or mutant or variant thereof.

The invention further provides a method for prophylaxis or treatment of C. difficile associated disease, the method comprising; obtaining a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans; forming a vaccine preparation comprised of said gene or peptide/polypeptide or derivative or fragment or mutant or variant, and administering the vaccine preparation to a host to raise an immune response.

One aspect of the invention provides monoclonal or polyclonal antibodies or fragments thereof, to a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans.

Another aspect of the invention provides monoclonal or polyclonal antibodies or fragments thereof, to C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof to which immunoreactivity is detected in individuals who have recovered from C. difficile infection.

The invention also provides purified antibodies or serum obtained by immunisation of an animal with a vaccine of the invention.

IE a 2 0 0 η TRI002/C The invention provides the use of the antibodies or fragments of the invention in the preparation of a medicament for treatment or prophylaxis of C. difficile infection or C. difficile associated disease.

Preferably the antibodies or serum are used in the preparation of a medicament for treatment or prophylaxis of C. difficile infection or C. difficile associated disease.

Most preferably the antibodies or fragments or serum of the invention are used in passive immunotherapy for established C. difficile infection.

In one embodiment of the invention the antibodies or fragment or serum of the invention are used for the eradication of C. difficile associated disease.

The invention also provides use of interleukin 12 as an adjuvant in C. difficile 15 vaccine.

The invention further provides use of humanised antibodies or serum for passive vaccination of an individual with C. difficile infection.

Brief Description of the Drawings The invention will be more clearly understood from the following description thereof given by way of example only with reference to the accompanying figures, in which:Fig. IA is a Western blot showing recognition of antigens from a crude extract of C. difficile 171500 (PCR type 1) by serum antibodies from a patient infected with this strain. Lane 1: Pre-infection; Lane 2: Early acute; Lane 3: Late acute; Lane 4: Convalescent; IE Ο 2 Ο Ο 9 7 g TRI002/C Fig. IB is a Western blot showing recognition of antigens from a crude extract of C. difficile 170324 (PCR type 12) by serum antibodies from a patient infected with this strain. Lane 1: Pre-infection; Lanes 2-5: Acute; Lanes 6-7: Convalescent; Fig. 2. is a Western blot showing recognition of antigens from two C. difficile strains of different type by serum from convalescent patients.

Lane 1: Strain 170324 (PCR type 12), crude antigen preparation Lane 2: Strain 170324, surface layer protein preparation Lane 3: Strain 171500 (PCR type 1), crude antigen preparation Lane 4: Strain 171500, surface layer protein preparation.

Molecular mass markers (kDa) are shown on the left; and Fig. 3 is an SDS-PAGE gel showing crude SLP preparations from selected strains of C. difficile. The gel contains 12% acrylamide, and has been stained for protein with Coomassie Blue. Each lane contains 5 pg of protein. Molecular weight markers are shown on the left.

Lane 1: 171500 (PCR type 1) Lane 2: 172450 (PCR type 5) Lane 3: 170324 (PCR type 12) Lane 4: 171448 (PCR type 12) Lane 5: 171862 (PCR type 17) Lane 6: 173644 (PCR type 31) Lane 7: 170444 (PCR type 46) Lane 8: 170426 (PCR type 92) Detailed Description of the invention Two antigenic peptides containing SEQ ID No. 1 and SEQ ID No. 2, associated with two common infecting types of C. difficile, were found to be immunogenic in humans. The antigenic peptides were found to induce a strong immune response in TRI002/C individuals who recover from C. difficile infection. Individuals who have recovered from C. difficile infection are those individuals who have been exposed to C. difficile or something strongly related and have recovered. This includes individuals where a carrier state exists in that the C. difficile infection has not and will not necessarily become clinically significant.

These antigenic peptides were found to be products of the slpA gene from C. difficile which is the structural gene for the surface layer protein, SlpA The gene or its products are therefore ideal candidates for the preparation of vaccines against C. difficile.

Surface layer proteins (SLPs), also known as S-layers or crystalline surface layers, are associated with a wide range of bacterial species. They form a 2-dimensional array, which covers the surface of the cell completely, and grows with the cell [Sleytr et al., 1993]. The molecular weight can range from 40 000 to 200 000 Da. The proteins are typically acidic, contain a large proportion of hydrophobic amino acid residues, and have few or no sulphur-containing amino acid residues. Glycosylated S-layer proteins occur in some species. The precise function of Slayers is not always known, but since they comprise approximately 15% of the cell protein, it seems likely that they are important for in vivo functioning of the organism. In Gram positive organisms, the SLP has been shown to delay or prevent the excretion of degradative enzymes from the cell to the outside milieu, and may thereby create a space analagous to the periplasmic space of Gram negative bacteria. Many pathogenic species possess SLPs, which have been ascribed functions such as antiphagocytosis (Campylobacter fetus), and inhibition of complement-mediated killing (Aeromonas salmonicida).

Kawata et al. [1984] described the SLPs of Clostridium difficile. They showed the S-layer to be composed of 2 polypeptides, and demonstrated size heterogeneity for the polypeptides from different strains. Delmee et al. [1986] showed that crude extracts from C. difficile strains of different serotype showed different polypeptide profiles in SDS-PAGE. Poxton et al. [1999] made similar observations using purified SLP preparations. Slide agglutination [Delmee et al., 1990] has identified 21 different serotypes, apparently distinguished by the heterogeneity of the SLP. ΙΕ ο 2 Ο Ο 9 7 IQ TRI002/C Pantosti et al. [1989] isolated C. difficile from a number of patients with antibioticassociated diarrhoea, and prepared SLPs from them.. Cerquetti et al. [2000] published N-terminal sequences of SLPs from several strains, indicating wide differences between strains.. In 2000 the complete DNA sequence of the C. difficile genome was published (available at web address http://www.sanger.ac.uk/Projects/C_difficile/).

The peptides of the invention were found to be encoded by a single open reading frame (ORF) named slpA from C. difficile. The peptides identified in our clinical study correspond to a lower molecular weight moiety of the slpA gene product. Since an immune response is also mounted against a higher molecular weight slpA gene product (Fig. 2), this entity may also be included in a vaccine.

The slpA gene has been sequenced from a number of strains corresponding to different PCR types. The sequences of strains 171500 (PCR type 1)(NCIMB 41081; PHLS R13537), 172450 (PCR type 5)(PHLS R12884), 170324 (PCR type 12) (NCIMB 41080; PHLS R12882),, 171448 (PCR type 12) (PHLS R13550), 171862 (PCR type 17) (PHLS R13702), 173644 (PCR type 31) (PHLS R13711), 170444 (PCR type 46) (PHLS R12883) and 170426 (PCR type 92) (PHLS R12871) with translations thereof are given in Appendices 1 to 8. Substantial variation in nucleotide and predicted amino acid sequence was found between strains of PCR types 1, 5, 12, 17 and 31. The genes from strains of PCR types 46 and 92 are almost identical in sequence to those of PCR type 12. When the DNA sequences of genes of different strains within a PCR type are compared, the sequences are almost if not quite identical, indicating that the potential for variation is not infinite. These findings are in agreement with serotyping studies [Delmee et al., 1986, 1990], and indicate that the production of an effective vaccine based on the slpA product is feasible. In this respect, the present invention includes all variant slpA genes and their products, individually and combined, fragments of them, and their mutants and derivatives.

One aspect of the invention provides the combination of immunodominant eptopes from the slpA gene products from various serotypes into a single vaccine. In this way a single vaccine may be used to immunise against several different C. difficile strains.

TRI002/C The most common PCR types isolated from infections in the clinical study carried out at St. James’s Hospital, Dublin, Ireland were PCR types 1 and 12. However, a vaccine which elicits an intense antibody response against many infecting types would be therapeutically very valuable. Recombinant DNA chimera, or several chimeras, encoding contiguous immunodominant epitopes may be made for use in the vaccine. The recombinant DNA may serve as the active component in a vaccine, or may be inserted into an appropriate expression system for the generation of a chimeric peptide vaccine in a suitable host.

Chimeras can be generated by PCR amplification of the DNA encoding peptide regions of interest, incorporating cleavage sites for restriction endonucleases into the primers. The amplified fragments can thus be cleaved to generate compatible ends, and spliced together to create chimeras.

The dominant epitopes may be identified by cleavage of the sip A products into fragments by agents which cleave at known sites, and by immunoblotting with homologous patient serum. Immunodominant peptides may be tested for their capacity to stimulate T-cell proliferative responses in vitro, using mouse splenic Tcells.

DNA vaccination involves immunisation with recombinant DNA encoding the antigen or epitope of interest, cloned in a vector which promotes high level expression in mammalian cells. Typically, the vector is a plasmid vector which which also replicates in a procaryotic vector such as Escherichia coli, so that the DNA can be produced in quantity. Following immunisation, the plasmid enters a host cell, where it remains in the nucleus, and directs synthesis of the recombinant polypeptide. The polypeptide stimulates the production of neutralising antibodies, as well as activating cytotoxic T-cells.

Using a DNA vaccine, it may be necessary to modify the DNA sequence to take account of codon usage in humans. The G+C content of mammalian DNA is much higher than that of C. difficile. The generation of such synthetic DNA molecules, essentially containing numerous silent mutations, is within the scope of the invention.

IEO2 00 9 7 TRI002/C A peptide vaccine will ideally be made using recombinant peptides. Similar considerations apply as in the generation of a DNA vaccine with regard to expression in a different host, such as Escherichia coli, which has a different codon usage pattern to C. difficile. Problems of expression may be overcome by the use of a special host strain which carries additional copies of rare tRNAs (e.g. E. coli BL21CodonPlus™-RIL from Stratagene), or by using de novo synthesis of a DNA segment carrying silent mutations which will enable normal expression in E. coli. There are many expression systems which are likely to allow high-level expression of slpA genes in E. coli. An example is the pBAD/Thio TOPO vector of Invitrogen, in which expressed genes are under control of the arabinose promoter, which is subject to positive and negative control, enabling very tight control of expression. In this vector, the recombinant protein is typically fused to a modified thioredoxin carrying several histidine residues which enable purification by nickel chromatography. The recombinant protein can be cleaved from the thioredoxin moiety by enterokinase enzyme.

Affinity chromatography may also be used with fixed antibodies or some other agent which strongly binds the peptide of interest to purify the protein from the native organism.

Purified immunogenic peptides may be used in combination with other C. difficile sub-units as a combined vaccine against C. difficile. Potential candidates are the products of the other sip genes, which share limited homology with the slpA gene product and with the N-acetylmuramoyl L-alanine amidase, (CwlB), from Bacillus subtilis, and which may be involved in remodelling of the peptidoglycan.

Oother purified proteins of C. difficile to which constitutive antibodies are detected in individuals recovering from C. difficile infection are also within the scope of the present invention A deposit of Clostridium difficile strain 171500, PCR type 1, was made at the NCIMB on January 29, 2001, and accorded the accession number NCIMB 41081.

A deposit of Clostridium difficile strain 170324, PCR type 12, was made at the NCIMB on January 29, 2001, and accorded the accession number NCIMB 41080.

TRI002/C Two peptides of the invention were found to contain the following sequences: 33kDa peptide SEQ ID No. 1: DKTKVETADQGYTVVQSKYK kPa peptide SEQ ID No. 2 ATTGTQGYTVVKNDGKKAVK The invention will be more clearly understood from the following examples.

Example 1. Clinical Study Examination of sequential antibody responses to C. difficile among elderly patients who developed the disease was carried out. The study was based on the hypothesis that the host immune response influenced the development of Clostridium difficile disease. In particular we determined that a particular pattern of immune response to C. difficile antigens correlated with the outcome of CDD.

Materials and Methods Patients Serum was collected from over 300 patients and of these 30 patients developed CDD. The infecting strain (homologous strain) was grown from each patient. Strains of C. difficile were typed at the Anaerobe Reference Laboratory, Wales [O’Neill et al., 1996]. The most common strains isolated were PCR type 1 (n = 15) which is the most common type causing epidemics and PCR type 12 (n = 5) which is also a common hospital strain. Pre-infection serum samples were obtained from patients. Acute phase sera were then collected from patients who developed C. difficile disease. Convalescent sera were collected from patients who recovered.

Protein extracts of patients’ infecting C. difficile strain were probed with the patients sera using Western blotting. IgG responses to the antigens were examined.

Western blotting Proteins from SDS-PAGE gels were electroblotted (0.8mA/cm2 for 1 h) to PVDF membrane using a semi-dry blotting apparatus (Atto). Primary antibodies (human ΙΕΟ2 00 9 7 TRI002/C serum: 1/50 - 1/10,000 dilution) were detected using a 1/5000 dilution of anti-human IgG (horse radish peroxidase-conjugated) in combination with enhanced chemiluminesence (ECL). Blots were washed in phosphate buffered saline (pH 7.5) containing Tween 20 (0.1% v/v), and incubated in the same solution comprising dried skim milk (5% w/v) and antibodies at the appropriate concentration. Blots were exposed to Kodak X-OMAT film for various periods of time and developed.

Results Overall 5 patients made a full recovery and new antibody responses to previously unrecognised antigens were evident in 4 of these patients. Three of these patients had C. difficile belonging to PCR type 1 and one patient had C. difficile PCR type 12. These patients developed an acute phase antibody response to previously unrecognised C. difficile antigens which persisted during convalescence (Figs. IA and IB). These antigens were recognised by antibodies from patients who recovered and represent potential candidate vaccine antigens. Fig IA shows a strong reaction of convalescent antibodies was observed with the 33 kDa antigen (Lane 4, arrow). Fig IB shows a strong reaction of convalescent antibodies was observed with the 31 kDa antigen (Lanes 6 and 7, arrow).

These antibody responses have also been found in some controls in the same ward who were also on antibiotics but who did not develop CDD.

Example 2. Further characterisation of protective antigens Materials and Methods Partial purification and N-terminal sequencing of the 33 kDa and the 31 kDa proteins The antigens were partially purified from C. difficile based on their molecular weight using preparative continuous-elution SDS-PAGE on a model 491 Prep-Cell (BioRad). The appropriate antigens were subsequently identified on Western blots · probed with serum obtained from individuals who recovered from C. difficile infection.

Preparation of surface layer proteins (SLPs) SLPs were purified from C. difficile by extracting washed cells with 8 M urea, in 50 mM Tris HCl, pH 8.3 in the presence of a cocktail of protease inhibitors TRI002/C (Complete®, Boehringer Mannheim), for 1 h at 37°C, followed by centrifugation for 000 x g for 30 min. The SLPs were recovered in the supernatant and dialysed to remove the urea [Cerquetti et al., 2000].

