Biological Mechanisms of Polyphenols against Clostridium Difficile: A Systematic Review

Mohammad Darvishi; Seyed Mahmoud Reza Hashemi Rafsanjani; Majid Nouri; Saber Abbaszadeh; Saeid Heidari-Soureshjani; Karamali Kasiri; Ghorbanali Rahimian

doi:10.2174/0118715265313944240726115600

Biological Mechanisms of Polyphenols against Clostridium Difficile: A Systematic Review

Infect Disord Drug Targets. 2024 Sep 4. doi: 10.2174/0118715265313944240726115600. Online ahead of print.

Authors

Mohammad Darvishi¹, Seyed Mahmoud Reza Hashemi Rafsanjani², Majid Nouri³, Saber Abbaszadeh⁴, Saeid Heidari-Soureshjani⁵, Karamali Kasiri⁶, Ghorbanali Rahimian⁷

Affiliations

¹ Infectious Diseases and Tropical Medicine Research Center (IDTMRC), School of Aerospace and Subaquatic Medicine, Aja University of Medical Sciences, Tehran, Iran.
² Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
³ Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Aja University of Medical Sciences, Tehran, Iran.
⁴ Department of Biochemistry and Genetics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
⁵ Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
⁶ Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran.
⁷ Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.

PMID: 39234903
DOI: 10.2174/0118715265313944240726115600

Abstract

Background: Clostridium difficile is an opportunistic infection that can lead to antibi-otic-associated diarrhea and toxic megacolon.

Objective: This systematic review study aimed to investigate polyphenols' antibacterial and anti-toxin properties and their effects on reducing complications related to C. difficile Infections (CDI).

Methods: This systematic review was conducted following the PRISMA guideline 2020. Multiple databases, including Web of Science, PubMed, Cochrane Library, EMBASE, and Scopus, were searched thoroughly for existing literature. After considering the inclusion and exclusion criteria for the review, 18 articles were included. Data were collected and registered into an Excel file for further investigations and conclusions.

Results: Polyphenols by reducing Reactive Oxygen Species (ROS) levels, increasing inflammatory factor Interleukin 10 (IL-10), reducing Nuclear Factor kappa B (NF-κB) and Tumour Necrosis Fac-tor-α (TNF-α), IL-6, IL-1α, IL-1β, Granulocyte Colony-stimulating Factor (G-CSF), and Monocyte Chemoattractant Protein-1 (MCP-1) and Macrophage Inflammatory Protein-1 alpha (MIP-1α) lev-els, and regulating the expression of Bcl-2 and Bax, make the growth and replication conditions of C. difficile more difficult and prevent it from producing toxins. Furthermore, polyphenols can ex-hibit prebiotic properties, promoting the growth of beneficial Bifidobacterium and Lactobacillus species and consequently regulating gut microbiota, exerting antimicrobial activities against C. dif-ficile. They also induce their beneficial effects by inhibiting the production of C. difficile TcdA and TcdB.

Conclusion: Polyphenols have been reported to inhibit C. difficile growth and toxin production by several mechanisms in preclinical studies. However, more clinical studies are needed to investigate their safety in humans.

Keywords: Clostridioides difficile; Clostridium difficile; diarrhea; polyphenol; systematic review.; toxic megacolon.