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Infection and Immunity, May 2007, p. 2269-2274, Vol. 75, No. 5
0019-9567/07/$08.00+0     doi:10.1128/IAI.01856-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Mucosal and Systemic Immune Responses in Patients with Diarrhea Due to CS6-Expressing Enterotoxigenic Escherichia coli{triangledown}

Firdausi Qadri,1* Tanvir Ahmed,1 Firoz Ahmed,1 M. Saruar Bhuiyan,1 Mohammad Golam Mostofa,1 Frederick J. Cassels,2 Anna Helander,3 and Ann-Mari Svennerholm4

International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh,1 Department of Enteric Infections, Walter Reed Army Institute of Research, Silver Spring, Maryland,2 Department of Infectious Diseases, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom,3 Göteborg University Vaccine Research Institute (GUVAX) and Department of Microbiology and Immunology, Sahlgrenska Academy at Göteborg University, Box 435, S-40530 Göteborg, Sweden4

Received 22 November 2006/ Returned for modification 5 January 2007/ Accepted 1 February 2007

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.

* Corresponding author. Mailing address: Laboratory Sciences Division, ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh. Phone: 880 2 8860523. Fax: 880 2 8822529. E. mail: fqadri{at}icddrb.org

{triangledown} Published ahead of print on 12 February 2007.

Editor: W. A. Petri, Jr.

Infection and Immunity, May 2007, p. 2269-2274, Vol. 75, No. 5
0019-9567/07/$08.00+0     doi:10.1128/IAI.01856-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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