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Infection and Immunity, June 2003, p. 3634-3638, Vol. 71, No. 6
0019-9567/03/$08.00+0 DOI: 10.1128/IAI.71.6.3634-3638.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.
Cytolethal Distending Toxin Gene Cluster in Enterohemorrhagic Escherichia coli O157:H- and O157:H7: Characterization and Evolutionary Considerations
Andreas Janka,1 Martina Bielaszewska,1 Ulrich Dobrindt,2 Lilo Greune,3 M. Alexander Schmidt,3 and Helge Karch1*
Institut für Hygiene, Universitätsklinikum Münster,1
Institut für Infektiologie, Zentrum für Molekularbiologie der Entzündung (ZMBE), Universität Münster, 48149 Münster,3
Institut für Molekulare Infektionsbiologie, Universität Würzburg, 97070 Würzburg, Germany2
Received 8 November 2002/
Returned for modification 26 February 2003/
Accepted 18 March 2003

ABSTRACT
We identified a cytolethal distending toxin (
cdt) gene cluster
in 87, 6, and 0% of sorbitol-fermenting (SF) enterohemorrhagic
Escherichia coli (EHEC) O157:H
-, EHEC O157:H7, and
E.
coli O55:H7/H
- strains, respectively. The toxin was expressed by the wild-type
EHEC O157 strains and by a
cdt-containing cosmid from a library
of SF EHEC O157:H
- strain 493/89. The
cdt flanks in strain 493/89
were homologous to bacteriophages P2 and lambda. Our data demonstrate
that
cdt, encoding a potential virulence factor, is present
in the EHEC O157 complex and suggest that
cdt may have been
acquired by phage transduction.