Results The immunodominant protein which was associated with a positive outcome from C. difficile strain 171500 (PCR type 1) was identified and purified using preparative SDS-PAGE. The N-terminal region of the protein was sequenced using an Applied Biosystems Procise Sequencer, viz DKTKVETADQGYTVVQSKYK (SEQ ID No. 1) The antigen which was associated with a protective antibody response from the C. difficile strain 170324 (PCR type 12) was identified and the N-terminal sequence obtained, viz ATTGTQGYTVVKNDGKKAVK (SEQ ID No. 2).

These sequences were used to interrogate the C. difficile genome sequence using the TBLASTN programme, which compared our query sequences with those of the genome project (available at web address http://www.sanger.ac.uk/Projects/C_difficile/), translated in all 6 possible reading frames. A nearly identical stretch of sequence was identified when the sequence from strain 1710324 (type 12) was used for interrogation. The same stretch of sequence was picked up with the sequence from strain 171500 ‘(type 1) was used, although the identity was much less strong. Since the homologous sequence belonged to an open reading frame encoding a 719-residue peptide, this result was somewhat surprising. However, when the N-terminal sequences from the higher molecular weight SLP component were later published by Cerquetti et al [2000], it became apparent that they were encoded downstream along the same gene, subsequently identified as sip A, and the reason for the discrepancy in size between the gene and its products became readily apparent.

The purified SLPs from strains 171500 (PCR type 1) and 170324 (PCR type 12) showed strong reactivity with homologous convalescent serum, and co-migrated with the dominant antigens detected in crude cell extracts as shown in Fig. 2. Lanes 1 and 3 contain crude antigen preparations from PCR types 1 and 12 respectively, and Lanes 2 and 4 contain SLP preparations from PCR types 1 and 12, respectively.

TRI002/C Panel A was probed with serum from a patient recovering from infection with PCR type 1, and Panel B was probed with serum from a patient recovering from infection with PCR type 12. Each serum detected 2 major antigens in the infecting strain (Panel A, Lane 3); (Panel B, Lane 1), which co-migrated with the 2 SLPs (Panel A, Lane 4; Panel B, Lane 2), with which the sera also reacted strongly. Note that serum from the patient infected with the PCR type 1 strain recognised the higher molecular weight SLP from the PCR type 12 strain (Panel A, Lanes 1 and 2), whereas the converse did not occur (Panel B, Lanes 3 and 4). There is no apparent antigenic cross-reactivity with regard to the lower molecular weight SLPs.

SLPs were prepared from selected strains by urea extraction, and subjected to SDSPAGE and staining with Coomassie Blue (Fig. 3). Most strains showed a characteristic profile, with two major bands located in the 29 000 to 36 000 and 45 000 to 50 000 molecular weight range. An exception was strain 172450 (Fig. 3, Lane 2), which showed a single, high molecular weight band, approximately 43 000 in size.

Cloning, sequencing and analysis of slpA genes The nucleotide sequences of the slpA genes from the two sample strains of C. 20 difficile (PCR types 1 and 12, deposited at the NCIMB) and of several others (PCR types 5, 12, 17, 31, 46 and 92, available from the Anaerobe Reference Unit at the Department of Medical Microbiology and Public Health Laboratory, Cardiff, Wales were obtained. The slpA gene and flanking sequence was amplified by polymerase chain reaction from genomic DNA prepared from C. difficile using a commercial kit (Puregene® DNA isolation kit for yeast and Gram positive bacteria, Gentra systems Minneapolis, MN). The forward primer (5’ ATGGATTATTATAGAGATGTGAG 3’), was based on sequence from the genome sequencing project, starting 112 nucleotides upstream from the start of the slpA open reading frame. Two reverse primers were used, depending on the PCR type. A downstream primer (5’ CTATTTAAAGTTTTATTAAAACTTATATTAC 3’) was used to amplify slpA from PCR types 12, 17, 31, 46 and 92. A reverse primer based on the 3’ end of the slpA open reading frame from strain 630 and the subsequent nonsense codon (5’ TTACATATCTAATAAATCTTTCATTTTGTTTATAACTG 3’) was used to IF Π 7 o n 9 7 TRI002/C amplify slpA from PCR types 1 and 5. The choice of primer for the latter two PCR types may have resulted in a small number of systematic errors in the nucleotide sequence obtained. PCR was carried out using HotStar™ Taq polymerase (Qiagen Ltd., Crawley, West Sussex, UK) according to the manufacturer’s instructions. A single fragment of approximately 2 kb was obtained for each strain, which was then cloned into the pBAD/Thio TOPO vector (Invitrogen, Groningen, Netherlands). Inserts were sequenced from both ends by standard procedures in commercial facilities at MWG (Wolverton Mill South, Milton Keynes, UK) and Cambridge University. New primers were designed on the basis of initial sequencing results, enabling sequencing of both strands to be completed (a process known as chromosome walking).

The results are shown in Appendices 1-8.

The nucleotide sequences were translated to enable prediction of the amino acid sequence(s) of the product(s) (Appendices 1-8). The N-terminal sequences obtained experimentally for the low molecular weight protective antigens from strains 171500 (PCR type 1) and 170324 (PCR type 12) were almost identical to those predicted from the nucleotide sequences of their respective slpA genes (18/20 identical residues for strain 171500, and 19/20 identical residues for strain 170324).

Appendix 1 shows the open reading frame with translation for slpA from strain 171500 (PCR type 1), SEQ ID No 3. Since the reverse primer was based on the 35 nucleotides from the 3’ end of the slpA gene, the sequence is not necessarily 100% accurate in this region. However, this part of the gene does not seem to vary greatly from strain to strain.

Appendix 2 shows the open reading frame with translation for slpA from strain 172450 (PCR type 5), SEQ ID No 4. Again, the sequence obtained for the 3’ 35 nucleotides is not fully reliable. This gene is considerably smaller than the other slpA genes sequenced, and shows strong sequence divergence from the other PCR types examined.

Appendix 3 shows the open reading frame with translation for slpA from strain 170324 (PCR type 12) , SEQ ID No 5. This gene showed a single base difference ΙΕ ο 2 Ο η 9 7 TRI002/C when compared with the strain used for the genome sequencing project, strain 630, of the same PCR type. The deduced amino acid sequence is identical.

Appendix 4 shows the open reading frame with translation for slpA from strain 5 171448 (PCR type 12), SEQ ID No 6. This gene was almost identical in sequence to that from strain 170324.

Appendix 5 shows the open reading frame with translation for slpA from strain 171862 (PCR type 17), SEQ ID No 7.

Appendix 6 shows the open reading frame with translation for slpA from strain 173644 (PCR type 31), SEQ ID No 8. Like the slpA from strain 172450, this sequence is very dissimilar to those of slpA genes from other PCR types encountered.

Appendix 7 shows the open reading frame with translation for slpA from strain 170444 (PCR type 46), SEQ ID No 9. This sequence is virtually identical to that obtained fors//>4 from PCR type 12 and 92 strains.

Appendix 8 shows the open reading frame with translation for slpA from strain 170426 (PCR type 92), SEQ ID No 10. This sequence is virtually identical to that obtained fori//?/! from PCR type 12 and 46.

The cleavage site of the putative signal sequences from both genes was determined from experimental evidence (the N-terminal sequence of the mature proteins as determined by Edman degradation), and by the prediction tool of the Centre for Biological Sequence Analysis at the Technical University of Denmark [Nielsen et al., 1997]. The site for cleavage of thes//?X gene product to form the mature SLPs was predicted from experimental [Cerquetti et al., 2000, Karjalainen et al., 2001 and Calabi et al., 2001]. The cleavage site is typically preceded by the motif TKS.

However, the relevant motif is likely to be TKG in strain 173644 (PCR type 31). No obvious motif appeared for strain 172450 (PCR type 5). However, the protein produced by type 5 strains does appear to be cleaved; hence we predicted the site to ΙΕ ο 2 Ο Ο 9 7 TRI002/C occur at a point where the SLP sequence aligns with the cleavage sites of other PCR types.

The molecular weight and isoelectric point was calculated for each of the predicted mature proteins by the ExPASy server of the Swiss Institute for Bioinformatics (Table 1). In general, the calculated molecular weights were in fair agreement with apparent molecular masses determined from migration in gels (Fig. 3). No lower molecular weight band was apparent for Strain 172450 (PCR type 5; Lane 2). However, a higher molecular weight band is present, which is similar in size to the predicted weight for the C-terminal moiety. We observed a similar profile for another type 5 strain. It is possible that the lower molecular weight species is subject to degradation in this strain. Another possibility is that it is heavily glycosylated, which can affect staining. All peptides had a predicted isoelectric point below 7, typical of acidic proteins, and characteristic of SLPs in general [Sleyter et al, 1993].

Table 1 C. difficile strain (PCR type) P1 (N-terminal) P1 (C-terminal) MW (N-terminal) MW (C-terminal) 171500 (Type 1) 4.83 4.66 33365.41 44220.37 172450 (Type 5) 4.86 4.65 19364.46 42757.63 170324 (Type 12) 4.92 4.58 34228.25 39522.24 171448 (Type 12) 4.98 4.58 34156.18 39492.21 171862 (Type 17) 5.09 4.53 33783.73 39407.11 173644 (Type 31) 5.05 4.56 33626.48 41821.69 170444 (Type 46) 5.06 4.58 34230.31 39522.24 170426 (Type 92) 4.99 4.58 34242.32 39522.24 The translated nucleotide sequences were compared with published SlpA sequences (EMBL Accession numbers AJ300676, and AJ300677 for examples from PCR types 1, and 17 respectively; strain 630 available from the Sanger Institute for PCR type 12; EMBL Accession number AY004256 for a variant from an unnamed.PCR type). The Clustal W alignment programme, which is freely available, was used. Where SlpA sequences from our isolates were compared with those of other strains of the same PCR types, they were found to be nearly or quite identical. This observation ΙΕ ο 2 Ο η 9 7 TRI002/C indicates, together with existing knowledge from serotyping, that the number of variants of slpA is not infinite, and that natural evolution of the gene is not rapid.

Table 2 shows a compilation of homologies, based on amino acid residue identity, for the different translated sequences measured against published sequences.

Homologies are compiled for the predicted mature peptides, either combined (Table 2A) or as N-terminal (low molecular weight, less conserved moiety) (Table 2B) and C-terminal (high molecular weight, more conserved) (Table 20 mature peptides according to predicted cleavage sites. It is clear that the SlpA sequences from strains 172450 (PCR type 5) and 173644 (PCR type 31) are quite distinct particularly with respect to N-terminal region.

Table 2A Strain.type 630 (type 12) AJ300676 (type 1) AJ300677 (type 17) AY004256 (type unknown) 171500.typel 55.2 99.7 55.4 56.42 17245O.type5 49.8 54.0 49.9 47.77 17O324.typel2 100.0 57.8 81.7 59.77 171448.typel2 99.7 171862.typel7 82.3 58.7 100 57.54 173644. type31 57.9 59.2 60.1 56.88 170444. type46 99.6 170426. type92 99.9 Table 2B Strain.type 630 (type 12) AJ300676 (type 1) AJ300677 (type 17) AY004256 (type unknown) 171500.typel 35.4 100 34.5 33.54 172450. type5 31.6 32.2 31.0 24.58 17O324.typel2 100 34.9 64.6 36.14 171448.typel2 99.7 171862.typel7 64.3 34.4 100 31.55 173644. type31 37.5 34.1 41.3 31.86 170444. type46 99.1 170426. type92 99.7 TRI002/C Table 2C Strain.type 630 (type 12) AJ300676 (type 1) AJ300677 (type 17) AY004256 (type unknown) 171500.typel 70.2 99.5 71.2 73.80 172450. type5 58.4 60.4 63.0 57.60 17O324.typel2 100 77.3 97.1 80.00 171448.typel2 99.7 171862.typel7 97.3 78.8 100 79.62 173644.type31 74.1 78.9 75.1 75.38 170444.type46 100 170426. type92 100 The term antibody used throughout the specification includes but is not limited to polyclonal, monoclonal, chimeric, single chain, Fab fragments and fragments produced by a Fab expression library.

The antibodies and fragments thereof may be humanised antibodies. Neutralising antibodies such as those which inhibit biological activity of the substance amino acid sequence are especially preferred for diagnostics and therapeutics.

Antibodies both polyclonal and monoclonal which are directed against epitopes obtainable from a polypeptide or peptide of the present invention are particularly useful in diagnosis and those which are neutralising are useful in passive immunotherapy.

Antibodies may be produced by any of the standard techniques well known in the art.

A therapeutically effective amount of the polypeptide, polynucleotide, peptide or antibody of the inventiion in the form of pharmaceutical composition may be adminsistered. The composition may optionally comprise a pharmaceutically acceptable carrier, diluent or excipients and including combinations thereof. The pharmaceutical composition may be used in conjugation with one or more additional pharmaceutically active compounds and/or adjuvants. ΙΕ ο 2 Ο Ο 9 7 TRI002/C Different adjuvants depending on the host may be used to increase immunological response. The adjuvant may be selected from the group comprising Freunds, mineral gels such as aluminium hydroxide and surface active substances.

The vaccine of the invention may be in the form of an immune modulating composition or pharmaceutical composition and may be administered by a number of different routes such as by injection (which includes parenteral, subcutaneous and intramuscular injection) intranasal, intramuscular, mucosal, oral, intra-vaginal, urethral or ocular administration. There may be different formulation/composition requirements dependent on the different delivery systems.

The invention is not limited to the embodiments hereinbefore described which may 15 be varied in detail.

TRI002/C References Calabi E., Ward S., Wren B., Paxton T., Panico M., Morris H., Dell A., Dougan G., Fairweather N. (2001). Molecular characterization of the surface layer proteins from Clostridium difficile. Mol. Microbiol. 40:1187-1199.

Cerquetti M., Molinari A., Sebastianelli A., Diociaiuti M., Petruzzelli R., Cap C., Mastrantonio P. (2000). Characterization of surface layer proteins from different Clostridium difficile clinical isolates. Microbial Pathogenesis, 28:363-372.

Cheng S.H, Lu J.J, Young T.G, Pemg C.L, Chi W.M. (1997) Clostridium difficile-associated diseases: comparison of symptomatic infection versus carriage on the basis of risk factors, toxin production, and genotyping results. Clin Infect Dis ; 25: 157-8.

Delmee M., Laroche Y., Avesani V., Cornells G. (1986). Comparison of serogrouping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J. Clin. Microbiol. 24:991-994.

Delmee M., Avesani V., Delferriere N., Burtonboy G. (1990). Characterization of flagella of Clostridium difficile and their role in serogrouping reactions.

