Enterohemorrhagic Escherichia coli (EHEC) is a food-borne pathogen that causes hemorrhagic colitis and acute renal failure. We used a germ-free mouse model to investigate the role of host factors, Shiga toxin 2 (Stx2), and bacterial strain in disease due to EHEC. Germ-free male and female Swiss-Webster mice that were 3 days to 12 weeks old were orally inoculated with 1 of 10 EHEC strains or derivatives of two of these strains with Stx2 deleted. All inoculated mice became infected regardless of the inoculum dose. All bacterial strains colonized the intestines, reaching levels of 10 9 to 10 12 CFU/g of feces by 4 days after inoculation. Seven of the 10 wild-type strains caused disease. However, the two Stx2 deletion mutants, unlike the Stx2 ؉ parental strains, did not cause disease. The clinical signs of disease in mice included lethargy, dehydration, polyuria, polydypsia, and death. Postmortem examination of affected mice revealed dehydration and luminal cecal fluid accumulation. Histologic examination revealed close adherence of bacteria to the intestinal epithelium in the ileum and cecum but not in the colon. Other lesions included progressive renal tubular necrosis, glomerular fibrin thrombosis, and red blood cell sludging. The severity of disease varied according to the bacterial strain and age, but not sex, of the host. This study demonstrated that EHEC colonizes germ-free mice in large numbers, adheres to the intestinal epithelium, and causes luminal cecal fluid accumulation and progressive renal failure. The disease in mice was Stx2 and bacterial strain dependent. This animal model should be a useful tool for studying the pathogenesis of renal disease secondary to EHEC infection.Enterohemorrhagic Escherichia coli (EHEC), a food-borne bacterial pathogen of humans, is a normal inhabitant of the ruminant intestine. This organism is most often transmitted to humans in undercooked meat, but it has also caused outbreaks associated with contaminated vegetables (5, 28), fruit juices (6), and drinking water (41). The disease manifestations include watery or bloody diarrhea and can be severe enough to cause hospitalization and even death (18). In addition, some affected children (and rarely adults) develop hemolytic-uremic syndrome (HUS), a rapidly progressive, often fatal form of renal failure that is attributed to expression of Shiga toxins (Stx) by pathogenic bacteria (2, 18). HUS is defined by a triad of symptoms that includes hemolysis, uremia, and thrombocytopenia. It is a rare complication of disease due to EHEC, but its importance is amplified by its severity, tendency to affect young children, and the absence of any specific treatment or preventative measure. Thus, the significance of disease due to EHEC is derived from its food-borne nature and its potentially severe consequences.Both HUS and hemorrhagic colitis caused by EHEC have been attributed to the production of Stx by pathogenic bacteria (2, 50) referred to as Stx-producing E. coli (STEC). The Stxs are macromolecular cytotoxins that are phage encode...