Unveiling the Role of Epsilon Toxin-Producing Strains in ms

Very excited to share Audra's cover art on the May 1, 2023 edition of the Journal of Clinical Investigation!

The image was created to show how two epsilon toxin (ETX)-producing strains of Clostridium perfringens, strains B and D, when found in the gut microbiome,

appear to be implicated in demyelination damage of neurons in areas of the brain associated with multiple sclerosis.

The lower half of the image shows the release of ETX molecules by an epsilon toxin-producing strain (blue bacteria) in the mucus layer of the small intestine, as well as a non-toxin-producing strain (green bacteria).

ETX molecules enter the circulation via blood vessels in the intestinal villi and travel to the capillaries of the blood-brain barrier, BBB. The top right of the cover shows the assembly of ETX molecules into pores in the endothelial cells of the BBB capillaries.

This results in damage to the integrity of the barrier allowing the infiltration of myelin autoreactive CD4+ T lymphocytes into the brain parenchyma and leading ultimately to the demyelination of neurons in specific areas of the brain.

The challenge in creating this piece was depicting a story that takes place in multiple environments - the gut microbiome, the blood-brain-barrier and the brain parenchyma - all while staying strictly aware of the title and copy placement on the cover.