Karjalainen T., Waligora-Dupriet A.-J., Cerquetti M., Spigaglia P., Maggioni A., Mauri P., Mastrantonio P., (2001). Molecular and genomic analysis of genes encoding surface-anchored proteins from Clostridium difficile. Infect. Immun. 69:3442-3446.

Kawata T., Takeoka A., Takumi K., Masuda K. (1984). Demonstration and preliminary characterization of a regular array in the cell wall of Clostridium difficile. FEMS Microbiol. Lett 24:323-328.

Kelly, C.P., Pothoulakis C and LaMont J.T. Clostridium difficile colitis. New England Journal of Medicine. 1994 330: 257-262.

Kyne L, Wamy M, Qamar A, Kelly C. Asymptomtic carriage of Clostridium difficile and serum levels of IgG antibody against Toxin A. New England Journal of Medicine 2000; 390-7.

Leung Y.M, Kelly C.P, Boguniewicz M, Pothoulakis C, LaMont J.T, Flores A. Treatment with intravenous gamma globulin of chronic relapsing colitis by Clostridium difficile: toxin:/. Pediatr 1991; 118: 633-7.

McFarland L.V, Elmer G.W, Stamm W.E, Mulligan M.E. Correlation of immunoblot type, enterotoxin production, and cytokine production with clinical manifestation of Clostridium difficile infection in a cohort of hospitalised patients. Infect Immun. 1991; 59: 2456-62. ΙΕ β 2 Ο ο 9 7 TRI002/C Mulligan M.E, Miller S.D, McFarland L.V, Fung H.C, Kwok R.Y. Elevated levels of serum immunoglobulins in asymptomatic carriers of Clostridium difficile. Clin Infect Dis 1993: 16(Suppl 4); S239-44.

Nielsen H., Engelbrecht J., Brunak S., von Heijne G. (1997). Identification of prokaryotic and eukaryotic signal peptides and. prediction of their cleavage sites. Protein Eng. :1-6.

O’Neill G.L., Ogunsota F.T, Brazier J.S, Duerdon B.I, Modification of a PCR ribotyping method for application as a routine typing scheme for Clostridium difficile.

Anaerobe (1996) 2, 205-209.

Pantosti A, Cerquetti M, Viti F, Ortisi G, Mastratonio P. Immunoblot Of Serum . Immunoglobulin G Response to Surface Proteins of Clostridium difficile in Patients With Antibiotic Associated Diarrhoea. J. Clin Microbiol 1989: 27; 2594-7.

Pelmutter D.H, Leichtnr A.M, Goldman H, Winter H.S. Chronic diarrahoea associated with 15 hypogammaglobulinaemia and enteropathy in infants and children: Dig Dis Sci 1985; 30;1149-55.

Poxton I.R., Higgins P.G., Currie C.G., McCoubrey J. (1999). Variation in the cell surface proteins of Clostridium difficile. Anaerobe 5:213-215.

Shim J. Johnson S, Samone M, Bliss DZ, Gerding D.N. Primary symptomless colonisation 20 by Clostridium difficile and decreased risk of subsequent diarrhoea. The Lancet Vol 351 1998: 633-5.

Sleytr U.B., Messner P., Pum D., Sara M. (1993). Crystalline bacterial cell surface layers.

Mol. Microbiol. 10:911-916. ΙΕ υ 2 υ υ 9 / TRJ002/C Appendix 1 SEQ ID No. 3. Nucleotide sequence of slpA from Clostridium difficile strain 171500, PCR type 1, with translation. The putative secretory signal cleavage site (Δ) and site of cleavage to form the two mature SLPs (♦) are indicated.

ATGAATAAGAAAAATATAGCAATAGCTATGTCAGGTTTAACAGTTTTAGCTTCGGCTGCA 60 ----------1-----------(-----------j-----------j-----------j---------10 1MNKKNIAIAMSGLTVLASAA CCTGTATTTGCAGATGATACAAAAGTTGAAACTGGTGATCAAGGATATACAGTGGTACAA 120 15 ---------+---------+---------+---------+---------+--------+ PVFADDTKVETGD'QGYTVVQ 40 Δ 121 AGCAAGTATAAGAAAGCTGTTGAACAATTACAAAAAGGAATATTAGATGGAAGTATAACA 180 ---------+---------+---------+---------+---------+--------41SKYKKAVEQLQKGILDGSIT 181 GAAATTAAAGTTTTCTTTGAGGGAACTTTAGCATCTACTATAAAAGTAGGTTCTGAGCTT 240 ----------1-----------1-----------—----— — — H---—----——H---------61EIKVFFEGTLASTIKVGSEL 241 AATGCAGCAGATGCAAGTAAATTATTGTTTACACAAGTAGATAATAAACTAGATAATTTA 300 ---------+---------+---------+---------+---------+--------81NAADASKLLFTQVDNKLDNL 100 301 GGTGATGGAGATTATGTAGATTTCTTAATAACTTCTCCAGGTCAAGGGGATAAAATAACT 360 ---------+---------+---------+---------+---------+--------101 GDGDYVDFLITSPGQGDKIT 120 361 ACAAGTAAACTTGTTGCATTGAAAGATTTAACAGGTGCTTCAGCAGATGCTATAATTGCT 420 ---------+---------+---------+---------+---------+--------121 TSKLVALKDLTGASADAI IA 140 421 GGAACATCTTCAGCAGATGGTGTTGTTACAAATACTGGAGCTGCTAGTGGTTCTACTGAG 480 ----------1-----------1-----------1-----------1-----------j---------141 GTSSADGVVTNTGAASGSTE 160 IE Ο 2 00 9 7 TRI0027C 481 ACAAATTCAGCAGGAACAAAACTTGCAATGTCAGCTATTTTTGACACAGCATATACAGAT 540 ---------+---------+---------+---------χ---------+--------161 TNSAGTKLAMSAI FDTAYTD 180 541 TCATCTGAAACTGCGGTTAAGATTACTATAAAAGCAGATATGAATGATACTAAATTTGGT 600 ---— — —--------------1-----------(-----------j-----------j---------181 S S Ε T A V K I Τ I K A D Μ N D Τ K F G 200 601 AAAGCAGGTGAGACAACTTATTCAACTGGGCTTACATTTGAAGATGGGTCTACAGAAAAA 660 ---------+---------+---------+---------+---------+--------201 KAGETTYSTGLTFEDGSTEK 220 661 ATTGTTAAATTAGGGGACAGTGATATTATAGATATAACTAAAGCTCTTAAACTTACTGTT 720 ---------+---------+---------+---------+---------+--------221 I V K L G D S D I I D I Τ K A L K L Τ V 240 721 GTTCCTGGAAGTAAAGCAACTGTTAAGTTTGCTGAAAAAACACCAAGTGCCAGTGTTCAA 780 ---------+---------+---------+---------+---------+--------241 V P G S K A Τ V K F A Ε Κ Τ P S A S V Q 260 781 CCAGTAATAACAAAGCTTAGAATAATAAATGCTAAAGAAGAAACAATAGATATTGACGCT 8 40 ---------+---------+---------+---------+---------+--------261 PVITKL RIINAKEETIDIDA 280 841 AGTTCTAGTAAAACAGCACAAGATTTAGCTAAAAAATATGTATTTAATAAAACTGATTTA 900 — —------— φ — — -------1-----------j-----------j-----------j---------281 SSSKTAQDLAKKYVFNKTDL 300 901 AATACTCTTTATAAAGTATTAAATGGAGATGAAGCAGATACTAATGGATTAATAGAAGAA 960 ---------+---------+---------+---------+---------+--------301 NTLYKVLNGDEADTNGLIE E 320 961 GTTAGTGGAAAATATCAAGTAGTTCTTTATCCAGAAGGAAAAAGAGTTACAACTAAGAGT 1020 ---------+---------+---------+---------+---------+--------321VSGKYQVVLYPEGKRVTTKS 340 1021 GCTGCAAAGGCTTCAATTGCTGATGAAAATTCACCAGTTAAATTAACTCTTAAGTCAGAT 1080 * ---------+---------+---------+---------+---------+--------341 AAKASIADENSPVKLTLKSD 360 ♦ 1081 AAGAAGAAAGACTTAAAAGATTATGTGGATGATTTAAGAACATATAATAATGGATATTCA 1140 ----------1-----------1-----------1-----------j-----------1--------361KKKDLKDYVDDLRTYNNGYS 380 ΙΕ ο 2 00 9 7 TRI002/C 1141 AATGCTATAGAAGTAGCAGGAGAAGATAGAATAGAAACTGCAATAGCATTAAGTCAAAAA ----------i-----------]-----------j-----------j-----------j--381 NAIEVAGEDRIETAIALS 400 1201 TATTATAACTCTGATGATGAAAATGCTATATTTAGAGATTCAGTTGATAATGTAGTATTG ---------+---------+---------+---------+---------+-- 401YYNSDDENAI FRDSVDNV 420 1261 gttggaggaaatgcaatagttgatggacttgtagcttctcctttagcttctgaaaagaaa ---------+---------+---------+---------+---------+— 421 V G G N A I V D G L V A S P L A S E 440 1321 GCTCCTTTATTATTAACTTCAAAAGATAAATTAGATTCAAGCGTAAAAGCTGAAATAAAG ---------+---------+---------+---------+---------+--441 A P L L L T S K D K L D S S V K A E 60 1381 AGAGTTATGAATATAAAGAGTACAACAGGTATAAATACTTCAAAGAAAGTTTATTTAGCT ----------1-----------1-----------1--------— — -1--------— — d---461RV MN IKSTTGINTSKKVY 480 1441 GGTGGAGTTAATTCTATATCTAAAGAAGTAGAAAATGAATTAAAAGATATGGGACTTAAA ---------+---------+---------+---------+---------+--481 G G V N S I S Κ Ε V Ε N E L K D M G 500 1501 GTTACAAGATTAGCAGGAGATGATAGATATGAAACTTCTCTAAAAATAGCTGATGAAGTA ---------+---------+---------+---------+---------+__. 501VTRLAGDDRYETS LKIAD 520 1561 GGTCTTGATAATGATAAAGCATTTGTAGTTGGAGGAACAGGATTAGCAGATGCCATGAGT ---------+---------+---------+---------+--------521GLDNDKAFVVGGTGLADA 540 1621 ATAGCTCCAGTTGCATCTCAATTAAGAAATGCTAATGGTAAAATGGATTTAGCTGATGGT ----------1-----------J-----------1-----------1-----------1---541 I A Ρ V A S Q L R N A N G Κ M D L A 560 1200 Q K 1260 V L 1320 K K 1380 I K 1440 L A 1500 L K 1560 Ε V 1620 M S 1680 D G IE Ο 2 ο ο 9 7 TRIOO27C 1681 GATGCTACACCAATAGTAGTTGTAGATGGAAAAGCTAAAACTATAAATGATGATGTAAAA 174 0 ---------+---------+---------+---------+---------+--------561 DATPIVVVDGKAKTINDDVK 580 1741 GATTTCTTAGATGATTCACAAGTTGATATAATAGGTGGAGAAAACAGTGTATCTAAAGAT 1800 ---------+---------+---------+---------+---------+--------581 DFLDDSQVDIIGGENSVSKD 600 1801 GTTGAAAATGCAATAGATGATGCTACAGGTAAATCTCCAGATAGATATAGTGGAGATGAT 1860 ---------+---------+---------+---------+---------+--------601 VENAIDDATGKSPDRYSGDD 620 1861 AGACAAGCAACTAATGCAAAAGTTATAAAAGAATCTTCTTATTATCAAGATAACTTAAAT 1920 ---------+---------+---------+---------+---------+--------621RQATNAKVIKESSYYQDNLN 640 1921 AATGATAAAAAAGTAGTTAATTTCTTTGTAGCTAAAGATGGTTCTACTAAAGAAGATCAA 1980 ---------+---------+---------+---------+---------+--------641 NDKKVVNFFVAKDGSTKEDQ 660 1981 TTAGTTGATGCTTTAGCAGCAGCTCCAGTTGCAGCAAACTTTGGTGTAACTCTTAATTCT 2040 ---------+---------+---------+---------+---------+--------661LVDALAAAPVAANFGVTLNS 680 2041 GATGGTAAGCCAGTAGATAAAGATGGTAAAGtATTAACTGGTTCTGATAATGATAAAAAT 2100 ---------+---------+---------+---------+---------+--------681DGKPVDKDGKVLTGSDNDKN 700 2101 AAATTAGTATCTCCAGCACCTATAGTATTAGCTACTGATTCTTTATCTTCAGATCaAAGT 2160 ---------+----------I----------+---------+---------+--------701 Κ L V S Ρ A Ρ I V L A Τ D S L S S D Q S 720 2161 GTATCTATAAGTAaAGTTCTTGATAAAGATAATGGAGAAAACTTAGTTCAAGTTGGTAAA 2220 , ---------+----·-----+---------+---------+---------+--------721 VSISKVLDKDNGENLVQVGK 740 2221 GGTATAGCTACTTCAGTTATAAACAAAATGAAAGATTTATTAGATATG 2268 ----------1-----------j-----------1-----------1--------741 G I A T S V I Ν Κ Μ K D L L D M 756 ,£0 2 00 97’ TRI002/C Appendix 2 SEQ ID No. 4. Nucleotide sequence of slpA from Clostridium difficile strain 172450, PCR type 5, with translation. The putative secretory signal cleavage site (Δ) is indicated, and an approximation of the and site of cleavage to form the two mature SLPs (♦) is also indicated.

