c Escherichia coli O157:H7 is a notorious foodborne pathogen due to its low infectious dose and the disease symptoms it causes, which include bloody diarrhea and severe abdominal cramps. In some cases, the disease progresses to hemorrhagic colitis (HC) and hemolytic uremic syndrome (HUS), due to the expression of one or more Shiga toxins (Stx). Isoforms of Stx, including Stx2a, are encoded within temperate prophages. In the presence of certain antibiotics, phage induction occurs, which also increases the expression of toxin genes. Additionally, increased Stx2 accumulation has been reported when O157:H7 was cocultured with phage-susceptible nonpathogenic E. coli. This study characterized an E. coli O157:H7 strain, designated PA2, that belongs to the hypervirulent clade 8 cluster. Stx2a levels after ciprofloxacin induction were lower for PA2 than for the prototypical outbreak strains Sakai and EDL933. However, during coculture with the nonpathogenic strain E. coli C600, PA2 produced Stx2a levels that were 2-to 12-fold higher than those observed during coculture with EDL933 and Sakai, respectively. Germfree mice cocolonized by PA2 and C600 showed greater kidney damage, increased Stx2a accumulation in feces, and more visible signs of disease than mice given PA2 or C600 alone. These data suggest one mechanism by which microorganisms associated with the colonic microbiota could enhance the virulence of E. coli O157:H7, particularly a subset of clade 8 strains.E scherichia coli can be either nonpathogenic, as exemplified by the bacteria associated with the normal human gut microflora, or pathogenic, classified as intestinal or extraintestinal (1). The intestinal pathogenic E. coli group is further subdivided into six pathotypes, among which enterohemorrhagic E. coli (EHEC) is a causative agent of bloody diarrhea, hemorrhagic colitis (HC), and hemolytic uremic syndrome (HUS). Shiga toxins (Stx) are one of the defining virulence factors of E. coli O157:H7 (2, 3). The stx genes are carried within lambdoid prophages downstream of the promoter for late gene expression. The toxin is released after phage-induced lysis of the bacterial cell (4). Shiga toxins are approximately 70-kDa proteins, consisting of an enzymatically active A subunit and a pentameric B subunit. The A subunit is an N-glycosidase and inactivates the 60S ribosomal subunit. This leads to inhibition of protein synthesis in the eukaryotic cell (5). There are two antigenically distinct Stx proteins, designated Stx1 and Stx2 (6). Despite having an amino acid identity of 57%, mouse and primate studies have shown that Stx2 causes more severe disease outcomes than Stx1 (7, 8). Several allelic variants of Stx2 have been described, based on the amino acid differences in the A and B subunits. The most common forms of Stx2 expressed by E. coli O157:H7 human isolates are Stx2a and Stx2c (9, 10).Since its first report in 1983 (11), the serotype O157:H7 rapidly became a notorious foodborne pathogen due to its severe disease outcomes and an infectious dose of less than 100...