Shigellosis due to Shigella dysenteriae. 1. Relative importance of mucosal invasion versus toxin production in pathogenesis

Characterization of Shigella dysenteriae 1 (Shiga) toxin purified by anti-Shiga toxin affinity chromatography

Shigella dysenteriae 1 (Shiga) toxin was purified from whole-cell lysates by antitoxin affinity column chromatography, radioiodination, and Sephacryl S-200 gel filtration of 125I-labeled affinity column eluates. Two chromatographic peaks were observed. The percentage of radioactivity in peak I samples immunoprecipitated with antitoxin ranged from 95 to 100%. A pool of samples from this first peak contained over 90% of the HeLa-cell-cytotoxic units applied to the column and was enterotoxic for rabbit ileal loops and lethal for rabbits. This radiolabeled material migrated as a single cytotoxic band after nondenaturing polyacrylamide gel electrophoresis, but formed three bands, of 33,000, 29,000, and 4,000 to 7,000 daltons, after sodium dodecyl sulfate-polyacrylamide gel electrophoresis. In addition, material estimated as 7,000 daltons by Bio-Gel P-10 chromatography could be generated by treatment of S-200 peak I samples with 8 M urea. Pooled fractions from the second S-200 peak were separable into several low-molecular-weight peaks on a P-10 column. One of these P-10 peaks (7,000 daltons) was 27% immunoprecipitable with antitoxin. These data indicate that three of the known biological activities of Shiga toxin are associated with a 33,000-dalton substance which can be dissociated into 29,000- and 4,000- to 7,000-dalton components.

Inhibition of protein synthesis in intact HeLa cells by Shigella dysenteriae 1 toxin

Shiga toxin purified to near homogeneity from cell lysates of Shigella dysenteriae 1 inhibited protein and deoxyribonucle acid syntheses in intact HeLa cells. Inhibition was dependent on toxin concentration and time of incubation. A minimal latent period of 30 min was observed with saturating doses of toxin. Ribonucleic acid synthesis, uptake of alpha-aminoisobutyric acid, and maintenance of intracellular K+ concentrations were not affected until well after maximal inhibition of protein and deoxyribonucleic acid syntheses. The inhibitory effect of toxin was sensitive to heat inactivation and was prevented by antibody neutralization. Several cytotoxic components were separated by polyacrylamide gel electrophoresis of the purified toxin preparations; all inhibited protein and deoxyribonucleic acid syntheses equally.

Genetic and physical evidence for plasmid control of Shigella sonnei form I cell surface antigen

Virulent Shigella sonnei synthesize a surface antigen (form I) which appears to be one of several requirements needed for this host to invade epithelial cells. Upon restreaking on agar media, form I cells readily and irreversibly generate form II cells that lack the form I antigen. All form II cells are avirulent. Plasmid deoxyribonucleic acid of form I and II cells of four different S. sonnei isolates, obtained from different areas of the world, was analyzed by agarose gel electrophoresis. A large plasmid (approximately 120 megadaltons in three of the strains) that is present in form I cells was always absent from form II derivatives. Attempts to transfer conjugally only this large plasmid from form I to genetically marked form II cells were unsuccessful. However, a composite molecule, apparently formed by recombination between the large form I plasmid and a self-transmissible plasmid, was found to transfer the form I trait. Transconjugant S. sonnei strains acquiring the form I antigen could retransfer this trait to S. sonnei, Shigella flexneri, or Salmonella typhi. These preliminary findings demonstrate that S. sonnei form I antigen synthesis is mediated by a large plasmid which is lost spontaneously at a relatively high frequency from S. sonnei strains.

Experimental Yersinia enterocolitica enteritis in rabbits

Young rabbits weighing 500 to 800 g were inoculated orogastrically with clinical isolates of Yersinia enterocolitica (serotype O:3; enterotoxigenic; HeLa cell invasive) at a dose of 1.4 X 10(10) bacteria suspended in 10% sodium bicarbonate solution. Diarrhea developed in 41 (87%) of 47 rabbits, with a mean +/- standard deviation onset at 5.4 +/- 2.4 days. The attack rate and onset of diarrhea were correlated with inoculum size. The 50% infectious dose was 2.9 X 10(8) bacteria. Bacterial colonization occurred in almost all rabbits, regardless of inoculum size. Seroconversion was demonstrated in 30 (71%) of 42 rabbits with or without diarrhea. Histopathological alterations were present in the jejuna, ilea, and colons of rabbits with diarrhea; the most pronounced changes were generally noted in the ilea. Crypt abscesses localized at the depth of the intestinal glands were observed consistently and were composed of a bacterial nidus admixed with and enveloped by inflammatory cells comprised of eosinophils, neutrophils, and mononuclear cells. Rabbits inoculated with a raw fish isolate of Y. enterocolitica (serotype O:6,30; non-enterotoxigenic; HeLa cell noninvasive) did not exhibit infection clinically, bacteriologically, or pathologically.