ATGAAAAAAAGAAATTTAGCAATGGCTATGGCAGCTGTTACTGTAGTAGGTTCTGCTGCT 60 ---------+---------+---------+---------+---------+--------1MKKRNLAMAMAAVTVVGSAA CCAGTTTTTGCAGCAGCTTCAGATGTAATATCACTACAAGATGGTACAAATGATAAGTAT 120 ---------+---------+---------+---------+---------+--------21PVFAAASDVISLQDGTNDKY Δ 121 ACAGTATCAAATACTAAAGCTAGTGACTTAGTAAAGGATATTTTAGCAGCACAAAACTTA 180 ---------+---------+---------+---------+---------+--------41TVSNTKASDLVKDILAAQNL 181 ACAACAGGTGCAGTTATTTTGAACAAAGATACAAAAGTTACTTTCTATGATGCAAATGAG 240 ---------+---------+---------+---------+---------+--------61TTGAVILNKDTKVTFYDANE 241 AAAGATTCTTCAACTCCAACTGGAGATAAAAAAGTTTATTCAGAACAAACTTTAACTACA 300 ----------j-----------1-----------1-----------(-----------J-------- - 81KDSSTPTGDKKV'YSE QTLTT 100 301 GCTAATGGAAATGAAGATTATGTAAAGACAACTTTAAAAAATTTAGATGCAGGAGAATAT 360 ----------1-----— —----h----_ —— 1-—-----— — —|----——— — 1----—----101ANGNEDYVKTTLKNLDAGEY 120 361 GCTATTATAGATTTAACTTATAATAATGCTAAAACTGTTGAAATTAAAGTAGTAGCAGCT 420 ---------+---------+---------+---------+---------+— -----121 A I I D L Τ Υ Ν Ν A K Τ V Ε I K V V A A 140 421 AGTGAAAAAACAGTAGTTGTATCTAGTGATGCGAAAAATAGTGCAAAAGATATAGCTGAA 4 80 ---------+---------+---------+---------+--------_+--------141 SEKTVVVSSDAKNSAKDIA E 160 481 AAATATGTGTTTGAAGACAAAGACTTAGAAAATGCACTAAAAACTATAAATGCCTCAGAT 54 0 ---------+---------+---------+---------+---------+---------161KYVFEDKDLENALKTINASD 180 IE Ο 2 Ο Θ g Τ TR1002/C 541 TTCAGTAAAACTGATAGTTACTATCAAGTAGTTCTTTATCCAAAAGGAAAGAGATTACAA 600 -----—----1-----—-----[-----------j— —--------[---------— -1 —----— 181FSKTDSYYQVVLYPKGKRLQ 200 601 GGTTTCTCAACTTATAGAGCTACAAATTATAATGAAGGAACTGCATATGGTAATACACCA 660 ---------+---------+---------+---------+---------+--------201 GFSTYRATNYNEGTAYGNTP 220 ♦ 661 GTAATATTAACTCTAAAATCTACTAGTAAGAGTAATTTAAAGACTGCAGTAGAAGAGTTA 720 ---------+---------+---------+---------+---------+--------15 221VILTLKSTSKSNLKTAVEEL 240 721 CAAAAATTGAATGCTAGTTATTCTAATACTACAACTTTAGCTGGTGATGACAGAATACAA 780 --------+---------+---------+---------+---------+--------20 241 QKLNASYSNTTTLAGDDRI Q 260 781 ACAGCTATAGAGATAAGTAAAGAATATTACAATAATGATGGCGAGAAATCAGATCATTCA 840 ---------+---------+---------+---------+---------+--------25 261TAIEISKEYYNNDGEKSDHS 280 841 GCTGATGTTAAAGAGAATGTTAAAAATGTTGTATTAGTAGGTGCAAATGCACTAGTAGAT 900 ---------+---------+---------+---------+---------+--------30 281 A D V Κ Ε Ν V Κ Ν V V L V G A Ν A L V D 300 901 GGATTAGTTGCGGCTCCTTTAGCAGCAGAAAAAGATGCTCCACTATTATTAACTTCAAAA 960 ---------+---------+---------+—,-------+---------+--------35 '301 GLVAAPLAAEKDAPLLLTSK 320 961 GATAAATTAGATTCGTCAGTAAAATCTGAAATAAAGAGAGTTTTAGACTTAAAAACTTCA 1020 ---------+---------+---------+---------+---------+--------40’ 321DKLDSSVKSEIKRVLDLKTS 340 1021 ACAGAAGTAACAGGAAAAACAGTTTATATAGCTGGTGGAGTTAATAGTGTATCTAAAGAA 1080 ---------+---------+---------+---------+---------+--------45 341 Τ Ε V Τ G Κ Τ V Υ I A G G V Ν S V S Κ Ε 360 1081 GTTGTAACAGAATTAGAATCAATGGGATTAAAAGTTGAAAGATTCTCAGGTGATGATAGA 1140 50 ----------1-----------1-----------1-----------1-----------!---------361 VVTELESMGLKV.ER FSGDDR 380 1141 TATGAAACTTCTTTAAAAATAGCAGGTGAAATAGGCTTAGATAATGATAAGGCTTATGTA 1200 ¢0 2 00 97 TRJ002/C 381 YETSLKIAGEIGLDNDKAYV 400 1201 GTTGGTGGAACAGGATTAGCAGATGCCATGAGTATAGCTTCAGTTGCTTCTACTAAATTA 1260 ---------+---------+---------+---------+---------+--------401 V G G T G L A D A M S I A S V A S Τ K L 420 1261 GATGGTAATGGTGTTGTAGATAGAACAAATGGACATGCTACTCCAATAGTTGTTGTAGAT 1320 ----------1-----------1-----------1-----------1-----------1---------421 D G N G V V D R Τ N G Η A Τ Ρ I V V V D 440 1321 GGAAAAGCTGATAAAATATCTGATGACTTAGATAGTTTCTTAGGAAGCGCTGATGTAGAT 1380 ---------+---------+---------+---------+---------+--------441 GKADKISDDLDSFLGSADVD 460 1381 ATAATAGGTGGATTTGCAAGTGTATCTGAAAAGATGGAAGAAGCTATATCAGATGCTACT 1440 ---------+---------+---------+---------+---------+__. 461 IIGGFASVSEKMEEAISD 480 1441 GGTAAAGGCGTTACAAGAGTTAAAGGCGACGATAGACAAGACACTAACTCTGAAGTTATA ---------+---------+---------+---------+---------+__. 481 GKGVTRVKGDDRQDTNSE 500 1501 AAAACATATTATGCTAATGATACTGAAATAGCTAAAGCTGCAGTTTTAGATAAAGATTCA ---------+---------+---------+---------+---------+--501 KTYYANDTEIAKAAVLDK 520 1561 GGTGCTTCAAGTAGTGATGCAGGAGTATTTAATTTCTATGTAGCTAAAGATGGATCTACA ---------+---------+---------+---------+---------+__. 521 G A S S S D A G V F N F Υ V A K D G 540 1621 AAAGAAGATCAATTAGTTGATGCATTAGCAGTAGGAGCTGTTGCTGGATATAAACTTGCT ---------+---------+---------+-------—+---------+ 541 K E D Q L V D A L A V G A V A G Y K A T 1500 V I 1560 D S 1620 S T 1680 L A 560 . TRI002/C 1681 CCAGTTGTATTAGCTACTGATTCTTTATCTTCTGATCAATCGGTTGCTATAAGCAAAGTT 1740 ---------+---------+---------+---------+---------+--------5 561 Ρ V V L A T D S L S S D Q S V A I S K V 580 1741 GTAGGAGAAAAATATTCTAAAGATTTAACACAAGTTGGTCAAGGAATAGCTAATTCAGTT 18 00 ---------+---------+---------+---------+---------+--------10 581 VGEKYSKDLTQVGQGIANSV 600 1801 AT AAACAAAAT GAAAGAT T TAT T AGAT AT G 1830 ---------+---------+---------+ 601 INKMKDLLDM 610 TRI002/C Appendix 3 SEQ ID No. 5. Nucleotide sequence of slpA from Clostridium difficile strain 170324, PCR type 12, with translation. The putative secretory signal cleavage site (Δ) and site of cleavage to form the two mature SLPs (♦) are indicated.

ATGAATAAGAAAAATATAGCAATAGCTATGTCAGGTTTAACAGTTTTAGCTTCGGCTGCT 10 60 ---------+---------+---------+---------+---------+--------1MN KKNIAIAMSGLTVLASAA CCTGTTTTTGCTGCAACTACTGGAACACAAGGTTATACTGTAGTTAAAAACGACTGGAAA 120 ---------+---------+---------+---------+---------+--------21PVFAATTGTQGYTVVKNDWK Δ 121 AAAGCAGTAAAACAATTACAAGATGGACTAAAAGATAATAGTATAGGAAAGATAACTGTA 180 ---------+---------+---------+---------+---------+--------41KAVKQLQDGLKDNSIGKITV 181 TCTTTTAATGATGGGGTTGTGGGTGAAGTAGCTCCTAAAAGTGCTAATAAGAAAGCGGAC 240 ---------+---------+---------+---------+---------+---------61SFNDGVVGEVAPKSANKKAD 241 AGAGATGCTGCAGCTGAGAAGTTATATAATCTTGTTAACACTCAATTAGATAAATTAGGT 300 ---------+---------+---------+---------+---------+--------81RDAAAEKLYNLVNTQLDKLG 100 301 GATGGAGATTATGTTGATTTTTCTGTAGATTATAATTTAGAAAACAAAATAATAACTAAT 360 ---------+---------+---------+---------+---------+--------101 DGDYVDFS-VDYNLENKI I TN 120 361 CAAGCAGATGCAGAAGCAATTGTTACAAAGTTAAATTCACTTAATGAGAAAACTCTTA-TT 420 ---------+---------+---------+---------+---------+--------121 Q A D A E A I V Τ K L N S L Ν Ε Κ T L I 140 421 GATATAGCAACTAAAGATACTTTTGGAATGGTTAGTAAAACACAAGATAGTGAAGGTAAA 480 ---------+---------+---------+---------+---------+--------141DIATKDTFGMVSKTQDSEGK 160 481 AATGTTGCTGCAACAAAGGCACTTAAAGTTAAAGATGTTGCTACATTTGGTTTGAAGTCT 540 ---------+---------+---------+---------+---------+--------161 NVAATKALKVKDVATF GLKS 180 541 GGTGGAAGCGAAGATACTGGATATGTTGTTGAAATGAAAGCAGGAGCTGTAGAGGATAAG 600 ---------+---------+---------+---------+---------+--------181 GGS EDTGYVVEMKAGAVEDK 200 601 TATGGTAAAGTTGGAGATAGTACGGCAGGTATTGCAATAAATCTTCCTAGTACTGGACTT 660 -----— — ——j-------— — —-j- —— — -----------1-----— — — j---------201 YGKVGDSTAGIAINLPSTGL 220 661 GAATATGCAGGTAAAGGAACAACAATTGATTTTAATAAAACTTTAAAAGTTGATGTAACA 720 ---------+---------+---------+---------+---------+--------221 EYAGKGTTIDFNKTLKVDVT 240 721 GGTGGTTCAACACCTAGTGCTGTAGCTGTAAGTGGTTTTGTAACTAAAGATGATACTGAT 780 ---------+---------+---------+---------+---------+--------241 GGSTPSAVAVSGFVTKDDTD 260 781 TTAGCAAAATCAGGTACTATAAATGTAAGAGTTATAAATGCAAAAGAAGAATCAATTGAT 840 ---------+---------+---------+---------+---------+--------261 LAKSGTINVRVINAKEESID 280 841 ATAGATGCAAGCTCATATACATCAGCTGAAAATTTAGCTAAAAGATATGTATTTGATCCA 900 ---------+---------+---------+---------+---------+--------281 IDASSYTSAENLAKRYVFDP 300 901 GATGAAATTTCTGAAGCATATAAGGCAATAGTAGCATTACAAAATGATGGTATAGAGTCT 960 ---------+---------+---------+---------+---------+--------301 DEI SEAYKAIVALQNDGIES 320 961 AACTTAGTTCAGTTAGTTAATGGAAAATATCAAGTGATTTTTTATCCAGAAGGTAAAAGA 1020 ---------+---------+---------+---------+---------+--------321 NLVQLVNGKYQVI FYPEGKR 340 1021 TTAGAAACTAAATCAGCAAATGATACAATAGCTAGTCAAGATACACCAGCTAAAGTAGTT 108 0 ---------+---------+---------+---------+---------+--------341 LET KSANDTIASQDTPAKVV 360 ♦ 1081 ATAAAAGCTAATAAATTAAAAGATTTAAAAGATTATGTAGATGATTTAAAAACATATAAT 114 0 ---------+---------+---------+---------+---------+--------35 IE o W 9 7 361 IKANKLKDLKDYVDDLKTYN 380 1141 AATACTTATTCAAATGTTGTAACAGTAGCAGGAGAAGATAGAATAGAAACTGCTATAGAA 1200 5 ---------+---------+---------+---------+---------+--------381 Ν Τ Y S Ν V V Τ V A G E D R I Ε T A I E 400 1201 TTAAGTAGTAAATATTATAATTCTGATGATAAAAATGCAATAACTGATAAAGCAGTTAAT 1260 IQ ----------1----------4-----------(.---------4;----------1---------401 LSSKYYNSDDKNAITDKAVN 420 1261 GATATAGTATcTAGTTGGATCTACATCTATAGTTGATGGTCTTGTTGCATCACCATTAGCT 1320 ---------+---------+---------+---------+---------+—------421 DIVLVGSTSIVDGLVASPLA 440 1321 TCAGAAAAAACAGCTCCATTATTATTAACTTCAAAAGATAAATTAGATTCATCAGTAAAA 1380 2Q ---—---——-------1-----------1-----------1-----------1---------441 SEKTAPLLLTSKDKLDSSVK 460 1381 TCTGAAATAAAGAGAGTTATGAACTTAAAGAGTGACACTGGTATAAATACTTCTAAAAAA 1440 25 ----------1-----------1-----------1----------4-----------1---------461 SEIKRVMNLKSDTGINTSKK 480 1441 GTTTATTTAGCTGGTGGAGTTAATTCTATATCTAAAGATGTAGAAAATGAATTGAAAAAC 1500 30 ----------1-----------1-----------1-----------1-----------1---------481 VYLAGGVNSISKDVENELKN 500 1501 ATGGGTCTTAAAGTTACTAGATTATCAGGAGAAGACAGATACGAAACTTCTTTAGCAATA 1560 35 ----------1-----------1-----------1-----------1-----------1---------501 MGLKVTRLSGEDRYETSLA I 520 1561 GCTGATGAAATAGGTCTTGATAATGATAAAGCATTTGTAGTTGGTGGTACTGGATTAGCA 1620 ---------+---------+---------+---------+---------+--------521 ADEIGLDNDKAFVVGGTGLA 540 1621 GATGCTATGAGTATAGCTCCAGTTGCTTCTCAACTTAAAGATGGAGATGCTACTCCAATA 1680 ---------+---------+---------+---------+---------+--------541 DAMS IAPVASQLKDGDATPI 560 1681 GTAGTTGTAGATGGAAAAGCAAAAGAAATAAGTGATGATGCTAAGAGTTTCTTAGGAACT 1740 ---------+---------+---------+---------+---------+--------561 VVVDGKAKEISDDAKSFLGT 580 1741 TCTGATGTTGATATAATAGGTGGAAAAAATAGCGTATCTAAAGAGATTGAAGAGTCAATA 1800 ---------+---------+---------+---------4----------4---------55 TRI002/C 581 S D V D I I G G K N S V S K Ε I Ε E S I 600 1801 GATAGTGCAACTGGAAAAACTCCAGATAGAATAAGTGGAGATGATAGACAAGCAACTAAT 18 60 ---------+---------+---------+---------+---------+--------601 DSATGKTPDRISGDDRQATN 620 1861 GCTGAAGTTTTAAAAGAAGATGATTATTTCACAGATGGTGAAGTTGTGAATTACTTTGTT 1920 ----— — — 1-----------1-----------1-----------(-----------1---------621 AEVLKEDDYFTDGEVVNYFV 640 1921 GCAAAAGATGGTTCTACTAAAGAAGATCAATTAGTAGATGCCTTAGCAGCAGCACCAATA 1980 ---------+---------+---------+---------+---------+--------641 A K D G S Τ K E D Q L V D A L A A A P I 660 1981 GCAGGTAGATTTAAGGAGTCTCCAGCTCCAATCATACTAGCTACTGATACTTTATCTTCT 2040 ----------1-----------1-----------1-----------1-----------1---------661 AGRFKESPAPIILATDTLSS 680 2041 GACCAAAATGTAGCTGTAAGTAAAGCAGTTCCTAAAGATGGTGGAACTAACTTAGTTCAA 2100 25 ---------+---------+---------+---------+---------+--------681 D Q Ν V A V S K A V P K D G G Τ N L V Q 700 2101 GTAGGTAAAGGTATAGCTTCTTCAGTTATAAACAAAATGAAAGATTTATTAGATATG 2157 ---------+---------+---------+---------+---------+------701 VGKGIASSVINKMKDLLDM 719 IEO 2 00 9 7 TR1002/C Appendix 4 SEQ ID No 6. Nucleotide sequence of slpA from Clostridium difficile strain 171448, PCR type 12, with translation. The putative secretory signal cleavage site (Δ) and site of cleavage to form the two mature SLPs (♦) are indicated.

