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Clostridium difficile is one of the most dangerous pathogens in hospital settings. Most strains ofC. difficile carry one or more prophages, and some of them, like ϕCD38-2 and ϕCD119, can influence the expression of toxin genes. However, little is known about the global host response in the presence of a given prophage. In order to fill this knowledge gap, we used high-throughput RNA sequencing (RNA-seq) to conduct a genome-wide transcriptomic analysis of the epidemicC. difficile strain R20291 carrying the ϕCD38-2 prophage. A total of 39 bacterial genes were differentially expressed in the R20291 lysogen, 26 of them being downregulated. Several of the regulated genes encode transcriptional regulators and phosphotransferase system (PTS) subunits involved in glucose, fructose, and glucitol/sorbitol uptake and metabolism. ϕCD38-2 also upregulated the expression of a group of regulatory genes located in phi-027, a resident prophage common to most ribotype 027 isolates. The most differentially expressed gene was that encoding the conserved phase-variable cell wall protein CwpV, which was upregulated ∼20-fold in the lysogen. Quantitative PCR and immunofluorescence showed that the increasedcwpV expression results from a greater proportion of cells actively transcribing the gene. Indeed, ∼95% of lysogenic cells expresscwpV , as opposed to only ∼5% of wild-type cells. Furthermore, the higher proportion of cells expressingcwpV results from a higher frequency of recombination of the genetic switch controlling phase variation, which we confirmed to be dependent on the host-encoded recombinase RecV. In summary, ϕCD38-2 interferes with phase variation of the surface protein CwpV and the expression of metabolic genes.

Global Transcriptional Response of Clostridium difficile Carrying the ϕCD38-2 Prophage