Previous Article | Next Article 
Infection and Immunity, October 2000, p. 6062-6065, Vol. 68, No. 10
0019-9567/00/$04.00+0
Purification and Characterization of a Cytotonic
Protein Expressed In Vitro by the Live Cholera Vaccine Candidate
CVD 103-HgR
Venugopal
Sathyamoorthy,
Robert H.
Hall,*
Barbara A.
McCardell,
Mahendra H.
Kothary,
Susie J.
Ahn, and
Shashikala
Ratnayake
Division of Virulence Assessment, Center for
Food Safety and Applied Nutrition, Food and Drug Administration,
Washington, D.C. 20204
Received 1 May 2000/Returned for modification 16 June 2000/Accepted 27 July 2000
 |
ABSTRACT |
Cholera vaccines developed by the deletion of CTX genes from
Vibrio cholerae induce a residual reactogenicity in up to
10% of vaccinees. A novel cytotonic agent named secreted CHO cell elongating protein (S-CEP) was purified from culture supernatants of
CVD 103-HgR (Levine et al., Lancet ii:467-470, 1988). Five fractionation steps yielded electrophoretically pure S-CEP with an
Mr of 79,000. A partially purified preparation
caused fluid accumulation in the sealed infant mouse model. The amino
terminus bore a unique sequence with strong homology to a cytotonic
toxin of El Tor V. cholerae.
 |
TEXT |
Vibrio cholerae utilizes
a complex array of structural and regulatory elements in the
pathogenesis and immunogenicity of cholera. Although site-specific
deletion mutagenesis of the genes encoding cholera toxin (11,
18) resulted in engendering significant protective immunity and
the dramatic elimination of the symptoms of cholera gravis, clinical
studies consistently reported a residual degree of diarrhea and malaise
among vaccinees, indicating that a secretogenic activity remained
(11, 16, 18, 21). The extent and intensity of symptoms among
vaccinees appeared to be dependent on the dose, the study population,
and the vaccine strain under investigation, although little is known of
the bacterial factors or the host secretogenic mechanism involved
(16, 21-25). Identifying and attenuating the cause of
vaccine reactogenicity while preserving immunogenicity remains a major
objective of oral vaccine development (19). Characterizing
virulence determinants may also contribute to a better understanding of
Vibrio pathogenesis and host responses.
Numerous model systems are available for the identification, assay, and
characterization of secretogenic activities. Morphological studies on
isolated mammalian tissue, such as the Chinese hamster ovary (CHO) cell
assay, have provided useful information on nonlethal virulence factors
from several bacterial pathogens because these tests do not require an
endpoint of cell death (9). A wide range of whole animal
systems, including the infant mouse model (13), has
contributed to the identification and characterization of numerous
virulence determinants from enteric pathogens.
In this study, we assayed culture supernatants from several
ctxA-negative V. cholerae strains for cytotonic
activity on cultured CHO cells. A CHO elongation activity expressed by
the cholera vaccine strain CVD 103-HgR was purified to electrophoretic
homogeneity by using (NH4)2SO4
fractionation and four chromatographic steps. Physical characteristics
of the protein were determined, including the Mr
subunit structure, stability, and amino-terminal sequence. The purified
protein was named secreted CHO cell elongating protein (S-CEP). A
partially purified cytotonic protein preparation induced fluid
accumulation (FA) in the infant mouse model. The identification and
description of a novel cytotonic protein in V. cholerae
raises questions about its expression and activity in the human
intestine and its possible role in vaccine reactogenicity.
The following El Tor biotype strains of O serogroup 1 V. cholerae were studied: JBK 70 (a
ctxAB mutant
derivative of Inaba strain N16961 [11]) and three
environmental isolates from Brazil, namely 8731, 1074, and 1196 (14). The classical biotype strains studied were CVD 103, CVD 103-HgR, and CVD 103-HgR2, all three of which are
ctxA mutants of Inaba V. cholerae strain 569B
(8). Overnight cultures in Luria broth (10 ml) were
inoculated into 1-liter volumes of casamino-yeast extract broth (30 g
of casamino acids [Difco; Becton Dickinson, Franklin Lakes, N.J.],
4 g of yeast extract [Difco], 0.5 g of
K2HPO4 dissolved in 1 liter of H2O,
pH 6.8) in 2-liter flasks and incubated at 37°C in a rotary shaker
for 18 h. Cultures were harvested by centrifugation
(8,300 × g for 20 min at 4°C), and supernatants were
sterilized by filtration (0.22-µm pore size) and stored at 0 to
4°C.