ATGAATAAGAAAAATATAGCAATAGCTATGTCAGGTTTAACAGTTTTAGCTTCGGCTGCT 6 0 ---------+---------+---------+---------+---------+--------1MNKKNIAIAMSGLTVLASAA CCTGTTTTTGCTGCAACTACTGGAACACAAGGTTATACTGTAGTTAAAAACGACTGGAAA 120 ---------+---------+---------+---------+---------+--------21PVFAATTGTQGYTVVKNDWK Δ 121 AAAGCAGTAAAACAATTACAAGATGGACTAAAAGATAATAGTATAGGAAAGATAACTGTA 180 ---------+---------+---------+---------+---------+--------41KAVKQLQDGLKDNSIGKITV 181 TCTTTTAATGATGGGGTTGTGGGTGAAGTAGCTCCTAAAAGTGCTAATAAGAAAGCGGAC 240 ---------+---------+---------+---------+---------+--------61SFNDGVVGEVAPKSANKKAD 241 AGAGATGCTGCAGCTGAGAAGTTATATAATCTTGTTAACACTCAATTAGATAAATTAGGT 300 ----------1-----------1---—--— —---f-_---------1-----------1---------81RDAAAEKLYNLVNTQLDKLG 100 301 GATGGAGATTATGTTGATTTTTCTGTAGATTATAATTTAGAAAACAAAATAATAACTAAT 360 ---------+---------+---------+---------+---------+--------101 D G D Υ V D F S V D Y N L Ε N Κ I I Τ N 120 361 CAAGCAGATGCAGAAGCAATTGTTACAAAGTTAAATTCACTTAATGAGAAAACTCTTATT 420 ---------+---------+---------+---------+---------+--------121 QADAEAIVTKLNSLNEKTLI 140 421 GATATAGCAACTAAAGATACTTTTGGAATGGTTAGTAAAACACAAGATAGTGGAGGTAAA 480 ---------+---------+---------+---------+---------+--------141 DI. ATKDTFGMVSKTQDSGGK 160 TRI002/C 481 AATGTTGCTGCAACAAAGGCACTTAAAGTTAAAGATGTTGCTACATTTGGTTTGAAGTCT 540 ---------+---------+---------+---------+---------+--------5 161 NVAATKALKVKDVA TFGLKS 180 541 GGTGGAAGCGAAGATACTGGATATGTTGTTGAAATGAAAGCAGGAGCTGTAGAGGATAAG 600 ---------+---------+---------+---------+---------+--------10 181 GGSEDTGYVVEMKAGAVEDK 200 601 TATGGTAAAGTTGGAGATAGTACGGCAGGTATTGCAATAAATCTTCCTAGTACTGGACTT 660 ---------+---------+---------+---------+---------+--------15 201 YGKVGDSTAGIAINLPSTGL 220 661 GAATATGCAGGTAAAGGAACAACAATTGATTTTAATAAAACTTTAAAAGTTGATGTAACA 720 ---------+---------+---------+---------+---------+--------20 221 EYAGKGTTIDFNKTLKVDVT 240 721 GGTGGTTCAACACCTAGTGCTGTAGCTGTAAGTGGTTTTGTAACTAAAGATGATACTGAT 780 ---------+---------+---------+---------+---------+--------25 241 GGSTPSAVAVSGFVTKDDTD 260 781 TTAGCAAAATCAGGTACTATAAATGTAAGAGTTATAAATGCAAAAGAAGAATCAATTGAT 840 ---------+---------+---------+---------+---------+--------30 261 LAKSGTINVRVINAKEESID 280 841 ATAGATGCAAGCTCATATACATCAGCTGAAAATTTAGCTAAAAGATATGTATTTGATCCA 900 ---------+---------+---------+---------+---------+--------35 281 IDASSYTSAENLAKRYVFDP 300 901 GATGAAATTTCTGAAGCATATAAGGCAATAGTAGCATTACAAAATGATGGTATAGAGTCT 960 ---------+---------+---------+---------+---------+--------40 301 DEI SEAYKAIVALQNDGIES 320 961 AATTTAGTTCAGTTAGTTAATGGAAAATATCAAGTGATTTTTTATCCAGAAGGTAAAAGA 1020 ---------+---------+---------+---------+---------+--------45 321 NLVQLVNGKYQVIFYPEGKR 340 1021 TTAGAAACTAAATCAGCAAATGATACAATAGCTAGTCAAGATACACCAGCTAAAGTAGTT 1080 ---------+---------+---------+---------+---------+--------50 341 LETKSANDTIASQDTPAKVV 360 1081 ATAAAAGCTAATAAATTAAAAGATTTAAAAGATTATGTAGATGATTTAAAAACATATAAT 114 0 ---------+---------+---------+---------+---------+--------IE Ο 2 Ο Ο 9 7 TRI002/C 361 I Κ Α Ν Κ L Κ D L Κ D Υ V D D L Κ Τ Υ Ν 380 1141 AATACTTATTCAAATGTTGTAACAGTAGCAGGAGAAGATAGAATAGAAACTGCTATAGAA 1200 5 ----------!-----------1-----------1-----------j-----------1---------381 NTYSNVVTVAGEDRIETAIE 400 1201 TTAAGTAGTAAATATTATAATTCTGATGATAAAAATGCAATAACTGATAAAGCAGTTAAT 1260 ---------+---------+---------+---------+---------+--------401 LSSKYYNSDDKNAITDKAVN 420 1261 GATATAGTATTAGTTGGATCTACATCTATAGTTGATGGTCTTGTTGCATCACCATTAGCT 1320 ---------+---------+---------+---------+---------+--------421 DIVLVGSTSIVDGLVAS PLA 440 1321 TCAGAAAAAACAGCTCCATTATTATTAGCTTCAAAAGATAAATTAGATTCATCAGTAAAA 1380 ---------+---------+---------+---------+---------+--------441 SEKTAPLLLAS KDKLDS SVK 460 1381 TCTGAAATAAAGAGAGTTATGAACTTAAAGAGTGACACTGGTATAAATACTTCTAAAAAA 1440 25 ----------1-----------1-----------1-----------1-----------1-_-------4 61SEI KRVMNLKSDTGINTSKK 480 1441 GTTTATTTAGCTGGTGGAGTTAATTCTATATCTAAAGATGTAGAAAATGAATTGAAAAAC 1500 30 ----------1-----------1-----------1-----------1-----------1---------481 VYLAGGVNSISKDVENELKN 500 1501 ATGGGTCTTAAAGTTACTAGATTATCAGGAGAAGACAGATACGAAACTTCTTTAGCAATA 1560 ---------+---------+---------+---------+---------+--------501 MGLKVTRLSGEDRYETSLAI 520 1561 GCTGATGAAATAGGTCTTGATAATGATAAAGCATTTGTAGTTGGTGGTACTGGATTAGCA 1620 40 ----------1-----------1-----------1-----------ί-----'———ι----------521 A D Ε I G L D N D K A F V V G G T G L A 540 1621 GATGCTATGAGTATAGCTCCAGTTGCTTCTCAACTTAAAGATGGAGATGCTACTCCAATA 1680 ---------+---------+---------+---------+---------+--------541 DAMSIAPVASQLKDGDATPI 560 1681 GTAGTTGTAGATGGAAAAGCAAAAGAAATAAGTGATGATGCTAAGAGTTTCTTAGGAACT 174 0 ---------+---------+---------+---------+---------+--------561 VVVDGKAKEISDDAKSFLGT 580 1741 TCTGATGTTGATATAATAGGTGGAAAAAATAGCGTATCTAAAGAGATTGAAGAGTCAATA 1800 -----------j-----------1-----------1-----------(-----------[---------55 9E 0 2 0 Ο 9 T‘ TRI002/C 581 SDVDI IGGKNSVSKEIEESI 600 1801 GATAGTGCAACTGGAAAAACTCCAGATAGAATAAGTGGAGATGATAGACAAGCAACTAAT 1860 5 ----------1-----------1-----------1-----------i-----------1---------601 DSATGKTPDRISGDDRQATN 620 1861 GCTGAAGTTTTAAAAGAAGATGATTATTTCACAGATGGTGAAGTTGTGAATTACTTTGTT 1920 ---------+---------+---------+---------+---------+--------621 AEVLKEDDYFTDGEVVNYFV 640 1921 GCAAAAGATGGTTCTACTAAAGAAGATCAATTAGTAGATGCCTTAGCAGCAGCACCAATA 1980 15 ----------i-----------1-----------1-----------1-----------1---------641 AKDGSTKEDQLVDALAAAPI 660 1981 GCAGGTAGATTTAAGGAGTCTCCAGCTCCAATCATACTAGCTACTGATACTTTATCTTCT 2040 ---------+---------+---------+---------+---------+--------661 AGRFKESPAPIILATDTLSS 680 2041 GACCAAAATGTAGCTGTAAGTAAAGCAGTTCCTAAAGATGGTGGAACTAACTTAGTTCAA 2100 25 ----------i-----------1-----------1-----------1-----------1---------681 DQNVAVSKAVPKDGGTNLVQ 700 2101 GTAGGTAAAGGTATAGCTTCTTCAGTTATAAACAAAATGAAAGATTTATTAGATATG 2157 ---------+---------+---------+---------+---------+------701 VGKGIASSVINKMKDLLDM 719 ΙΕΟ 2 Ο Ο 9 7 TRI002/C Appendix 5 SEQ ID No. 7. Nucleotide sequence of slpA from Clostridium difficile strain 171862, PCR type 17, with translation. The putative secretory signal cleavage site (Δ) and site of cleavage to form the two mature SLPs (♦) are indicated.

