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Mucosal and systemic immune responses in patients with diarrhea due to CS6-expressing enterotoxigenic Escherichia coli.

Journal article
Authors Firdausi Qadri
Tanvir Ahmed
Firoz Ahmed
M Saruar Bhuiyan
Mohammad Golam Mostofa
Frederick J Cassels
Anna Helander
Ann-Mari Svennerholm
Published in Infection and immunity
Volume 75
Issue 5
Pages 2269-74
ISSN 0019-9567
Publication year 2007
Published at Institute of Biomedicine, Department of Microbiology and Immunology
Pages 2269-74
Language en
Keywords Adolescent, Adult, Antibodies, Bacterial, analysis, blood, immunology, Antibody Specificity, Antigens, Bacterial, genetics, immunology, metabolism, Child, Preschool, Diarrhea, immunology, microbiology, Escherichia coli, immunology, pathogenicity, Escherichia coli Infections, immunology, microbiology, Escherichia coli Proteins, genetics, immunology, metabolism, Feces, chemistry, Female, Hospitalization, Humans, Immunity, Mucosal, Immunoglobulin A, Secretory, analysis, blood, immunology, Immunoglobulin G, blood, Infant, Male, Middle Aged, Recombinant Proteins, genetics, immunology, metabolism
Subject categories Microbiology in the medical area


Colonization factor CS6 expressed by enterotoxigenic Escherichia coli (ETEC) is a nonfimbrial polymeric protein. A substantial proportion of ETEC strains isolated from patients in endemic settings and in people who travel to regions where ETEC is endemic are ETEC strains expressing CS6, either alone or in combination with fimbrial colonization factor CS5 or CS4. However, relatively little is known about the natural immune responses elicited against CS6 expressed by ETEC strains causing disease. We studied patients who were hospitalized with diarrhea (n = 46) caused by CS6-expressing ETEC (ETEC expressing CS6 or CS5 plus CS6) and had a disease spectrum ranging from severe dehydration (27%) to moderate or mild dehydration (73%). Using recombinant CS6 antigen, we found that more than 90% of the patients had mucosal immune responses to CS6 expressed as immunoglobulin (IgA) antibody-secreting cells (ASC) or antibody in lymphocyte supernatant (ALS) and that about 57% responded with CS6-specific IgA antibodies in feces. More than 80% of the patients showed IgA seroconversion to CS6. Significant increases in the levels of anti-CS6 antibodies of the IgG isotype were also observed in assays for ASC (75%), ALS (100%), and serum (70%). These studies demonstrated that patients hospitalized with the noninvasive enteric pathogen CS6-expressing ETEC responded with both mucosal and systemic antibodies against CS6. Studies are needed to determine if the anti-CS6 responses protect against reinfection and if protective levels of CS6 immunity are induced by vaccination.

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