Both culture supernatants and chromatographic fractions (prepared as
described below) were subjected to the CHO tissue culture assay
conducted as reported elsewhere (9, 13). Briefly, CHO cells
were cultured to confluence in Eagle minimal essential medium containing Hanks base salts (Sigma Chemical Co., St. Louis, Mo.) supplemented with 10% fetal bovine serum and 10% tryptose phosphate broth. After incubation at 37°C for 48 h in a humid atmosphere containing 5% CO2, monolayers of CHO cells were released
by treatment with 0.025% trypsin containing 1 µM EDTA. CHO cells
were resuspended and seeded into fresh microtiter plates at a density
of approximately 1,000 cells per well. The CHO cells were treated with
a test or control sample (20 µl) and examined microscopically after
24 h of incubation. One CHO cell unit was defined as the
reciprocal of the dilution that caused elongation of 50% of the cells
in the well.
V. cholerae classical strain CVD 103-HgR was selected as the
source of cytotonic agent because of its relatively high level of
activity compared with other organisms tested (data not shown), its
role as a vaccine, and the extensive literature on this organism. An
additional advantage in studying this strain is its deficiency in the
expression of HlyA and engineered deletion of CtxA, which would
otherwise exert, respectively, powerful cytolytic and cytotonic effects
on CHO cells (5, 6, 8, 10, 15). The absence of cholera toxin
and hemolysin activity removed a mask and thereby revealed a remaining
CHO cell cytotonic activity which was purified in this study.
Cytotonic toxin purification.
Culture supernatants of V. cholerae CVD 103-HgR were subjected to five steps of protein
purification, (i) ammonium sulfate fractionation, (ii) anion exchange,
(iii) cation exchange, (iv) hydrophobic interaction, and (v) gel
filtration chromatography, to yield electrophoretically homogeneous
protein bearing a single, unique amino-terminal sequence. Purification
proceeded as follows.
In step 1, (NH4)2SO4 was added to
culture supernatants to 55% saturation (351 g/liter) and proteins
precipitated overnight at 4°C. After centrifugation (8,300 × g for 20 min at 4°C), precipitated proteins were resuspended,
dialyzed, equilibrated against 20 mM Tris (pH 7.5) containing leupeptin
(0.5 mg/liter), pepstatin (0.7 mg/liter) phenylmethylsulfonyl fluoride
(1.0 mM), and EDTA (1.0 mM), and sterilized by filtration (0.2-µm
pore size). Material obtained from 100 liters of culture was bulked.
In step 2, concentrated supernatant proteins were applied to
Q-Sepharose anion-exchange resin in a prepacked fast protein
liquid
chromatography (FPLC) column (Amersham Pharmacia Biotech,
Piscataway,
N.J.), fractionated, and subjected to CHO cell assay.
The S-CEP bound
the anion-exchange chromatography column when
loaded in low-salt buffer
and eluted in the presence of NaCl in
six fractions of 6 ml
each.
Step 3 consisted of bulking the active fractions (numbers 7 to 12) from
anion-exchange chromatography and applying the sample
to a prepacked
Mono-S cation-exchange FPLC column (Amersham Pharmacia
Biotech).
Pigment and other positively charged contaminating material
in the
bulked active fractions was removed during this step. The
CHO cell
assay identified the flowthrough (nonbinding) material
as possessing
the cytotonic activity, whereas a significant quantity
of contaminating
proteins and pigment bound to the
matrix.
Step 4 comprised application of the bulked flowthrough activity to a
prepacked hydrophobic interaction phenyl-Sepharose FPLC
column
(Amersham Pharmacia Biotech). The CHO cell-elongating activity
fractionated in a decreasing concentration gradient from 0.3 M
(NH
4)
2SO
4. Active fractions eluting
from the phenyl-Superose FPLC
column were concentrated by
ultrafiltration centrifugation (Centricon
30; Amicon, Beverly, Mass.).
In step 5, the concentrate was applied to a prepacked Superose 12 gel
filtration FPLC column (Amersham Pharmacia Biotech).
The elution
pattern of the fractions possessing CHO cell elongating
activity was
compared to that of known protein standards, indicating
an active
protein with an apparent molecular mass of 75,000 (Fig.
1).

View larger version (10K):
[in this window]
[in a new window]
|
FIG. 1.
