Thirteen strains of Vibrio cholerae O1 belonging to the Inaba serotype El Tor biotype isolated from patients during an outbreak of cholera in the town of Warangal in southern India were found to be nontoxigenic (NT), since they did not produce cholera toxin or hybridize with DNA probes specific for cholera toxin, Zot, or Ace. The unheated and heated culture supernatants of the NT V. cholerae O1 evoked a rapid cell-rounding effect when introduced on confluent layers of CHO and HeLa cells which could not be inhibited by antiserum against known toxins. Culture supernatants of two representative NT V. cholerae O1 strains caused an increase in short-circuit current in rabbit ileal tissue mounted on an Ussing chamber, and the pattern of increase in short-circuit current was consistent with the presence of a quickly acting toxin like stable toxin. None of the strains of NT V. cholerae O1 hybridized with a DNA probe specific for the heat-stable enterotoxin of V. cholerae non-O1, nor did the factor produced by NT V. cholerae O1 resemble the recently described heat-stable enterotoxin produced by enteroaggregative Escherichia coli as determined by a PCR assay. To our knowledge, this is the first report of NT V. cholerae O1 being associated with a cluster of cases of cholera, and it appears that a clone of NT V. cholerae O1 has the potential to cause localized outbreaks of cholera.Biochemically and serologically indistinguishable strains of Vibrio cholerae belonging to the O1 serogroup which do not produce cholera toxin (CT) and which lack the toxin structural genes are currently termed as nontoxigenic (NT) strains. From time to time, NT V. cholerae O1 has been isolated from patients and from environmental sources in several countries, including Bangladesh, Guam, Brazil, Peru, Japan, England, and the United States (17). The NT strains of V. cholerae O1 have remained a scientific curiosity in the absence of a proper understanding of the mechanism of pathogenesis and also because of the lack of knowledge of what factors interplay in initiating acute secretory diarrhea. These strains are, however, important to bridge the hiatus in our knowledge of why recombinant attenuated candidate vaccine strains of V. cholerae O1 lacking all known putative toxigenic factors (21) are still able to cause residual diarrhea.The past few years have witnessed unprecedented changes in the history of cholera. Foremost among these changes was the emergence of a new serogroup causing cholera (3) classified as V. cholerae O139 Bengal (20). At the time when the O139 serogroup was in the process of rapidly spreading through vast areas of India (11), a set of strains of V. cholerae isolated from a cholera outbreak in southern India were referred to us at the National Reference Center for Cholera in Calcutta, India. Characterization of these strains revealed them to be nontoxigenic, and to our knowledge they are the first NT strains of V. cholerae O1 associated with a cluster of cases of cholera. In this study, we report the extensive characterization of ...