Shiga toxin-producing Escherichia coli (STEC) is a group of pathogens which cause gastrointestinal disease in humans and have been associated with numerous food-borne outbreaks worldwide. The intimin adhesin has been considered for many years to be the only colonization factor in these strains. However, the rapid progress in whole-genome sequencing of different STEC serotypes has accelerated the discovery of other adhesins (fimbrial and afimbrial), which have emerged as important contributors to the intestinal colonization occurring during STEC infection. This review summarizes recent progress to identify and characterize, at the molecular level, novel adhesion and colonization factors in STEC strains, with an emphasis on their contribution to virulence traits, their host-pathogen interactions, the regulatory mechanisms controlling their expression, and their role as targets eliciting immune responses in the host.
STEC O157:H7 AND NON-O157 STEC
Shiga-toxigenic Escherichia coli (STEC) O157:H7 is an important cause of human gastrointestinal disease and the beststudied STEC associated with large outbreaks worldwide (43, 74). STEC O157:H7 strains cause diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS) (59). Disease-associated human isolates of E. coli O157:H7 are characterized for the presence of specific sets of virulence genes, including those encoding Shigatoxins (stx 1 , stx 2 ), intimin (eae), hemolysin (hlyA), and long polar fimbriae (lpf1 and lpf2) (45, 97). The production of Stx is the main virulence feature of STEC associated with the development of HUS (82) but cannot be solely responsible for full pathogenicity. STEC associated with severe human disease is usually capable of colonizing the intestinal mucosa and possesses mobile genetic elements carrying virulence genes, such as plasmids, transposons, phages, and pathogenicity islands (79,92,97). Several important colonization properties are carried by the locus of enterocyte effacement (LEE) pathogenicity island (92), which governs the ability of STEC to colonize the intestinal mucosa of the host and produces a peculiar pathogenic process known as the attachingand-effacing (A/E) lesion (for a review, see reference 59).Most virulence/colonization factors have been described for STEC O157:H7 isolates; however, it is important to identify and determine the virulence traits of other STECs important for disease in humans, the so-called "non-O157 STEC" strains. In addition to diarrhea, these isolates are also associated with severe disease. Several serogroups of non-O157 STEC have been described; however, the serogroups O26, O45, O103, O111, and O145 have been identified as the "big six" non-O157 STEC O serogroups, because they have been associated with increasing frequency in patients with bloody diarrhea and HUS (12,29,41,55). Because the U.S. Food and Drug Administration recognizes that non-O157 STEC serogroups are emerging as an important cause of food-borne disease, these isolates impact both the imported and domestic food supply. Therefor...