Molecular mass estimation by gel exclusion
chromatography. The molecular mass of S-CEP was estimated from the
elution profile of standard proteins with known masses. An estimate of
75,000 was made for the molecular mass of the active form of the native
toxin.
|
|
Table
1 represents the protein
purification table for S-CEP. Expression of S-CEP under the conditions
described was low,
necessitating preparation of large volumes of
bacterial culture.
The low level of protein expression combined with
loss of activity
during purification through numerous purification
steps resulted
in a small yield of pure protein after four
chromatographic steps.
The yield depended on the size of batch:
generally, larger batches
yielded a greater percentage recovery. Over
100 liters of culture
was required to produce 30 to 100 µg of
homogeneous cytotonic
toxin. After five steps, a final yield of
approximately 12% of
the culture supernatant activity was purified to
homogeneity.
Protein analysis.
Protein concentrations were estimated either
by using the Bio-Rad Protein Assay kit (Bio-Rad, Richmond, Calif.)
(3) or by using visual estimations of sodium dodecyl
sulfate-polyacrylamide electrophoresis (SDS-PAGE) gels stained with
Coomassie brilliant blue. The subunit composition of S-CEP was
investigated by using PAGE (8 to 25% [wt/vol] total acrylamide) in
the presence of SDS according to the manufacturer's instructions
(PhastSystem; Amersham Pharmacia Biotech). Analysis of bulked active
fractions from Superose-12 fractionation revealed an homogeneous,
electrophoretically pure protein band migrating with an
Mr of 79,000 (Fig.
2), with no visible evidence of
copurifying subunit polypeptides. When compared to the elution pattern
of the S-CEP activity directly from gel filtration chromatography
(active moiety of Mr of 75,000), the estimated
molecular masses were sufficiently similar to support a model of S-CEP
as a toxin active as a single major polypeptide chain.

View larger version (83K):
[in this window]
[in a new window]
|
FIG. 2.
SDS-PAGE analysis of purified S-CEP. Purified S-CEP was
analyzed under denaturing conditions in gradient (8 to 25% total
acrylamide) gels. A single discernable band of
Mr = 79,000 was identified, suggesting a
single major active polypeptide species.
|
|
Previously described methods were used to determine the amino-terminal
sequence of S-CEP (
20). Samples were applied to multiple
tracks of polyacrylamide gradient gels as described above. After
electrophoresis, the minigels were separated from the plastic
backing
and electrophoretically transblotted onto polyvinylidene
membranes
(
20) (Pro-Blott; PE Biosystems, Foster City, Calif.).
Proteins were visualized with Coomassie brilliant blue, and bands
corresponding to an
Mr of 79,000 were excised
and applied to the
reaction cartridge of a PE Biosystems Model 477A
automated amino-terminal
sequencer. Twenty cycles of Edman degradation
yielded a single
amino-terminal protein sequence comprising
NH
3-Ser-Ser-Gly-Ala-Ser-Thr-Glu-Val-Val-Tyr-Glu-Ser-Tyr-Ile-Gln-Gln-.
This sequence was compared to the preliminary genome sequencing
project
reported by The Institute for Genome Research (TIGR) and
was found to
be identical to a chromosomally carried DNA sequence
of unknown
functionality in
V. cholerae El Tor N16961
(
http://www.tigr.org).
Structural analysis of the N-terminal sequence
and adjacent sequences
(1,000 bases up- and downstream) was conducted
by using the web-based
Expert Protein Analysis System of Geneva
BioInformatics (
http://www.expasy.com),
which maintains a comprehensive
set of proteomics database querying
and analysis tools and provides
secure access to a large number
of database collections. An open
reading frame was identified
which bore homology to sequences in the
GenBank database obtained
from the phospholipase A1 of
Aeromonas
hydrophila. Comparison
of the two sequences indicated 40%
identity and 55% similarity
between
A. hydrophila
phospholipase A1 and the
V. cholerae genomic
sequence
reported by TIGR. The predicted
Mr of the
translated
Aeromonas sequence was 82,000, approximating the
molecular mass
identified above for
V. cholerae S-CEP. The
presence of a homologous
sequence to S-CEP in the TIGR
V. cholerae prototype sequence database,
and the homology of the
V. cholerae sequence with that of a putative
Aeromonas virulence factor associated with gastroenteritis
(
4),
suggest that similar sequences may be prevalent among a
range
of
Vibrio and
Aeromonas strains, and
possibly
beyond.
