Bacterial pathogenesis

Trevor's research utilizes high-throughput genome sequencing to investigate C. difficile populations and intestinal microbial communities that are associated with health and disease, and murine infection models to identify the host genetic factors that are linked to disease susceptibility. Healthcare-associated pathogens are a major focus of the research programme.

[David Goulding, Genome Research Limited]


Hospital-acquired infections are presenting a major challenge to clinical practice and public health control. There is evidence that the modern hospital environment selects for super-fit variants of commensal, environmental or opportunistic pathogens that confound control and treatment regimens. The evolution and transmissibility of such organisms is tractable by high quality phylogenetic, phenotypic and epidemiological analysis.

Clostridium difficile is a prime example of a significant hospital-acquired pathogen. This bacterial species is a major cause of antibiotic-associated diarrhoea and is a rapidly emerging hospital-acquired infection currently confounding standard medical practices associated with antibiotic prescribing and infection control protocols. The use of antibiotics to treat other infections can trigger C. difficile disease and transmission, whereas antibiotics used to treat C. difficile infections are becoming less effective. Little is known about how C. difficile causes disease or transmits so efficiently within the hospital setting, but this appears to be due to an infective cycle that relies on highly resistant and infectious spores. An improved understanding of C. difficile biology, transmission and pathogenesis will directly benefit the ability to control and treat C. difficile in hospitals.


The goals of the research programme are to investigate the genetic traits that contribute to C. difficile pathogenesis, persistence and transmission. Additional aims are to identify avenues for novel therapeutic intervention and to guide hospital infection control measures.


The Lawley Group has strong internal collaborations with the Microbial pathogenesis group, Pathogen Genomics Group, the Proteomic Mass Spectrometry Laboratory and the Mouse Genetics Programme.

The Group has several productive external collaborations including those with Professor Fiona Powrie's Group at the University of Oxford, Professor Brendan Wren's Group at London School of Hygiene & Tropical Medicine (LSHTM) and Professor Neil Fairweather's Group at Imperial College London as well as close interactions with several NHS hospitals and the Health Protection Agency reference laboratories within the UK and abroad.

Selected Publications

  • Emergence and global spread of epidemic healthcare-associated Clostridium difficile.

    He M, Miyajima F, Roberts P, Ellison L, Pickard DJ, Martin MJ, Connor TR, Harris SR, Fairley D, Bamford KB, D'Arc S, Brazier J, Brown D, Coia JE, Douce G, Gerding D, Kim HJ, Koh TH, Kato H, Senoh M, Louie T, Michell S, Butt E, Peacock SJ, Brown NM, Riley T, Songer G, Wilcox M, Pirmohamed M, Kuijper E, Hawkey P, Wren BW, Dougan G, Parkhill J and Lawley TD

    Nature genetics 2013;45;1;109-13

  • Intestinal colonization resistance.

    Lawley TD and Walker AW

    Immunology 2013;138;1;1-11

  • The Clostridium difficile spo0A gene is a persistence and transmission factor.

    Deakin LJ, Clare S, Fagan RP, Dawson LF, Pickard DJ, West MR, Wren BW, Fairweather NF, Dougan G and Lawley TD

    Infection and immunity 2012;80;8;2704-11

  • Targeted restoration of the intestinal microbiota with a simple, defined bacteriotherapy resolves relapsing Clostridium difficile disease in mice.

    Lawley TD, Clare S, Walker AW, Stares MD, Connor TR, Raisen C, Goulding D, Rad R, Schreiber F, Brandt C, Deakin LJ, Pickard DJ, Duncan SH, Flint HJ, Clark TG, Parkhill J and Dougan G

    PLoS pathogens 2012;8;10;e1002995

  • Evolutionary dynamics of Clostridium difficile over short and long time scales.

    He M, Sebaihia M, Lawley TD, Stabler RA, Dawson LF, Martin MJ, Holt KE, Seth-Smith HM, Quail MA, Rance R, Brooks K, Churcher C, Harris D, Bentley SD, Burrows C, Clark L, Corton C, Murray V, Rose G, Thurston S, van Tonder A, Walker D, Wren BW, Dougan G and Parkhill J

    Proceedings of the National Academy of Sciences of the United States of America 2010;107;16;7527-32

  • Antibiotic treatment of clostridium difficile carrier mice triggers a supershedder state, spore-mediated transmission, and severe disease in immunocompromised hosts.

    Lawley TD, Clare S, Walker AW, Goulding D, Stabler RA, Croucher N, Mastroeni P, Scott P, Raisen C, Mottram L, Fairweather NF, Wren BW, Parkhill J and Dougan G

    Infection and immunity 2009;77;9;3661-9

  • Proteomic and genomic characterization of highly infectious Clostridium difficile 630 spores.

    Lawley TD, Croucher NJ, Yu L, Clare S, Sebaihia M, Goulding D, Pickard DJ, Parkhill J, Choudhary J and Dougan G

    Journal of bacteriology 2009;191;17;5377-86

  • Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium.

    Stabler RA, He M, Dawson L, Martin M, Valiente E, Corton C, Lawley TD, Sebaihia M, Quail MA, Rose G, Gerding DN, Gibert M, Popoff MR, Parkhill J, Dougan G and Wren BW

    Genome biology 2009;10;9;R102

  • Host transmission of Salmonella enterica serovar Typhimurium is controlled by virulence factors and indigenous intestinal microbiota.

    Lawley TD, Bouley DM, Hoy YE, Gerke C, Relman DA and Monack DM

    Infection and immunity 2008;76;1;403-16

  • Genome-wide screen for Salmonella genes required for long-term systemic infection of the mouse.

    Lawley TD, Chan K, Thompson LJ, Kim CC, Govoni GR and Monack DM

    PLoS pathogens 2006;2;2;e11


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