eWe report here the quantitative detection of Vibrio cholerae toxin (CT) in isolates and stool specimens by dynamic monitoring of the full course of CT-mediated cytotoxicity in a real-time cell analysis (RTCA) system. Four cell lines, including Y-1 mouse adrenal tumor cells, Chinese hamster ovary (CHO) cells, small intestine epithelial (FHs74Int) cells, and mouse adrenal gland (PC12-Adh) cells, were evaluated for their suitability for CT-induced cytotoxicity testing. Among them, the Y-1 line was demonstrated to be the most sensitive for CT-mediated cytotoxicity, with limits of detection of 7.0 pg/ml for purified CT and 0.11 ng/ml for spiked CT in pooled negative stool specimens. No CT-mediated cytotoxicity was observed for nontoxigenic V. cholerae, non-V. cholerae species, or non-V. cholerae enterotoxins. The CT-RTCA assay was further validated with 100 stool specimens consecutively collected from patients with diarrhea and 200 V. cholerae isolates recovered from patients and the environment, in comparison to a reference using three detection methods. The CT-RTCA assay had sensitivities and specificities of 97.5% and 100.0%, respectively, for V. cholerae isolates and 90.0% and 97.2% for stool specimens. For stool specimens spiked with CT concentrations ranging from 3.5 pg/ml to 1.8 ng/ml, the inoculation-to-detection time was 1.12 ؎ 0.38 h, and the values were inversely correlated with CT concentrations ( ؍ ؊1; P ؍ 0.01). The results indicate that the CT-RTCA assay with the Y-1 cell line provides a rapid and sensitive tool for the quantitative detection of CT activities in clinical specimens.
Vibrio cholerae is a Gram-negative, comma-shaped, bacterial pathogen causing cholera, an acute secretory diarrheal disease. Epidemic cholera is common in developing countries and affects about 100,000 people annually (1). Cholera toxin (CT) is a major virulence determinant of V. cholerae, leading to rapidly progressing dehydration, shock, metabolic acidosis, and even death within hours without adequate and appropriate therapy (2). CT is a key biomarker of V. cholerae that is used for forecasting and assessing epidemic disease, monitoring and controlling cholera outbreaks, preventing epidemics, and guiding medical personnel in providing timely treatment of patients. There has been urgent demand for the development of novel sensitive assays for the detection and identification of CT proteins.Conventional biochemical and immunological methods for CT detection and identification can be completed only after V. cholerae is isolated. The bacterial isolation and subsequent CT detection and identification are laborious and usually require several days, resulting in significant delays in patient care and disease control (3, 4). In addition, classic CT determinations require the use of either animal methods (5, 6) or tissue culture methods (7,8), which are also time-consuming and are subjective in the interpretation of results. Efforts have been made recently to develop more-sensitive methods, including enzyme-linked immunosorbent...