The El Tor sequence homologue with an additional 2 kb of flanking
sequence was analyzed for open reading frames. The resulting
extrapolated protein sequence encompassing the N-terminal amino
acids
was compared with sequences in the GenBank and SWISS-PROT
databases. A
close match was found with the phospholipase A1 of
A. hydrophila (GenBank accession no. AAC64133.1). Lesser scores
were
found with a family of DNA sequences from extracellular lipases
from
A. hydrophila. Significant homology was also found with a
cell-associated protein with similar activity isolated from El
Tor
V. cholerae Inaba JBK 70, although the El Tor N-terminal
sequence
possessed six additional residues at the amino terminus
(XGDETN-)
(
17). No homology was found with the recently
described novel
V. cholerae cytotoxin of Walia et al.
(
27).
The thermal stability of S-CEP was studied by incubating toxin for 15 min at 21, 56, and 100°C. The effect of pH was evaluated
by
incubation at 4°C for 24 h at pH 4.0, 5.0, 6.0, 7.0, 8.0, 9.0,
and 10.0, followed by assay for CHO cell activity. The effects
of the
proteases trypsin (1.0 mg/ml), chymotrypsin (1.0 mg/ml),
papain (1.0 mg/ml), subtilisin (0.1 mg/ml), and thermolysin (0.1
mg/ml) on the
activity of the toxin were determined after digestion
for 4 h at
37°C, except for thermolysin, which is optimally active
at 45°C
(1-h incubation). Residual activities were determined
using the CHO
cell elongation assay as described above. Incubation
at 100°C
abolished toxin activity. The toxin displayed stability
from pH 5.0 to
10.0, with a reduction to 50% activity at pH 4.0.
S-CEP was resistant
to papain and thermolysin, but lost 50% activity
after incubation with
trypsin or chymotrypsin and 99% activity
after incubation with
subtilisin.
Partially purified toxin comprised bulked, active fractions from the
third stage of purification (i.e., after cation-exchange
chromatography) and was assayed in the sealed infant mouse model.
By
using previously described methods (
1,
13), infant mice
(3 to 5 days of age, approximately 3 to 4 g in weight, five mice
per
sample) were fed 50 µl (containing 53,250 U of activity) of
protein
purified through step 3 suspended in Evans' Blue (0.01%
[wt/vol]).
After incubation for 6 h, the animals were sacrificed
and the
intestine plus stomach weight of each animal was measured.
The FA ratio
was expressed as 1,000 times the ratio of the weight
of the stomach
plus intestine to the remaining body weight. The
FA ratios representing
means ± standard deviations were compared
to those of negative
controls fed 0.01% Evans' Blue in phosphate-buffered
saline and
positive controls fed cholera toxin. The following
data indicate that
significant FA was elicited. FA ratios induced
by the toxin (74.0 ± 11.88) were significantly higher than those
induced by buffer
(57.0 ± 1.23;
P = 0.012, paired
t
test). In
comparison, FA ratios induced by 0.5 µg of cholera toxin
(500,000
U) had values of 93.2 ± 2.8 (
P 
0.001;
paired
t test).
The complex regulatory and structural interactions between
V. cholerae and the human host have yet to be fully described.
Poorly
understood aspects of cholera remain, for example, nontoxigenic
mutants
present an unexplained reactogenicity in the adult volunteer
model
(
15,
16,
22-25), and numerous putative virulence
determinants
have been identified without a clearly prescribed role in
disease
(
2,
7,
10,
17,
26,
27). A range of model systems
have identified several products of
V. cholerae as potential
reactogenic
factors; however, evaluation of numerous cholera vaccine
candidates
bearing mutations in putative toxins has yet to identify a
role
for any of these virulence factors in reactogenicity in the adult
volunteer model (
12). Recently, Silva et al. (
21)
suggested
that a host inflammatory response might account for the
symptoms
observed in vaccinees. To the inventory of potentially
bioactive
macromolecules expressed and secreted by
V. cholerae can now be
added the S-CEP described in this report. A
determination of the
significance, if any, of S-CEP as a specific cause
of vaccine
reactogenicity may be clarified in the adult volunteer
model.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Food and Drug
Administration, CFSAN/DVA/HFS 327, Washington, DC 20204. Phone: (202) 205-4918. Fax: (202) 205-4939. E-mail:
rhh{at}cfsan.fda.gov.
Editor:
J. T. Barbieri
 |
REFERENCES |
| 1.
|
Baselski, V.,
R. Briggs, and C. Parker.
1977.
Intestinal fluid accumulation induced by oral challenge with Vibrio cholerae or cholera toxin in infant mice.