TEXT
Sorbitol-fermenting (SF) enterohemorrhagic
Escherichia coli (EHEC) O157:H
- strains have emerged as causes of diarrhea, hemorrhagic
colitis, and the hemolytic-uremic syndrome (HUS) in continental
Europe (
11). Multilocus enzyme electrophoresis and sequence
typing (
5,
16) demonstrated that SF EHEC O157:H
- is closely
related to EHEC O157:H7 and evolved from a common enteropathogenic
E.
coli O55:H7-like ancestor or a similar, closely related organism
(
5). Whereas the complete genome sequences of two EHEC O157:H7
strains (EDL933 and the Sakai outbreak strain) have been published
(
6,
14), the genome of SF EHEC O157:H
- remains mostly uncharacterized.
In this study, a cosmid library of SF EHEC O157:H
- reference
strain 493/89 was used to characterize a novel gene cluster
encoding cytolethal distending toxin (CDT) (
8) in SF EHEC O157:H
-.
SF EHEC O157:H- strain 493/89 (9, 10) genomic DNA was partially digested with Sau3AI (Gibco BRL, Eggenstein, Germany), and the fragments were dephosphorylated with shrimp alkaline phosphatase, ligated into the arms of a cosmid (SuperCos I; Stratagene, Heidelberg, Germany), and packaged into phage heads with the Gigapack III XL-4 system (Stratagene). E. coli XL1-Blue MR transductants were selected on Luria-Bertani agar containing ampicillin (100 µg/ml) and sorted into a cosmid library. Plasmid DNA from randomly selected clones was isolated (Qiagen Midi Kit; Qiagen, Hilden, Germany) and sequenced with primers supercos1fwd (5'-CGGCCGCAATTAACCCTCAC-3') and supercos1rwd (5'-GCGGCCGCATAATACGACTCACT-3') by AGOWA GmbH, Berlin, Germany. Sequences were analyzed with the DNASIS program (Hitachi Software). Homology searches were performed with the EMBL GenBank database. PCRs with three different primer pairs (Fig. 1), i.e., c338f (5'-AGCATTAAATAAAAGCACGA-3') and c2135r (5'-TACTTGCTGTGGTCTGCTAT-3'), c1309f (5'-AGCACCCGCAGTATCTTTGA-3') and c2166r (5'-AGCCTCTTTTATCGTCTGGA-3'), and P105 (5'-GTCAACGAACATTAGATTAT-3') and c2767r (5'-ATGGTCATGCTTTGTTATAT-3'), which are specific for cdtA, cdtB, and cdtC (12), respectively, were applied to DNA from 175 EHEC O157:H7 or H- and 26 E. coli O55:H7 or H- clinical isolates (Table 1). The primers were designed on the basis of the cdt sequence of SF EHEC O157:H- strain 493/89 and from the published cdt-III sequence (accession number U89305). The PCRs included 30 cycles of denaturing (94°C, 30 s), annealing (52, 54, and 49°C [cdtA, cdtB, and cdtC, respectively], 60 s), and extension (72°C, 60 s), followed by a final extension (72°C, 5 min), resulting in amplicons of 1,329, 1,363, and 748 bp for cdtA, cdtB, and cdtC, respectively. CDT was assayed with Chinese hamster ovary (CHO) cells and a modification of the procedure described by Scott and Kaper (18). Briefly, supernatants of overnight bacterial cultures grown with shaking (180 rpm) in cell culture medium (Ham's F12 with 10% fetal calf serum) were filter sterilized (0.22-µm-pore-size filters; Schleicher & Schuell GmbH, Dassel, Germany) and 1-ml portions of filtrates or their twofold dilutions were added in duplicate to 103 freshly seeded CHO cells in 1.5 ml of Ham's F-12 medium in six-well tissue culture plates (Falcon 3502; Becton Dickinson Labware, Franklin Lakes, N.J.). The assay mixtures were incubated for 5 days at 37°C in 5% CO2 and examined daily for a typical distending effect (8). The CDT titer was defined as the highest filtrate dilution that caused distension in 50% of CHO cells. Strain 6468/62, producing CDT-I (18) (gift from D. A. Scott, University of Maryland School of Medicine, Baltimore), and E. coli XL1-Blue MR, containing the SuperCos I vector, were used as the positive and negative controls, respectively. Statistical analysis was performed with the
2 test (4); P values of <0.05 were considered significant.
Identification and characterization of the cdt cluster in SF EHEC O157:H-.
Three hundred 493/89 cosmid clones were sequenced and tested
for homology to EHEC O157:H7 strain EDL933 (
14) (accession number
AE005174); 118 were homologous at both ends. Sequence data suggested
an insertion of ca. 30 kb in one cosmid, compared to the
E.
coli O157:H7 sequence. Subcloning of this insert demonstrated
cdt components
cdtA,
cdtB, and
cdtC. Figure
2 depicts the differences
among the deduced amino acid sequences of CDT from strain 493/89,
CDT-II from
E.
coli O128:H
- strain 9142/88 (
15) (accession number
U04208), and CDT-III from
E.
coli O15:H21 strain S5 (
13) (accession
number
U89305). The 54 differences between CDT from 493/89 and
CDT-II are distributed over each of the three open reading frames
(ORFs), resulting in 93, 93, and 89% amino acid identity among
CdtA, -B, and -C, respectively. In contrast, the 17 amino acid
differences between CDT from 493/89 and CDT-III are clustered
at the 5' end of CdtA and the 3' end of CdtC whereas the CdtB
sequences are 100% identical (Fig.
2). The amino acid sequence
homologies of CDT from 493/89 to CDT-I from
E.
coli O86:H34
strain 6468/62 (
18) (accession number
U03293) are only 39, 54,
and 31% for CdtA, -B, and -C, respectively. CDT-III, which is
the most similar to CDT from strain 493/89, has been reported
to be encoded by a gene on a plasmid (
13). However, the insert
ends of the
cdt-containing cosmid of the 493/89 library are
homologous to the EDL933 chromosome.
Shotgun cloning to assess the
cdt flanks in strain 493/89 was
performed and demonstrated homologues of a bacteriophage P2
(accession number
AF063097) cohesive end and portal protein
downstream of
cdtA and bacteriophage P2 DNA replication protein
upstream of
cdtC (Fig.
1). This suggested that the 2,822-bp
sequence containing the three
cdt ORFs in strain 493/89 is located
within the region of bacteriophage P2 late genes, where it replaces
3,255 bp of the phage genes that encode ORF91 and a hypothetical
protein with no known essential function. The homology to the
cdt-
