ArticleNature2018
Dietary trehalose enhances virulence of epidemic Clostridium difficile.
Article in Nature, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 216 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
216 citing papers in PubMed, 2 syntheses or guidelines pooled it, 365 citations in OpenAlex.
- Pooled it
- Global and Historical Distribution ofFrontiers in medicine · 2020Pooled it
- Effects of D-allulose on glucose tolerance and insulin response to a standard oral sucrose load: results of a prospective, randomized, crossover study.BMJ open diabetes research & care · 2021Trial
- BeyondEmerging microbes & infections · 2026Article
- From colonization to infection: Genomic evolution of Clostridioides difficile pathogenesis.Cell reports · 2026Review
- Gut microbiota-derived short-chain fatty acids (SCFAs): immunomodulatory effects and therapeutic potential in infections.Clinical microbiology reviews · 2026Review
- Acquisition of a gene cluster inmSphere · 2026Article
- Metabolic strategies of Enterobacteriaceae gut colonization.Nature reviews. Microbiology · 2026Review
- Ecological and dietary strategies to constrain Clostridioides difficile.Cell host & microbe · 2026Review
- Development and Evaluation of Exosporium-Anchored Bioluminescent and Fluorescent Reporters for TrackingACS synthetic biology · 2026Article
- Bifunctional trehalase FsTreA coordinates intracellular mobilization and extracellular utilization of trehalose to modulate virulence inApplied and environmental microbiology · 2026Article
- Acidification-dependent suppression ofInfection and immunity · 2026Article
- Clostridioides difficile as a Zoonotic and Foodborne Pathogen: Reviewing the Global Evidence and South African Data.MicrobiologyOpen · 2026Review
- Uniform bacterial genetic diversity along the gut.Nature communications · 2026Article
- A multifunctional probiotic co-delivery platform for the treatment of Clostridium difficile infection.Journal of controlled release : official journal of the Controlled Release Society · 2026Article
- Acidification-dependent suppression ofbioRxiv : the preprint server for biology · 2026Article
- Trehalose ameliorates severe acute pancreatitis by modulating gut microbial metabolism.NPJ biofilms and microbiomes · 2026Article
- Fecal metabolic signals are associated with changes in microbiota and systemic metabolic pathways in Crohn's disease.Scientific reports · 2026Article
- Characterization of the clade 4 non-toxigenicFEMS microbes · 2026Article
- Non-targeted metabolomics reveals metabolic signatures associated withFrontiers in microbiology · 2026Article
156 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
Clostridium difficile disease has recently increased to become a dominant nosocomial pathogen in North America and Europe, although little is known about what has driven this emergence. Here we show that two epidemic ribotypes (RT027 and RT078) have acquired unique mechanisms to metabolize low concentrations of the disaccharide trehalose. RT027 strains contain a single point mutation in the trehalose repressor that increases the sensitivity of this ribotype to trehalose by more than 500-fold. Furthermore, dietary trehalose increases the virulence of a RT027 strain in a mouse model of infection. RT078 strains acquired a cluster of four genes involved in trehalose metabolism, including a PTS permease that is both necessary and sufficient for growth on low concentrations of trehalose. We propose that the implementation of trehalose as a food additive into the human diet, shortly before the emergence of these two epidemic lineages, helped select for their emergence and contributed to hypervirulence.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.