Infect. Immun.
15:704-712[Abstract/Free Full Text].
|
| 2.
|
Baudry, B.,
A. Fasano,
J. Ketley, and J. B. Kaper.
1992.
Cloning of a gene (zot) encoding a new toxin produced by Vibrio cholerae.
Infect. Immun.
60:428-434[Abstract/Free Full Text].
|
| 3.
|
Bradford, M. M.
1976.
A rapid and sensitive method for the quantification of microgram quantities of protein utilizing the principle of protein-dye binding.
Anal. Biochem.
72:248-254[CrossRef][Medline].
|
| 4.
|
Chuang, Y. C.,
S. F. Chiou,
J. H. Su,
M. L. Wu, and M. C. Chang.
1997.
Molecular analysis and expression of the extracellular lipase of Aeromonas hydrophila MCC-2.
Microbiology
143:803-812[Abstract/Free Full Text].
|
| 5.
|
Clements, J. D., and R. A. Finkelstein.
1979.
Isolation and characterization of homogeneous heat-labile enterotoxins with high specific activity from Escherichia coli.
Infect. Immun.
24:760-769[Abstract/Free Full Text].
|
| 6.
|
Dubey, R. S.,
M. Linblad, and J. Holmgren.
1990.
Purification of El Tor cholera enterotoxins and comparisons with classical toxins.
J. Gen. Microbiol.
136:1839-1847[Abstract/Free Full Text].
|
| 7.
|
Fasano, A.,
B. Baudry,
D. W. Pumplin,
S. S. Wasserman,
B. D. Tall,
J. M. Ketley, and J. B. Kaper.
1991.
Vibrio cholerae produces a second enterotoxin which affects intestinal tight junctions.
Proc. Natl. Acad. Sci. USA
88:5242-5246[Abstract/Free Full Text].
|
| 8.
|
Finkelstein, R. A.
1973.
Cholera.
Crit. Rev. Microbiol.
2:553-623.
|
| 9.
|
Guerrant, R. L.,
L. L. Brunton,
T. C. Schnaitman,
L. L. Rebhun, and A. G. Gilman.
1974.
Cyclic adenosine monophosphate and alteration of Chinese hamster ovary cell morphology: a rapid, sensitive in vitro assay for the enterotoxins of Vibrio cholerae and Escherichia coli.
Infect. Immun.
10:320-327[Abstract/Free Full Text].
|
| 10.
|
Honda, T., and R. A. Finkelstein.
1979.
Purification and characterization of a hemolysin produced by Vibrio cholerae biotype El Tor: another toxic substance produced by cholera vibrios.
Infect. Immun.
26:1020-1027[Abstract/Free Full Text].
|
| 11.
|
Kaper, J. B.,
H. Lockman,
M. M. Baldini, and M. M. Levine.
1984.
Recombinant nontoxigenic Vibrio cholerae strains as attenuated cholera vaccine candidates.
Nature (London)
308:655-658[CrossRef][Medline].
|
| 12.
|
Kaper, J. B.,
J. G. Morris, and M. M. Levine.
1995.
Cholera.
Clin. Microbiol. Rev.
8:48-86[Abstract].
|
| 13.
|
Kothary, M. H., and S. H. Richardson.
1987.
Fluid accumulation in infant mice caused by Vibrio hollisae and its extracellular enterotoxin.
Infect. Immun.
55:626-630[Abstract/Free Full Text].
|
| 14.
|
Levine, M. M.,
R. E. Black,
M. L. Clemens,
L. Cisneros,
A. Saah,
D. R. Nalin,
D. M. Gill,
J. P. Craig,
C. R. Young, and P. Ristaino.
1982.
The pathogenicity of non-enterotoxigenic Vibrio cholerae serogroup O1 biotype El Tor isolated from sewage water in Brazil.
J. Infect. Dis.
145:296-299[Medline].
|
| 15.
|
Levine, M. M.,
J. B. Kaper,
D. Herrington,
J. Ketley,
G. Losonsky,
C. O. Tacket,
B. Tall, and S. Cryz.
1988.
Safety, immunogenicity, and efficacy of recombinant live oral vaccines, CVD 103 and CVD 103-HgR.
Lancet
ii:467-470.
|
| 16.
|
Levine, M. M.,
J. B. Kaper,
D. Herrington,
G. Losonsky,
J. G. Morris,
M. L. Clements,
R. E. Black,
B. Tall, and R. Hall.
1988.