III sequence extends to the beginning of the phage homology
(Fig.
1). In addition, shotgun cloning of the 493/89
cdt-containing
insert demonstrated homology to bacteriophage lambda (accession
number
J02459) spanning the first half of the phage sequence
that encodes DNA-packaging enzymes and tail and head components.
cdt in E. coli O157 and O55.
PCR targeting cdtA, cdtB, and cdtC (Fig. 1) was used to assess the conservation of these loci in 100 EHEC O157:H7, 75 SF EHEC O157:H-, and 26 E. coli O55:H7/H- strains isolated from patients (Table 1). Each of the three cdt genes was significantly more frequent in SF EHEC O157:H- (87%) than in EHEC O157:H7 (6%) (P < 0.000001) and was absent from all of the E. coli O55:H7/H- strains investigated (Table 1). Five of the 10 cdt-negative SF EHEC O157:H- strains originated from HUS patients, and five came from patients with diarrhea. Of the six cdt-positive EHEC O157:H7 strains, one was from an HUS patient and five were from patients with diarrhea.
CDT expression.
After 5 days of incubation, sterile filtrates from the 493/89 cdt-containing cosmid (Fig. 3B), wild-type SF EHEC O157:H- strain 493/89 (Fig. 3C), and EHEC O157:H7 strain 5791/99 (Fig. 3D) distended CHO cells to an extent comparable to that caused by CDT+ control strain 6468/62 (Fig. 3A). No morphological changes, compared to CHO cells incubated in Ham's F-12 medium only (Fig. 3F), were observed with E. coli XL1-Blue MR cells transduced with the SuperCos I vector (Fig. 3E). The CDT titer expressed by the 493/89 cdt-containing cosmid and by EHEC O157 wild-type strains 493/89 and 5791/99 was 1:4; strain 6468/62 produced a CDT titer of 1:8.
CDT, first described in 1987 (
8), has been associated mainly
with enteropathogenic and necrotoxigenic
E.
coli (
3). We report
the presence of
cdt in EHEC strains. Although the
cdt cluster
of SF EHEC O157:H
- strain 493/89 demonstrates the highest degree
of homology to
cdt-
III, it differs from
cdt-
III by the presence
of phage flanking regions. The juxtaposition of the
cdt region
of strain 493/89 with the bacteriophage P2 sequence (Fig.
1)
suggests that
cdt may have been acquired by phage transduction.
In addition, the presence of bacteriophage lambda sequences
in the cosmid insert containing
cdt from strain 493/89 suggests
possible recombination between these two phages. Mosaicism,
resulting from multiple phage recombination events, has been
well documented in Shiga toxin-converting bacteriophages (
17).
Furthermore, the conservation of all three
cdt components in
each of the
cdt-positive EHEC O157 strains indicates that
cdt may have been introduced by a single ancestral phage transduction
into the O157 complex. Because
cdt is present in most SF EHEC
O157:H
- strains but absent from most EHEC O157:H7 strains and
from all of the
E.
coli O55:H7 strains tested, which are the
proposed ancestors of EHEC O157 (
5), we believe that the most
parsimonious sequence of events is that a mobile element containing
this cluster was acquired by SF EHEC O157:H
- after this lineage
diverged from
E.
coli O157:H7. This sequence contrasts with
the situation that we believe happened with the
efa1 (
lifA)
gene, which was lost by EHEC O157:H7 (
7). The 10
cdt-negative
SF EHEC O157:H
- and 6
cdt-positive EHEC O157:H7 strains that
represent exceptions to the evolutionary concept proposed above
need to be investigated further to test the hypothesis that
cdt was lost or acquired through a phage or other mobile element
in these specific cases. For bacteriophage P2, such investigation
is hampered by the fact that although spontaneous induction
of the phage does occur (
1), P2 phage lysogens cannot be artificially
induced to release phage particles (
1). Besides
efa1 (lifA),
which encodes a multifunctional virulence factor that can act
as an adhesin or lymphostatin (
7), and the
sfp gene cluster,
which encodes SF EHEC O157-specific fimbriae (
2), the
cdt cluster
is a putative virulence gene that is typically associated with
SF EHEC O157:H
- but absent from EHEC O157:H7. In contrast, EHEC
O157:H7 regularly harbors the pathogenicity island TAI (tellurite
resistance- and adherence-conferring island) (
19) and the
espP and
katP plasmid genes (
11), which are absent from SF EHEC O157:H
- (
11,
19). In O157:H7, CDT does not appear to play a significant
role in human diseases, because it is mostly absent from such
strains. However, in SF EHEC O157:H
-, CDT is commonly present
and studies investigating its role in SF EHEC O157:H
--associated
disease are under way.
Nucleotide sequence accession number.
The sequence of the cdt-containing fragment from strain 493/89 has been deposited in the GenBank database and assigned accession number AJ508930.

ACKNOWLEDGMENTS
This study was supported by grants from the BMBF Project Network
of Competence Pathogenomics Alliance [Functional Genomic Research
on Enterohaemorrhagic, Enteropathogenic and Enteroaggregative
Escherichia coli (EHEC, EPEC, EAEC)], project group Schmidt/Karch,
Universitätsklinikum Münster (BD numbers 119523 and
207800), and from the First European Graduate College (Gene
Regulation in and by Microbial Pathogens).
The excellent technical assistance of Barbara Plaschke is greatly appreciated. We thank Phillip I. Tarr (Washington University School of Medicine, St. Louis, Mo.) for critical reading of the manuscript and helpful discussions.

FOOTNOTES
* Corresponding author. Mailing address: Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch Str. 41, 48149 Münster, Germany. Phone: 49-251-8355361. Fax: 49-251-8355341. E-mail:
hkarch{at}uni-muenster.de.

Editor: A. D. O'Brien

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Infection and Immunity, June 2003, p. 3634-3638, Vol. 71, No. 6
0019-9567/03/$08.00+0 DOI: 10.1128/IAI.71.6.3634-3638.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.
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