Review of Newly Identified Functions Associated With the Heat-Labile Toxin of Enterotoxigenic Escherichia coli

Enterotoxigenic Escherichia coli (ETEC) infection is the most common type of colibacillosis of young animals (primarily pigs and calves), and it is a significant cause of diarrhoea among travellers and children in the developing world. The main virulence attributes of ETEC are adhesins and enterotoxins, which are mostly regulated on large plasmids. Almost all ETEC bacteria are known to adhere to receptors on the small intestinal epithelium by their proteinaceous surface appendages (fimbriae, pili) or by afimbrial proteins without inducing significant morphological changes. Furthermore, they secrete protein toxins (enterotoxins) to reduce absorption and to increase fluid and electrolyte secretion of small intestinal epithelial cells. Regarding details of epidemiology, pathogenesis, diagnosis and prevention of ETEC infections and diarrhoea in animals, readers are referred to an earlier more extensive review [Nagy and Fekete, 1999. Enterotoxigenic Escherichia coli (ETEC) in farm animals. Vet. Res. 30, 259-284]. This paper intends to summarise our basic knowledge and to highlight the new developments and most actual research topics in the area of ETEC infections in veterinary medicine. Attention is paid to recently described new virulence factors and to new genetic vectors in ETEC bacteria. Applications of our knowledge in the diagnosis and prevention of ETEC diarrhoea in animals will also be discussed.

The gastrointestinal tract is the largest reservoir of commensal bacteria in the human body, providing nutrients and space for the survival of microbes while concurrently operating mucosal barriers to confine the microbial population. The epithelial cells linked by tight junctions not only physically separate the microbiota from the lamina propria, but also secrete proinflammatory cytokines and reactive oxygen species in response to pathogen invasion and metabolic stress and serve as a sentinel to the underlying immune cells. Accumulating evidence indicates that commensal bacteria are involved in various physiological functions in the gut and microbial imbalances (dysbiosis) may cause pathology. Commensal bacteria are involved in the regulation of intestinal epithelial cell turnover, promotion of epithelial restitution and reorganization of tight junctions, all of which are pivotal for fortifying barrier function. Recent studies indicate that aberrant bacterial lipopolysaccharide-mediated signaling in gut mucosa may be involved in the pathogenesis of chronic inflammation and carcinogenesis. Our perception of enteric commensals has now changed from one of opportunistic pathogens to active participants in maintaining intestinal homeostasis. This review attempts to explain the dynamic interaction between the intestinal epithelium and commensal bacteria in disease and health status.

Vaccine development for enterotoxigenic Escherichia coli (ETEC) is dependent on in-depth understanding of toxin and colonization factor (CF) distribution. We sought to describe ETEC epidemiology across regions and populations, focusing on CF and toxin prevalence. We conducted a systematic review of the published literature, including studies reporting data on ETEC CF and toxin distributions among those with ETEC infection. Point estimates and confidence intervals were calculated using random effects models. Data on 17,205 ETEC isolates were abstracted from 136 included studies. Approximately half of the studies (49%) involved endemic populations, and an additional 17% involved only travel populations. Globally, 60% of isolates expressed LT either alone (27%) or in combination with ST (33%). CFA/I-expressing strains were common in all regions (17%), as were ETEC expressing CFA/II (9%) and IV (18%). Marked variation in toxins and CFs across regions and populations was observed. These results demonstrate the relative importance of specific CFs in achieving target product profiles for a future ETEC vaccine. However, heterogeneity across time, population, and region, confounded by variability in CF and toxin detection methodologies, obfuscates rational estimates for valency requirements. Published by Elsevier Ltd.