ATGAATAAGAAAAACTTAGCAATGGCTATGGCAGCAGTTACTGTTGTGGGTTCTGCAGCG 60 —--------4-----------l·----------)-----------(-----------j.--------1MNKKNLAMAMAAVTVVGSAA CCAATATTTGCAGATAGTACTACGCCAGGTTATACTGTAGTGAAAAATGATTGGAAAAAA 120 ----------1-----------1-----------1-----------'---------1---------21PIFADSTTPGYTVVKNDWKK Δ 121 GCAGTAAAACAATTACAAGATGGGTTGAAAAATAAAACTATATCAACAATAAAGGTGTCT 180 ---------+---------+---------+---------+---------+--------41AVKQLQDGLKNKTISTIKVS 181 TTTAATGGAAACTCTGTTGGAGAAGTTACACCAGCCAGTTCTGGAGCAAAAAAAGCAGAT 24 0 ----------1-----------1-----------1-----------1-----------1---------61FNGN SVGEVTPAS SGAKKAD 241 AGAGATGCTGCAGCTGAAAAGTTATATAATTTAGTAAATACACAATTAGATAAACTAGGT 300 ---------+---------+---------+---------+---------+--------81RDAAAEKLYNLVNTQLDKLG 100 301 GATGGAGATTACGTTGACTTTGAAGTAACTTATAATTTAGCTACTCAAATAATTACAAAA 360 ----------1-----------1-----------1-----------1-----------1---------101 DGDYV DFEVTYNL ATQI I TK 120 361 GCAGAAGCAGAGGCAGTTCTTACAAAATTACAACAATATAATGATAAAGTACTTATAAAT 420 ---------+---------+---------+---------+---------+--------121 AEAEAVLTKLQQYNDKVLIN 140 421 TCTGCAACAGATACAGTAAAAGGTATGGTATCTGATACACAAGTTGATAGCAAAAATGTT 4 80 ----------1-----------1-----------1-----------)-----------1---------141 SATDTVKGMVSDTQVDSKNV 160 TRI002/C 481 GCAGCTAACCCACTTAAAGTTAGTGATATGTATACAATACCATCTGCTATTACTGGAAGT 540 ---------+---------+---------+---------+---------+--------5 161 A A Ν P L K V S D Μ Υ Τ I P S A I T G S 180 541 GATGATTCTGGGTATAGTATTGCTAAACCAACAGAAAAGACTACAaGTTTATTGTATGGT 600 ---------+---------+---------+---------+---------+--------10 181DDSGYSIAKPTEKTTSLLYG 200 601 ACGGTTGGTGATGCAACTGCAGGTAAAGCAATAACAGTAGATACAGCTTCAAATGAAGCT 660 ---------+---------+---------+---------+---------+--------15 201 TVGDATAGKAITVDTASNEA 220 661 TTTGCTGGAAATGGAAAGGTTATTGACTACAATAAATCATTCAAAGCAACTGTACAAGGA 720 ---------+---------+---------+---------+---------+--------20 221 FAGNGKVIDYNKSFKATVQG 240 721 GATGGAACAGTTAAGACAAGCGGGGTTGTACTTAAAGATGCAAGTGATATGGCTGCAACA 780 25 ----------1-----------1-----------1-----------1-----------1---------241 DGTVKTSGVVLKDASDMAAT 260 781 GGTACTATAAAAGTTAGAGTTACAAGTGCAAAAGAAGAATCTATTGATGTGGATTCAAGT 84 0 30 ---------+---------+---------+— ------+---------+--------261 GTIKVRVTSAKEESIDVDSS 280 841 TCATATATTAGTGCTGAAAATTTAGCTAAAAAATATGTATTTAATCCTAAAGAGGTTTCT 900 35 ---------h----------+----------1-----------1-----------1---------281 SYI SAENL AK KYVFNPKEVS 300 901 GAAGCTTATAATGCAATAGTTGCATTACAAAATGATGGAATAGAATCTGATTTAGTACAA 960 40 ---------+---------+---------+---------+---------+--------301 Ε A Y N A I V A L Q N D G I E S D L V Q 320 961 TTAGTTAATGGAAAATATCAAGTTATTTTCTATCCAGAAGGAAAAAGATTAGAAACTAAA 1020 45 ----------1-----------1-----------1-----------1-----------1---------321 LVNGKYQVIFYPEGKRLETK 340 1021 TCTGCAGATATAATAGCTGATGCAGATAGTCCAGCTAAAATAACTATAAAAGCTAATAAA 1080 ------- (-----------1-----------μ----------1—----------1 —-----341 SADI IADADSPAKITIKANK 360 ♦ 1081 TTAAAAGATTTAAAAGATTATGTAGATGATTTAAAAACATACAATAATACTTACTCAAAT 114 0 ---------+---------+---------+---------+---------+--------10 361 LKDLKDYVDDLKTYNNTYSN 380 1141 GTTGTAACAGTAGCAGGAGAAGATAGAATAGAAACTGCTATAGAATTAAGTAGTAAATAT 1200 ---------+---------+---------+---------+---------+--------15 381 VVTVAGEDRIETAIELSSKY 400 1201 TATAATTCTGATGATAAAAATGCAATAACTGATGATGCAGTTAATAATATAGTATTAGTT 1260 ---------+---------+---------+---------+---------+--------20 401 Y N S D D K N A I T D D A V Ν Ν I V L V 420 1261 GGATCTACATCTATAGTTGATGGTCTTGTTGCATCACCATTAGCTTCAGAAAAAACAGCT 1320 ---------+---------+---------+_--------+---------+--------25 421 G S T S I V D G L V A S P L A S Ε K T A 440 1321 CCATTATTATTAACTTCAAAAGATAAATTAGATTCATCAGTAAAATCTGAGATAAAAAGA 1380 ---------+---------+---------+---------+---------+--------30 441 PLLLTSKDKLDSSVK SEIKR 460 1381 GTTATGAACTTAAAGAGTGATACTGGTATAAATACTTCTAAAAAAGTTTATTTAGCTGGT 14 4 0 ---------+---------+---------+---------+---------+--------35 4 61 V Μ N L K S D T G I Ν T S K K V Y L A G 480 1441 · GGAGTTAATTCTATATCTAAAGATGTAGAAGATGAATTGAAAAATATGGGCCTTAAAGTT 1500 ---------+---------+---------+---------+---------+--------40 481GVNSISKDVEDELKNMGLKV 500 1501 ACTAGATTATCAGGAGAAGACAGATACGAAACTTCTTTAGCAATAGCTGATGAAATAGGT 1560 ---------+---------+---------+---------+---------+--------45 501 T R L S G E D R Υ Ε T S L A I A D Ε I G 520 1561 CTTGATAATGATAAAGCATTTGTAGTTGGTGGTACTGGATTGGCAGATGCTATGAGTATA 1620 ---------+---------q.---------+---------+---------+--------50 521 L D N D K A F V V G G T G L A D A M S I 540 1621 GCTCCAGTTGCTTCTCAACTTAAAGATGGAGATGCTACTCCAATAGTAGTTGTAGATGGA 1680 ---------+---------+---------+---------+---------+--------IE Ο 2 Ο Ο 9 7 TRI002/C 541 A Ρ V A S QLKDG DAT Ρ I -V V V D G 560 1681 AAAGCAAAAGAAATAAGTGATGATGCTAAGAGTTTCTTAGGAACTTCTGATGTTGATATA 174 0 ---------+---------+---------+---------+-------__+--------561 KAKEISDDAKSFLGTSDVDI 580 1741 ATAGGTGGAAAAAATAGCGTATCTAAAGAGATTGAAGAGTCAATAGATAGTGCAACTGGA 1800 ----------1----------Ί-----------Η----------1-----------1---------581 IGGKNSVSKEIEESIDSATG 600 1801 AAAACTCCAGATAGAATAAGTGGAGATGACAGACAAGCAACTAATGCTGAAGTTTTAAAA 1860 ----------1----------ί-----------1-----------1-----------1---------601 Κ Τ Ρ D R I S G D D R Q Α Τ Ν A Ε V L Κ 620 1861 GAAGATGATTATTTCAAAGATGGTGAAGTTGTGAATTACTTTGTTGCAAAAGATGGTTCT 1920 ---------+---------+---------+---------+---------+--------621 EDDYFKDGEVVNYFVAKDGS 640 1921 ACTAAAGAAGATCAATTAGTAGATGCATTAGCAGCAGCACCAATAGCAGGTAGATTTAAG 1980 25 ---------+---------+---------+---------+---------+--------641TKEDQLVDALAAAPIAGRFK 660 1981 GAGTCTCCAGCTCCAATCATACTAGCTACTGATACTTTATCTTCTGACCAAAATGTAGCT 2040 30 ----------1-----------1-----------1-----------1-----------1---------661 ESPAPIILAT DTL-SSDQNVA 680 2041 GTAAGTAAAGCAGTTCCTAAAGATGGTGGAACTAACTTAGTTCAAGTAGGTAAAGGTATA 2100 ---------+---------+---------+---------+---------+--------681 VSKAVPKDGGTNLVQVGKGI 700 2101 GCTTCTTCAGTTATAAACAAAATGAAAGATTTATTAGATATGTAA 2145 ---------+---------+---------+---------+--701 ASSVINKMKDLLDM* 715 ΙΕ ο 2 Ο Ο 9 7 TRJ002/C Appendix 6 SEQ ID No 8. Nucleotide sequence of slpA from Clostridium difficile strain 173644, PCR type 31, with translation. The putative secretory signal cleavage site (Δ) and site of cleavage to form the two mature SLPs (♦) are indicated.

ATGAATAAGAAGGATATAGCAATAGCTATGTCAGGATTAACAGTATTAGCTTCTGCAGCA 60 ---------+---------+---------+---------+---------+--------1MNKKDIAIAMSGLTVLASAA CCTGTATTTGCTGCTAGTAGTTTTACAGCAGATTATAATTATACTGTAGTGCAAGGAAAA 120 ---------+---------+---------+---------+---------+--------21PVFAASSFTADYNYTVVQGK Δ 121 TATCAAAAAGTTATAACTGGATTACAAGATGGTTTAAAAAATGGAAAAATAACAAATATT 180 ----------1-----------1-----------1-----------1-----------1---------41YQKVITGLQDGLKNGKITNI 181 GATGTAATATTTGATGGAAGTTCAATTGGTGAGGTAGTGCCAGGTTCTGATGCTGCAGCT 24 0 ---------+---------+---------+---------+---------+--------61DVI FDGSSIGEVVPGSDAAA 241 GCAGCTACTAAATTAAAAAGTTTAGTTGATGATAAGTTAGATAACTTAGGTGATGGAAAA 300 ---------+---------+---------+---------+---------+--------81AATKLKSLVDDKLDNLGDGK 100 301 TACGTTCAATTTAATGTTACTTATACTACTAAATCTATAATAACTAAAGCAGAATTAAAA 360 ---------+---------+---------+---------+---------+--------101 Υ V Q F N V Τ Υ Τ Τ K S I I Τ K A E L K 120 361 AATTATTATAATCAATTAGAAAGTAGTAAAGATAGAATACTTATAGGAAATGAACCTCAA 420 ---------+---------+---------+---------+---------+--------121NYYNQLESSKDRILIGNEPQ 140 421 GATACAGGAACTAAAGGTCTTATAAAAGCTGATACTGATGGTACTACTGCTGTTGCAGCA 480 ---------+---------+---------+---------+---------+--------141 DTGTKGLIKADTDGTTAVAA 160 481 GCTGCACCATTGAAATTATCAGATATATTTACGTTTAGTTATGATGAAGTAACAGGTGTA 54 0 ---------+---------+---------+---------+---------+--------161 AAPLKLSDIFTFSYDEVTGV 180 IE Ο 2 Ο Ο 9 7 TRI002/C 541 CTTAAAGCAGAACCAACAAGTAAAGTAAGCGCTGGTAAAGTTCAAGGTCTAAAATATGGA 600 ---------+---------+---------+---------+---------+--------181LKAEPTSKVSAGKVQGLKYG 200 601 AATACAGGAGCAACTAACTATACTTCTGGAGCTGAAATATCTGTTCCTACTACAGGCTTA 660 ---------+---------+---------+---------+---------+--------201 NTGATNYTSGAEISVPTTGL 220 661 ACATTAACTGCTGATACAACTGCAACAACAGATGTAAATATTTCTGATGTTATGAGTGCA 720 ---------+---------+---------+---------+---------+--------221 TLTADTTATTDVNISDVMSA 240 721 TTTAAATTTAATGGTACTGATACGATTAGTGGATTCCCAGCTGGTTCATCAGCTTCTACT 780 ---------+---------+---------+---------+---------+--------241FKFNGTDTISGFPAGSSAST 260 781 CTTAGAGCAAGTATAAAAGTAATAAATGCAAAAGAAGAATCTATAGATGTTGATTCAAGT 84 0 ---------+---------+---------+---------+---------+--------261 LRASIKVINAKEESIDVDSS 280 841 TCACATAGAACAGCTGAAGATTTAGCTGAAAAATATGTATTTAAACCAGAAGATGTGAAT 900 ---------+---------+---------+---------+----:-----+--------281 SHRTAEDLAEKYVFKPEDVN 300 901 AAAACTTATGAGGCACTGACTGATTTATATAAAGAAGGTATAACAAGTAATCTTATCACT 960 ---------+---------+---------+---------+---------+--------301 KTYEALTDLYKEGITSNLIT 320 961 CAAGATGGTGGAAAATATCAAGTTGTTTTATTTGCTCAAGGAAAGAGATTAACTACTAAA 1020 ---------+---------+---------+----------+---------+--------321 QDGGKYQVVLFAQGKRLTTK 340 1021 GGAGCAACTGGAACTTTAGCAGATGAAAATTCTCCTCTTAAAGTAACAATAAAAGCAGAT 1080 ----------1-----------1------— — 1 —-----— 4-----------1---------341GATGTLADENSPLKVTIKAD 360 ♦ 1081 AAAGTAAAAGACTTAAAAGATTATGTTGAAGATTTAAAAAATGCTAACAATGGATATTCA 1140 50 ----------1-----------ι-----------1-----------1-----------1---------361KVKDLKDYVEDLKNANNGYS 380 1141 AATTCTGTTGTTGTAGCAGGTGAAGATAGAATAGAAACAGCAATAGAGTTAAGTAGCAAA 1200 TRI002/C 381 NSVVVAGEDRIETAIELSSK 400 1201 TACTATAACTCTGATGATGACAATGCAATAACTAAAGATCCAGTTAACAATGTTGTTTTA 1260 ---------+---------+---------+---------+---------+--------401YYNSDDDNAITKDPVNNVVL 420 1261 GTTGGTTCTCAAGCTGTAGTTGATGGGCTTGTAGCTTCACCTTTAGCATCTGAAAAAAGA 1320 ---------+---------+---------+---------+---------+--------421 VGSQAVVDGLVAS PLASE. KR 440 1321 GCTCCTTTACTATTAACTTCAGCAGGAAAATTAGATTCAAGTGTTAAAGCTGAGTTGAAA 1380 ----------1-----------1-----------1-----------1-----------1---------441 APLLLTSAGKLDSSVKAELK 460 1381 AGAGTAATGGATTTAAAATCTACAACAGGTGTAAATACTTCTAAAAAAGTTTACTTAGCT 14 40 ---------+---------+---------+---------+---------+-------.4 61RVMDL KS T TGVN T SKKVYLA 480 1441 GGTGGAGTAAACTCTATATCTAAAGATGTAGAAAATGAATTAAAAGATATGGGACTTAAA 1500 ----------1·----------1-----------1-----------1-----------1---------481 GGVNS ISKDVENELKDMGLK 500 1501 GTTACAAGATTATCAGGAGATGATAGATATGAAACTTCTTTAGCTATAGCTGATGAAATA 1560 · ---------+---------+---------+---------+---------+--------501 VTR. LSGDDRYETSLAIADEI 520 1561 GGTCTTGATAATGATAAAGCTTTTGTAGTTGGAGGAACAGGATTAGCGGATGCTATGAGT 1620 35 ---------*-----------1--------------------ί-----------1---------521 GLDNDKAFVVGGTGLADAMS 540 1621 ATAGCTCCAGTTGCTTCTCAATTAAGAAACTCAAATGGAGAACTTGACTTAAAAGGTGAT 1680 40 ----------'-----------'-----------1-----------'-----------'---------541 IAPVASQLRNSNGELDLKGD 560 1681 GCAACTCCAATAGTAGTTGTTGATGGAAAAGCTAAAGATATAAATTCTGAAGTAAAAGAT 1740 ---------+---------+---------+---------+---------+--------561 A Τ Ρ I V V V D G K A K D I N S Ε V K D 580 1741 TTCTTAGATGATTCACAAGTTGATATAATAGGTGGTGTAAATAGTGTTTCTAAAGAAGTA 1800 ----------1-----------[-----------j-----------j-----------(---------581 FLDDSQVDIIGGVNSVSKEV 600 1801 ATGGAAGCAATAGATGATGCTACTGGAAAATCACCTGAGAGATATAGTGGAGAAGATAGA 18 60 ---------+---------+---------+---------+---------+--------IE Ο 2 Ο Ο 9 7 TRI002/C 6O1MEAIDDATGKSPERYSGEDR 620 1861 CAAGCAACAAATGCTAAAGTTATAAAAGAAGATGATTTCTTTAAAAATGGAGAAGTTACA 1920 ---------·ί----------+---------*-----------·---------ί---------621 Q Α Τ Ν A Κ V I Κ Ε D D F F Κ Ν G Ε V Τ 640 1921 AACTTCTTTGTAGCTAAAGATGGTTCAACTAAAGAAGATCAATTAGTAGATGCTTTAGCA 1980 ---------->·---------+----------1-----------ι_----------1---------641NFFVAKDGSTKEDQLVDALA 660 1981 GGTGCTGCAATTGCTGGTAACTTTGGTGTAACAGTAGATAATGAAGGAAAACCTACAGTT 2040 |5 ---------+---------+---------+---------+---------+--------661 G A A I A G Ν F G V Τ V D Ν Ε G Κ Ρ Τ V 680 ’ 2041 GCTGATAAAAAAGCTTCTCCAGCACCAATTGTTTTAGCAACAGATTCTTTATCTTCTGAT 2100 ----------η---------+----------1-----------1-----------ι---------681ADKKASPAPIVLATDSLSSD 700 2101 CAAAATGTAGCTATAAGTAAAGCTGTAAATGATGACGCTAATACTAAGAATCTAGTTCAA 2160 ---------+---------+---------+---------+---------+--------701 QN'VAI SKAVNDDANTKNLVQ 720 2161 GTTGGTAAAGGTATAGCTACTTCAGTTGTAAGTAAAATAAAAGATTTATTAGATATG 2217 ---------+---------+---------+---------+---------+------721 V G K G I A T S V V S Κ I K D L L D Μ 739 ,Ε υ ζ υ u g / TRI002/C Appendix 7 SEQ ID No 9. Nucleotide sequence of slpA from Clostridium difficile strain 170444, PCR type 46, wit-h translation. The putative secretory signal cleavage site (Δ) and site of cleavage to form the two mature SLPs (♦) are indicated.