Studies on the production of enterotoxins by Bacillus cereus

Evidence is presented for the existence of three distinct enterotoxins detected in concentrated cell-free culture filtrates of selected Bacillus cereus strains. The first was a product capable of stimulating the adenylate cyclase-cyclic-AMP system in intestinal epithelial cells and, possibly through this, causing fluid accumulation in ligated ileal sections ("loops") of young rabbits. This was elaborated by a strain isolated from an incident of diarrhoea and which caused diarrhoea in 6 of 10 monkey feedings. The second was tentatively identified as a factor which caused fluid accumulation in rabbit loops but not, apparently, through stimulation of the adenylate cyclase-cyclic-AMP system; this was elaborated by a strain isolated from raw rice which failed to produce symptoms in eight monkey feedings. Together, the behaviour of these two factors indicates that diarrhoea caused by B. cereus enterotoxin may be a cyclic-AMP-mediated event. The third, here referred to as "pyogenic toxin", caused severe tissue damage in the ileal mucosa and was elaborated by a strain isolated from a brain abscess. A factor produced by a strain isolated from an outbreak of vomiting which caused vomiting in 10 of 24 monkey feedings could bot be detected in tests reported here but appears to be a fourth enterotoxin type. Cytopathic effects in tissue cultures, suckling mouse tests, and assays of glycerol production by fat cells were not found to be of value in the detection of any of the enterotoxins.

Pathogenesis of shigella diarrhea. Serum anticytotoxin antibody response produced by toxigenic and nontoxigenic Shigella dysenteriae 1

The serum antitoxin response to the cytotoxin contained in preparations of Shigella dysenteriae 1 (Shiga's bacillus) exotoxin was studied in natural and experimental infections of man. Natural infection resulted in the rapid appearance of toxin-neutralizing antibody, which disappeared some time between 9 and 18 mo after infection. Experimental infection of human volunteers provided the opportunity to study immunoglobulin class of the antibody in sera obtained serially from 7 to 50 days after infection. Neutralizing antibody was present only in the IgM fraction isolated by sucrose density gradient ultracentrifugation. This was confirmed by the use of solid-phase immunoaffinity chromatography. Even though the time-course and immunoglobulin class of the antitoxin antibody response was similar to that previously observed for anti-O polysaccharide antibody, the biologically active cytotoxin was shown to be highly susceptible to destruction by proteolytic enzymes. Sera from subjects infected with a virulent invasive chlorate-resistant Shiga mutant thought to be "nontoxigenic" also contained antibody which was similarly restricted to the IgM fraction. Biologically active cytotoxin was recovered when this mutant organism was grown in liquid media with controlled ion concentration. The mutant cytotoxin was heat labile, neutralized by antiwild-type cytotoxin antibody, and was separable by isoelectric focusing into two fractions with pI 7.2 and 6.1 like the wild-type toxin. These studies show that cytotoxin antigen is produced during in vivo infection with Shiga bacilli, resulting in a serum antitoxin antibody response. Without explanation is the restriction of the antibody to the IgM class and lack of evidence for an IgG antibody to the protein cytotoxin. Finally, mutant strain 725, previously designated "nontoxigenic," was shown to produce biologically active cytotoxin in vitro and, in experimentally infected volunteers, to result in a serum IgM antibody similar to that observed during infection with the wild-type strain.

Stimulation of steroidogenesis in tissue culture by enterotoxigenic Escherichia coli and its neutralization by specific antiserum

Y1 adrenal cells in monolayer tissue culture react to culture filtrates from enterotoxigenic strains of Escherichia coli, but not to those from nontoxigenic strains, by undergoing morphological changes similar to those inducible by cholera enterotoxin and increasing their production of steroids. Heating destroys the ability of crude preparations of the E. coli enterotoxin to effect these tissue culture changes. None of a number of culture filtrates of other enteric or enteropathogenic bacteria were capable of inducing either the morphological changes or steroidogenesis. The maximal degree of steroidogenesis achievable with E. coli enterotoxin was comparable to that of cholera enterotoxin and could not be further increased by combination of the two toxins. As with cholera enterotoxin, removal of the E. coli toxin from the tissue culture medium after an initial brief exposure of the cells to the toxin was accompanied by some decrease in maximal steroidogenesis and no changes in either the onset or the permanency of the morphological changes. Antiserum raised to one of the crude E. coli enterotoxins was capable of completely neutralizing the steroidogenic effects and preventing the morphological changes secondary to a variety of different enterotoxigenic strains of E. coli. At the concentrations tested, this antiserum was not effective in preventing these same tissue culture changes inducible by cholera enterotoxin. The results of these and other related experiments suggest that cholera and heat-labile E. coli enterotoxins have similar mechanisms of action which are dissimilar to those of the other enterotoxins thus far described and tested.

Pathogenesis of salmonellosis. Studies of fluid secretion, mucosal invasion, and morphologic reaction in the rabbit ileum

Strains of Salmonella typhimurium were studied in the ligated rabbit ileal loop model to gain insight into the mechanisms whereby bacteria which invade the gastrointestinal mucosa evoke fluid exsorption. The organisms employed differed in various biologic attributes including the ability to invade the ileal epithelium, multiply within the mucosa, elicit an acute inflammatory reaction, and disseminate across the intestinal wall. Some strains provoked small intestinal fluid exsorption although these did not elaborate enterotoxin. Only those strains which invaded the mucosa were accompanied by either mucosal inflammation or fluid exsorption. Noninvasive strains produced neither histologic abnormalities nor fluid secretion. While strains which invaded the mucosa caused an acute inflammatory reaction, not all such strains evoked fluid secretion. Furthermore, there was no correlation in ability of invasive organisms to evoke fluid secretion or in the intensity of mucosal inflammation, number of intramucosal salmonellae, or in ability to disseminate from the rabbit ileum. These observations suggest that, as is the case in shigellosis, mucosal invasion may be a necessary factor for the intestinal fluid loss in salmonellosis. A bacterial property or factor, in addition to invasion of the gastrointestinal mucosa, seems to be responsible for fluid exsorptin. However, it is unlikely that a salmonella enterotoxin comparable to that elaborated by Vibrio cholerae, toxigenic Escherichia coli, or Shigella dysenteriae 1 is related to fluid secretion in salmonellosis.