Volunteer studies of deletion mutants of Vibrio cholerae O1 prepared by recombinant techniques.
Infect. Immun.
56:161-167[Abstract/Free Full Text].
|
| 17.
|
McCardell, B. A.,
M. H. Kothary,
R. H. Hall, and V. Sathyamoorthy.
2000.
Identification of a CHO-cell elongating toxin produced by Vibrio cholerae O1.
Microb. Pathog.
29:1-8[CrossRef][Medline].
|
| 18.
|
Mekalanos, J. J.,
D. J. Swartz,
G. D. N. Pearson,
N. Harford,
F. Groyne, and M. deWilde.
1983.
Cholera toxin genes: nucleotide sequence, deletion analysis, and vaccine development.
Nature (London)
306:551-557[CrossRef][Medline].
|
| 19.
|
Michalski, J.,
J. E. Galen,
A. Fasano, and J. B. Kaper.
1993.
CVD110, an attenuated Vibrio cholerae O1 El Tor live oral vaccine strain.
Infect. Immun.
61:4462-4468[Abstract/Free Full Text].
|
| 20.
|
Moos, M.,
N. Y. Nguyen, and T.-Y. Liu.
1988.
Reproducible high yield sequencing of proteins electrophoretically separated and transferred to an inert support.
J. Biol. Chem.
263:6005-6008[Abstract/Free Full Text].
|
| 21.
|
Silva, T. M.,
M. A. Schleupner,
C. O. Tacket,
T. S. Steiner,
J. B. Kaper,
R. Edelman, and R. Guerrant.
1996.
New evidence for an inflammatory component in diarrhea caused by selected new, live attenuated cholera vaccines and by El Tor and Q139 Vibrio cholerae.
Infect. Immun.
64:2362-2364[Abstract].
|
| 22.
|
Tacket, C. O.,
K. L. Kotloff,
G. Losonsky,
J. P. Nataro,
J. Michalski,
J. B. Kaper,
R. Edelman, and M. M. Levine.
1997.
Volunteer studies investigating the safety and efficacy of live oral El Tor Vibrio cholerae O1 vaccine strain CVD 111.
Am. J. Trop. Med. Hyg.
56:533-537.
|
| 23.
|
Tacket, C. O.,
G. Losonsky,
J. P. Nataro,
S. J. Cryz,
R. Edelman,
A. Fasano,
J. Michalski,
J. Kaper, and M. M. Levine.
1993.
Safety and immunogenicity of live oral cholera candidate CVD 110, a ctx zot ace derivative of El Tor Ogawa Vibrio cholerae.
J. Infect. Dis.
168:1536-1540[Medline].
|
| 24.
|
Taylor, D. N.,
J. L. Sanchez,
J. M. Castro,
C. Lebron,
C. M. Parrado,
D. E. Johnson,
C. O. Tacket,
G. A. Losonsky,
S. S. Wasserman,
M. M. Levine, and S. J. Cryz.
1999.
Expanded safety and immunogenicity of a bivalent, oral, attenuated vaccine, CVD 103-HgR plus CVD 111, in United States military personnel stationed in Panama.
Infect. Immun.
67:2030-2034[Abstract/Free Full Text].
|
| 25.
|
Taylor, D. N.,
C. O. Tacket,
G. Losonsky,
O. Castro,
J. Gutierrez,
R. Meza,
J. P. Nataro,
J. B. Kaper,
S. S. Wasserman,
R. Edelman,
M. M. Levine, and S. J. Cryz.
1997.
Evaluation of a bivalent (CVD 103-HgR) live oral cholera vaccine in adult volunteers from the United States and Peru.
Infect. Immun.
65:3852-3856[Abstract].
|
| 26.
|
Trucksis, M.,
J. E. Galen,
J. Michalski,
A. Fasano, and J. B. Kaper.
1993.
Accessory cholera enterotoxin (Ace), the third toxin of a Vibrio cholerae virulence cassette.
Proc. Natl. Acad. Sci. USA
90:5267-5271[Abstract/Free Full Text].
|
| 27.
|
Walia, K.,
S. Ghosh,
H. Singh,
G. B. Nair,
A. Ghosh,
G. Sahni,
H. Vohra, and N. K. Ganguly.
1999.
Purification and characterization of novel toxin produced by Vibrio cholerae O1.
Infect. Immun.
67:5215-5222[Abstract/Free Full Text].
|
Infection and Immunity, October 2000, p. 6062-6065, Vol. 68, No. 10
0019-9567/00/$04.00+0