ATGAATAAGAAAAATATAGCAATAGCTATGTCAGGTTTAACAGTTTTAGCTTCGGCTGCT 60 ----------j-----------[-----------1-----------1-----------]---------1MNKKNIAIAMSGLTVLASAA CCTGTTTTTGCTGCAACTACTGGAACACAAGGTTATACTGTAGTTAAAAACGACTGGAAA 120 ---------+---------+---------+---------+---------+--------21PVFAATTGTQGYTVVKNDWK Δ 121 AAAGCAGTAAAACAATTACAAGATGGACTAAAAGATAATAGTATAGGAAAGATAACTGTA 180 ------— j — —-----------]----—————— -1— —--------1---------41KAVK QLQDGLKDNSIGKITV 181 TCTTTTAATGATGGGGTTGTGGGTGAAGTAGCTCCTAAAAGTGCTAATAAGAAAGCGGAC 240 ---------+---------+---------+---------+---------+--------61SFNDGVVGEVAPKSANKKAD 241 AGAGATGCTGCAGCTGAGAAGTTATATAATCTTGTTAACACTCAATTAGATAAATTAGGT 300 ---------+---------+---------+---------+---------+--------81RDAAAEKLYNLVNTQLDKLG 100 301 GATGGAGATTATGTTGATTTTTCTGTAGATTATAATTTAGAAAAAAAAATAATAACTAAT 360 ---------+---------+---------+---------+---------+--------101 DGDYVDFSVDYNLEKKI ITN 120 361 CAAGCAGATGCAGAAGCAATTGTTACAAAGTTAAATTCACTTAATGAGAAAACTCTTATT 420 ---------+---------+---------+---------+---------+--------121 QADAEAIVTKLNSLNEKTLI 140 421 GATATAGCAACTAAAGATACTTTTGGAATGGTTAGTAAAACACAAGATAGTGAAGGTAAA 4 80 ---------+---------+---------+---------+---------+--------141 DIATKDTFGMVSKTQDSEGK 160 TRI002/C 481 AATGTTGCTGCAACAAAGGCACTTAAAGTTAAAGATGTTGCTACATTTGGTTTGAAGTCT 540 ---------+---------+---------+---------+--------- +--------5 1 61 Ν V A A Τ K A L K V K D V A T F G L K S 180 541 GGTGGAAGCGAAGATACTGGATATGTTATTGAAATGAAAGCAGGAGCTGTAGAGGATAAG 600 ----------1-----------j-----------j-----------1-----------,---------10 181GGSEDTGYVIEMKAGAVEDK 200 601 TATGGTAAAGTTGGAGATAGTACGGCAGGTATTGCAATAAATCTTCCTAGTACTGGACTT 660 ---------+---------+---------+---------+---------+--------15 201YGKVGDSTAGIAINLPSTGL 220 661 GAATATGCAGGTAAAGGAACAACAATTGATTTTAATAAAACTTTAAAAGTTGATGTAACA 720 ----------(-----------(-----------(-----------1---------------------20 221 EYAGK GTTIDFNKTLKVDVT 240 721 GGTGGTTCAACACCTAGTGCTGTAGCTGTAAGTGGTTTTGTAACTAAAGATGATACTGAT 780 ---------+---------+----------(.---------+----------,.--------25 241GGSTPSAVAVSGFVTKDDTD 260 781 TTAGCAAAATCAGGTACTATAAATGTAAGAGTTATAAATGCAAAAGAAGAATCAATTGAT 840 ---------+---------+---------+---------+---------+--------30 261 L A K S G Τ I Ν V R V ,1 Ν A K Ε E S I D 280 841 ATAGATGCAAGCTCATATACATCAGCTGAAAATTTAGCTAAAAGACATGTATTTGATCCA 900 ---------+---------+---------+---------+---------+--------35 281 IDASSYTSAENLAKRHVFDP 300 901 GATGAAATTTCTGAAGCATATAAGGCAATAGTAGCATTACAAAATGATGGTATAGAGTCT 960 ---------+----,-----+---------+---------+---------+--------40 301 D Ε I S Ε A Y K A I V A L Q N D G I E S 320 961 AATTTAGTTCAGTTAGTTAATGGAAAATATCAAGTGATTTTTTATCCAGAAGGTAAAAGA 1020 ---------+---------+---------+---------+---------+--------45 321 NLVQLVNGKYQVIFYPEGKR 340 IE U 2 Ο Ο 9 7 TRI002/C 1021 TTAGAAACTAAATCAGCAAATGATACAATAGCTAGTCAAGATACACCAGCTAAAGTAGTT 1080 ---------+---------+---------+---------+---------+--------341 LETKSANDTIASQDTPAKVV 360 ♦ 1081 ATAAAAGCTAATAAATTAAAAGATTTAAAAGATTATGTAGATGATTTAAAAACATATAAT 1140 -------- --j----------4-----------J-----------μ----------1---------10 361IKANKLKDLKDYVDDLKTYN 380 1141 AATACTTATTCAAATGTTGTAACAGTAGCAGGAGAAGATAGAATAGAAACTGCTATAGAA 1200 ---------+---------+---------+---------+---------+--------15 381 NTYSNVVTVAGEDRIETAIE 400 1201 TTAAGTAGTAAATATTATAATTCTGATGATAAAAATGCAATAACTGATAAAGCAGTTAAT 1260 ----------1----------4-----------1-----------1-----------1---------20 401 LSSKYYNSDDKNAITDKAVN 420 1261 GATATAGTATTAGTTGGATCTACATCTATAGTTGATGGTCTTGTTGCATCACCATTAGCT 1320 ---------+---------+---------+---------+---------+--------25 421 D I V L V G S T S I V D G L V A S P L A 440 1321 TCAGAAAAAACAGCTCCATTATTATTAACTTCAAAAGATAAATTAGATTCATCAGTAAAA 1380 ---------+---------+---------+---------+---------+--------30 441 SEKTAPLLLTSKDK LDSSVK 460 1381 TCTGAAATAAAGAGAGTTATGAACTTAAAGAGTGACACTGGTATAAATACTTCTAAAAAA 144 0 ---------+---------+---------+---------+---------+--------35 461 SEIKRVMNLKSDTGINTSKK 480 1441 GTTTATTTAGCTGGTGGAGTTAATTCTATATCTAAAGATGTAGAAAATGAATTGAAAAAC 1500 ---------+---------+---------+---------+---------+--------40 481 VYLAGGVNSISKDVENELKN 500 1501 ATGGGTCTTAAAGTTACTAGATTATCAGGAGAAGACAGATACGAAACTTCTTTAGCAATA 1560 ---------+---------+---------+---------+---------+--------45 501 MGLKVTRLSGEDRYETSLAI 520 1561 GCTGATGAAATAGGTCTTGATAATGATAAAGCATTTGTAGTTGGTGGTACTGGATTAGCA 1620 ----------1-----------j-----------j-----------1-----------(---------50 521 ADEIGLDNDKAFVVGGTGLA 540 1621 GATGCTATGAGTATAGCTCCAGTTGCTTCTCAACTTAAAGATGGAGATGCTACTCCAATA 1680 ---------+---------+---------+---------+---------+-------52 TRI002/C 541 D A M S IAPVASQLKDGDATPI 560 1681 GTAGTTGTAGATGGAAAAGCA.AAAGAAATAAGTGATGATGCTAAGAGTTTCTTAGGAACT 1740 ---------+---------+---------+---------+---------+-------561 V V V D G K A Κ Ε I S D D A K S F L G T 580 1741 TCTGATGTTGATATAATAGGTGGAAAAAATAGCGTATCTAAAGAGATTGAAGAGTCAATA 1800 ---------+---------+---------+---------+---------+-------581 SDVDIIGGKNSVSKEIEESI 600 1801 GATAGTGCAACTGGAAAAACTCCAGATAGAATAAGTGGAGATGATAGACAAGCAACTAAT 1860 ---------+---------+---------+---------+---------+--------601 D S A T G Κ Τ P D R I S G D D R Q A Τ N 620 1861 GCTGAAGTTTTAAAAGAAGATGATTATTTCACAGATGGTGAAGTTGTGAATTACTTTGTT 1920 ---------+---------+---------+---------+---------+------— 621 AEVLKEDDYFTDGEVVNYFV 640 1921 GCAAAAGATGGTTCTACTAAAGAAGATCAATTAGTAGATGCCTTAGCAGCAGCACCAATA 1980 ---------+---------+---------+---------+---------+--------641 A K D G S Τ Κ E D Q L V D A L A A A P I 660 1981 GCAGGTAGATTTAAGGAGTCTCCAGCTCCAATCATACTAGCTACTGATACTTTATCTTCT 2040 ----------·---------------------1-----------1-----------1---------661A GRFKESPAPIILATDTLSS 680 2041 GACCAAAATGTAGCTGTAAGTAAAGCAGTTCCTAAAGATGGTGGAACTAACTTAGTTCAA 2100 ----------1----------·-----------1-----------1-----------1---------681 D Q N V A V S K A V P K D G G Τ N L V Q 700 2101 GTAGGTAAAGGTATAGCTTCTTCAGTTATAAACAAAATGAAAGATTTATTAGATATG 2157 ----------1----------η-----------t----------Ί----------+------701 VGKGIASSVINKMKDLLDM 719 a V U O f TRI002/C Appendix 8 SEQ ID No 10. Nucleotide sequence of slpA from Clostridium difficile strain 170426, PCR type 92, with translation. The putative secretory signal cleavage site (Δ) and site of cleavage to form the two mature SLPs (♦) are indicated.

ATGAATAAGAAAAATATAGCAATAGCTATGTCAGGTTTAACAGTTTTAGCTTCGGCTGCT ---------+---------+---------+---------+---------+— 1MNKKNIAIAMSGLTVLAS CCTGTTTTTGCTGCAACTACTGGAACACAAGGTTATACTGTAGTTAAAAACGACTGGAAA ---------+---------+---------+---------+--------21 PVFAATTGTQ GYTVVKND 40 Δ 121 AAAGCAGTAAAACAATTACAGGATGGACTAAAAGATAATAGTATAGGAAAGATAACTGTA ---------+---------+---------+---------+---------+__.

