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Primary bile acids (PBAs) promote Clostridioides (Clostridium) difficile spore germination in vitro, whereas certain Secondary bile salts / Secondary bile acids (SBAs) inhibit its vegetative growth.
Deoxycholic acid (DCA) and lithocholic acid (LCA) block the growth of Clostridium difficile, promote hepatocellular carcinoma and modulate host metabolism via the G-protein-coupled receptor TGR5
In eubiosis, the levels of cholate (CA) and chenodeoxycholate (CDCA) in the small intestine are high. Chenodeoxycholate inhibits spore germination. Since cholate is less well absorbed in the terminal ileum than chenodeoxycholate, the net effect here is an increased ratio of cholate to chenodeoxycholate. This leads to increased spore germination
When vegetative Clostridioides (Clostridium) difficile cells then move into the colon, they are prevented from establishing in the colon by the toxic effects of deoxycholate (DCA). In dysbiosis, for example caused by antibiotics, the bacterial conversion of cholate to DCA can be greatly suppressed. In this case, CA levels remain high. This leads to increased CA-mediated spore germination and a loss of the inhibitory effects of deoxycholate on the growth of C. difficile. The net effect is that this pathogen can easily spread in the colon.