K A V. KQLQDGLKDNSIGKI 181 TCTTTTAATGATGGGGTTGTGGGTGAAGTAGCTCCTAAAAGTGCTAATAAGAAAGCGGAC ---------+---------+---------+---------+---------+-- 61SFNDGVVGEVAPKSANKK 241 AGAGATGCTGCAGCTGAGAAGTTATATAATCTTGTTAACACTCAATTAGATAAATTAGGT ---------+---------+---------+---------+---------+— 81RDAAAEKLYNLVNTQLDK 100 301 GATGGAGATTATGTTGATTTTTCTGTAGATTATAATTTAGAAAAAAAAATAATAACTAAT ---------+---------+---------+---------+---------+--101 DGDYVDFSVDYNLEKKII 120 361 CAAGCAGATGCAGAAGCAATTGTTACAAAGTTAAATTCACTTAATGAGAAAACTCTTATT ---------+---------+---------+---------+---------+--121QADAEAIVTKL NSLNEKT 140 421 GATATAGCAACTAAAGATACTTTTGGAATGGTTAGTAAAACACAAGATAGTGAAGGTAAA ----------]-----------j-----------1-----------1-----------[---+ 141 DIATKDTFGMVSKTQDSE 160 A A 120 W K 180 T V 240 A D 300 L G 360 Τ N 420 L I 480 G K 481 AATGTTGCTGCAACAAAGGCACTTAAAGTTAAAGATGTTGCTACATTTGGTTTGAAGTCT 540 ---------+---------+---------+---------+---------+-------161 NVAATKALKVKDVATFGLKS 180 ΙΕΟ 2 00 9 7 TRI002/C 541 GGTGGAAGCGAAGATACTGGATATGTTGTTGAAATGAAAGCAGGAGCTGTAGAGGATAAG 600 ---------+---------+---------+---------+---------+--------181 G G S Ε D Τ G Υ V V Ε Μ Κ A G A V Ε D Κ 200 601 TATGGTAAAGTTGGAGATAGTACGGCAGGTATTGCAATAAATCTTCCTAGTACTGGACTT 660 ---------+---------+---------+---------+---------+--------201 YGKVGDSTAGIAINLPSTGL 220 661 GAATATGCAGGTAAAGGAACAACAATTGATTTTAATAAAACTTTAAAAGTTGATGTAACA 720 ---------+---------+---------+---------+---------+--------221 EYAGKGTTIDFNKTLKVDVT 240 721 GGTGGTTCAACACCTAGTGCTGTAGCTGTAAGTGGTTTTGTAACTAAAGATGATACTGAT 780 ---------+---------+---------+---------+---------+--------241 GGS TPSAVAVSGFVTKDDTD 260 781 TTAGCAAAATCAGGTACTATAAATGTAAGAGTTATAAATGCAAAAGAAGAATCAATTGAT 8 4 0 ---------+---------+---------+__-------+---------+--------261 LAKSGTINVRVINAKEESID 280 841 ATAGATGCAAGCTCATATACATCAGCTGAAAATTTAGCTAAAAGATATGTATTTGATCCA 900 ---------+---------+---------+---------+---------+--------281 IDASSYTSAENL AKRYVFDP 300 901 GATGAAATTTCTGAAGCATATAAGGCAATAGTAGCATTACAAAATGATGGTATAGAGTCT 960 ---------+---------+---------+---------+---------+--------301 DEI SEAYKAIVALQNDGIES 320 961 AATTTAGTTCAGTTAGTTAATGGAAAATATCAAGTGATTTTTTATCCAGAAGGTAAAAGA 1020 ---------+---------+---------+---------+---------+--------321 NLVQLVNGKYQVIFYPEGKR 340 1021 TTAGAAACTAAATCAGCAAATGATACAATAGCTAGTCAAGATACACCAGCTAAAGTAGTT 1080 ---------+---------+---------+---------+---------+--------341 L Ε Τ K S A N D Τ I A S Q D Τ Ρ A Κ V V 360 ♦ 1081 ATAAAAGCTAATAAATTAAAAGATTTAAAAGATTATGTAGATGATTTAAAAACATATAAT 114 0 ---------+---------+---------+---------+---------+--------361 IKANKLKDLKDYVDDLKTYN 380 1141 AATACTTATTCAAATGTTGTAACAGTAGCAGGAGAAGATAGAATAGAAACTGCTATAGAA 1200 5h ----------f-----------1-----------1-----------1-----------1---------55 TRI002/C 381 ntysnvvt'vagedrietaie 400 1201 TTAAGTAGTAAATATTATAATTCTGATGATAAAAATGCAATAACTGATAAAGCAGTTAAT 1260 ---------+---------+---------+---------+---------+--------401LSSKYYNSDDKNAITDKAVN 420 1261 GATATAGTATTAGTTGGATCTACATCTATAGTTGATGGTCTTGTTGCATCACCATTAGCT 1320 ---------+---------+---------+---------+---------+--------421 D I V L V G S T S I V D G L V A S P L A 440 1321 TCAGAAAAAACAGCTCCATTATTATTAACTTCAAAAGATAAATTAGATTCATCAGTAAAA 1380 ---------+---------+---------+---------+---------+--------441SEKTAPLLLTSKDKLDSSVK 460 1381 TCTGAAATAAAGAGAGTTATGAACTTAAAGAGTGACACTGGTATAAATACTTCTAAAAAA 1440 ---------4-----------1-----------1-----------1-----------1---------461 S Ε I K R V Μ N L K S D T G I Ν T S Κ K 480 1441 GTTTATTTAGCTGGTGGAGTTAATTCTATATCTAAAGATGTAGAAAATGAATTGAAAAAC 1500 25 ----------1-----------1-----------1-----------1-----------1---------481 VYLAGGVNSI SKDVENELKN 500 1501 ATGGGTCTTAAAGTTACTAGATTATCAGGAGAAGACAGATACGAAACTTCTTTAGCAATA 1560 30 ----------1-----------1-----------1-----------1-----------1---------501 MGLKVTRLSGEDRYETSLAI 520 1561 GCTGATGAAATAGGTCTTGATAATGATAAAGCATTTGTAGTTGGTGGTACTGGATTAGCA 1620 ---------+---------+---------+---------+---------+--------521 A D Ε I G L D N D K A F V V G G T G L A 540 1621 GATGCTATGAGTATAGCTCCAGTTGCTTCTCAACTTAAAGATGGAGATGCTACTCCAATA 1680 ---------+---------+---------+---------+---------+--------541 DAMSIAPVASQLKDGDATPI 560 1681 GTAGTTGTAGATGGAAAAGCAAAAGAAATAAGTGATGATGCTAAGAGTTTCTTAGGAACT 1740 ---------+---------+---------+---------+---------+-------561 V V V D G Κ A Κ Ε I S D D A K S F L G T 580 1741 TCTGATGTTGATATAATAGGTGGAAAAAATAGCGTATCTAAAGAGATTGAAGAGTCAATA 1800 ---------+---------+---------+---------+---------+--------581SDV DIIGGKNSVSKEIEESI 600 1801 GATAGTGCAACTGGAAAAACTCCAGATAGAATAAGTGGAGATGA-TAGACAAGCAACTAAT 1860 ---------+ _.--------+---------+---------+---------+--------jig Ο 2 00 8 7 TRI002/C 601 DSATGKTPDRISGDDRQATN 620 1861 GCTGAAGTTTTAAAAGAAGATGATTATTTCACAGATGGTGAAGTTGTGAATTACTTTGTT 1920 ---------+---------+---------+---------+---------+--------621AEVLKEDDYFTDGEVVNYFV 0 1921 GCAAAAGATGGTTCTACTAAAGAAGATCAATTAGTAGATGCCTTAGCAGCAGCACCAATA 1980 ---------+---------+---------+---------+---------+--------641 AKDGSTKEDQLVDALAAAPI 660 1981 GCAGGTAGATTTAAGGAGTCTCCAGCTCCAATCATACTAGCTACTGATACTTTATCTTCT 2040 ---------+---------+---------+---------+---------+--------661AGRFKESPAPIILATDTLSS 680 2041 GACCAAAATGTAGCTGTAAGTAAAGCAGTTCCTAAAGATGGTGGAACTAACTTAGTTCAA 2100 ---------+---------+---------+---------+---------+--------681 DQNVAVSKAVPKDGGTNLVQ 700 2101 GTAGGTAAAGGTATAGCTTCTTCAGTTATAAACAAAATGAAAGATTTATTAGATATG 2157 ----------1-----------1-----------1-----------1-----------1-------701VGKGIASSVINKMKDLLDM

Claims (66)

Claims

1. A vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising a C. difficile gene or a C. difficile peptide/polypeptide 5 or a derivative or fragment or mutant or variant thereof which is immunogenic in humans.

2. A vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising a C. difficile gene or C. difficile peptide/polypeptide 10 or a derivative or fragment or mutant or variant thereof to which immunoreactivity is detected in individuals who have recovered from C. difficile infection.

3. A vaccine as claimed in claim 1 or 2 wherein the gene encodes a C. difficile 15 surface layer protein, SlpA or variant or homologue thereof.

4. A vaccine as claimed in claim 1 or 2 wherein the peptide/polypeptide is a C. difficile surface layer protein, SlpA or variant or homologue thereof. 20

5. A vaccine as claimed in any of claims 1 to 4 wherein the vaccine comprises a chimeric nucleic acid sequence.

6. A vaccine as claimed in 5 wherein the chimeric nucleic acid sequence is derived from the 5' end of the gene, encoding the mature N-terminal moiety 25 of SlpA from C. difficile.

7. A vaccine as claimed in any of claims 1 to 4 wherein the vaccine comprises a chimeric peptide/polypeptide. 30 8. A vaccine as claimed in 7 wherein the amino acid sequence of the chimeric peptide/polypeptide is derived from the mature N-terminal moiety of SlpA from C. difficile.

?F Π ? Ο η 5 Τ' 58 TRI002/C

9. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains an amino acid sequence SEQ ID No.l or a derivative or fragment or mutant or variant thereof.

5. 10. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains an amino acid sequence SEQ ID No.2 or a derivative or fragment or mutant or variant thereof.

11. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains a 10 nucleotide sequence SEQ ID No. 3 or a derivative or fragment or mutant or variant thereof.

12. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains a nucleotide sequence SEQ ID No.4 or a derivative or fragment or mutant or 15 variant thereof.

13. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains a nucleotide sequence SEQ ID No.5 or a derivative or fragment or mutant or variant thereof.

14. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains a nucleotide sequence SEQ ID No. 6. Or a derivative or fragment or mutant or variant thereof. 25

15. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains a nucleotide sequence SEQ ID No. 7. Or a derivative or fragment or mutant or variant thereof. }

16. A vaccine as claimed in any of claims 1 to 8. Wherein the vaccine contains a nucleotide sequence SEQ ID No.8 or a derivative or fragment or mutant or variant thereof. Π; γ ' TRI002/C

17. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains a nucleotide sequence SEQ ID No.

9. Or a derivative or fragment or mutant or variant thereof. 5 18. A vaccine as claimed in any of claims 1 to 8 wherein the vaccine contains a nucleotide sequence SEQ ID No. 10 or a derivative or fragment or mutant or variant thereof.

19. A vaccine as claimed in any preceding claim in combination with at least one 10 other C. difficile sub-unit.

20. A vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising the mature N-terminal moiety of a surface layer protein, SlpA of C. difficile or variant or homologue thereof which is 15 immunogenic in humans.

21. A vaccine as claimed in claim 20 wherein the N-terminal moiety of SlpA contains an amino acid sequence SEQ ID No. 1.

22. A vaccine as claimed'in claim 20 wherein the N-terminal moiety of SlpA contains an amino acid sequence SEQ ID No. 2.

23. A vaccine for the treatment or prophylaxis of C. difficile associated disease, the vaccine comprising an immunodominant epitope derived from a C. 25 difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans.

24. A vaccine as claimed in any preceding claim comprising a pharmaceutically acceptable carrier.

25. A vaccine as claimed in any preceding claim in combination with a pharmacologically suitable adjuvant. ΙΕ θ 2 Ο Ο 9 7 5Q TRI002/C

26. A vaccine as claimed in claim 25 wherein the adjuvant is interleukin 12.

27. A vaccine as claimed in claim 25 or 26 wherein the adjuvant is a heat shock protein.

28. A vaccine as claimed in any preceding claim comprising at least one other pharmaceutical product.

29. A vaccine as claimed in claim 28 wherein the pharmaceutical product is an 10. Antibiotic.

30. A vaccine as claimed in claim 29 wherein the antibiotic is selected from one or more metronidazole, amoxycillin, tetracycline or erythromycin, clarithromycin or tinidazole.

31. A vaccine as claimed in claim 28 wherein the pharmaceutical product comprises an acid-suppressing agent such as omeprazole or bismuth salts.

32. A vaccine as claimed in any preceding claim in a form for oral 20 administration.

33. A vaccine as claimed in any preceding claim in a form for intranasal administration.

34. A vaccine as claimed in any preceding claim in a form for intravenous administration.

35. A vaccine as claimed in any preceding claim in a form for intramuscular administration.

36. A vaccine as claimed in any of claims 1 to 35 including a peptide delivery system. TRI002/C

37. An immunodominant epitope derived from a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof.

38. An immunodominant epitope as claimed in claim 37 wherein the C. difficile 5 peptide/polypeptide contains an amino acid sequence SEQ ID No.l or SEQ ID No.2 or a derivative or fragment or mutant or variant thereof.

39. An immunodominant epitope as claimed in claim 35 wherein the C. difficile peptide/polypeptide contains an amino acid sequence SEQ ID No.3 or SEQ 10 ID No.4 or SEQ ID No.5 or SEQ ID No.6 or SEQ ID No.7 or SEQ ID No.8 or SEQ ID No. 9 or SEQ ID No. 10 or a derivative or fragment or mutant or variant thereof.

40. A chimeric nucleic acid sequence derived from the 5' end of the slpA gene 11. 15 encoding the mature N-terminal moiety of SlpA from C. difficile which is immunogenic in humans.

41. A chimeric peptide/polypeptide wherein the amino acid sequence of the chimeric peptide/polypeptide is derived from the mature N-terminal moiety 12. 20 of SlpA from C. difficile.

42. A C. difficile peptide comprising SEQ ID No. 1.

43. A C. difficile peptide comprising SEQ ID No. 2. 25

44. A C. difficile gene comprising SEQ ID No. 3.

45. A C. difficile gene comprising SEQ ID No. 4.

46. A C. difficile gene comprising SEQ ID No. 5. IE Ο 2 Ο Ο 9 7 TRIOO2/C

47. A C. difficile gene comprising SEQ ID No. 6.

48. A C. difficile gene comprising SEQ ID No. 7. 5

49. A C. difficile gene comprising SEQ ID No. 8.

50. A C. difficile gene comprising SEQ ID No. 9.

51. AC. difficile gene comprising SEQ ID No. 10.

52. The use of a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans in the preparation of a medicament for use in a method for the treatment or prophylaxis of C. difficile infection or C. difficile associated 15 disease in a host.

53. The use as claimed in claim 52 wherein the medicament which is prepared is a vaccine as claimed in any of claims 1 to 36. 20 54. A method for preparing a vaccine for prophylaxis or treatment of C. difficile associated disease, the method comprising; obtaining a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is 13. 25 immunogenic in humans; and forming a vaccine preparation comprised of said gene or peptide/polypeptide or derivative or fragment or mutant or variant, which is suitable for administration to a host and which when administered raises an immune response.

TRI002/C

55. A method as claimed in claim 54 wherein the C. difficile peptide/polypeptide contains an amino acid sequence SEQ ID No.l or SEQ ID No.2 or a derivative or fragment or mutant or variant thereof. 5

56. A method as claimed in claim 54 wherein the C. difficile gene contains an amino acid sequence SEQ ID No.3 or SEQ ID No.4 or SEQ ID No.5 or SEQ ID No.6 or SEQ ID No.7 or SEQ ID No.8 or SEQ ID No.9 or SEQ ID No.10 or a derivative or fragment or mutant or variant thereof.

57. A method for prophylaxis or treatment of C. difficile associated disease, the method comprising; obtaining a C. difficile gene or a C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is 15 immunogenic in humans; forming a vaccine preparation comprised of said gene or peptide/polypeptide or derivative or fragment or mutant or variant, and administering the vaccine preparation to a host to raise an immune response.

58. Monoclonal or polyclonal antibodies or fragments thereof, to a C. difficile 25 peptide/polypeptide or a derivative or fragment or mutant or variant thereof which is immunogenic in humans.

59. Monoclonal or polyclonal antibodies or fragments thereof, to C. difficile peptide/polypeptide or a derivative or fragment or mutant or variant thereof to which immunoreactivity is detected in individuals who have recovered from C. difficile infection. IE Ο 2 Ο Ο 9 7 ¢4 TRI002/C

60. Purified antibodies or serum obtained by immunisation of an animal with a vaccine according to any of claims 1 to 36.

61. The use of the antibodies or fragments as claimed in claims 58 and 59 in the 5 preparation of a medicament for treatment or prophylaxis of C. difficile infection or C. difficile associated disease.

62. The use of the antibodies or serum as claimed in 60 in the preparation of a medicament for treatment or prophylaxis of C. difficile infection or C. 10 difficile associated disease.

63. The use of the antibodies or fragments or serum as claimed in any of claims 58 to 60 for use in passive immunotherapy for established C. difficile infection.

64. The use of the antibodies or fragment or serum as claimed in any of claims 58 to 60 for the eradication of C. difficile associated disease.

65. Use of interleukin 12 as an adjuvant in C. difficile vaccine.

66. The use of humanised antibodies or serum for passive vaccination of an individual with C. difficile infection.