title: Enterotoxigenic Escherichia coli diarrhea in an endemic area prepares the intestine for an anamnestic immunoglobulin A antitoxin response to oral cholera B subunit vaccination.
abstract: We examined whether infection with enterotoxigenic Escherichia coli (ETEC) producing the heat-labile enterotoxin (LT) can prime the gut immune system to respond more efficiently to the immunologically related cholera B subunit component of a recently developed oral B subunit-whole-cell cholera vaccine (B-WCV). Nine Bangladeshi adults who had been hospitalized for watery diarrhea caused by LT-producing ETEC were given a single oral immunization with B-WCV on day 28 after hospital admission. The vaccine preparation used was adjusted to contain a lower-than-usual dose of B subunit, which had been found in previous studies to elicit a significant gut mucosal immunoglobulin A antitoxin response mainly in individuals with previous toxin-specific priming of their gut immune system. For comparison, nine patients convalescing from severe cholera disease and eight healthy subjects with no recent history of either cholera or ETEC infection were given the same oral vaccination with B-WCV. Vaccination in the ETEC convalescents induced an immunoglobulin A antitoxin response in intestinal lavage fluid which was comparable with that in the vaccinated cholera convalescents and superior to that in the vaccinated, previously uninfected controls. By contrast, only the cholera patients responded with anamnestic-type anti-cholera lipopolysaccharide antibody titer rises in the intestine after vaccination. These data support the specificity of the anamnestic anti-cholera toxin response in the ETEC patients after vaccination with cholera B-WCV.
authors.affiliation: Department of Medical Microbiology, University of Göteborg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Holmgren
authors.forename: A M
authors.initials: AM
authors.lastname: Svennerholm
authors.forename: L
authors.initials: L
authors.lastname: Gothefors
authors.forename: M
authors.initials: M
authors.lastname: Jertborn
authors.forename: B
authors.initials: B
authors.lastname: Stoll
mesh_terms: D001427:Bacterial Toxins / Q000276:immunology*; D002772:Cholera Toxin / Q000494:pharmacology*; D003289:Convalescence; D003967:Diarrhea / Q000276:immunology / Q000382:microbiology*; D004768:Enterotoxins / Q000276:immunology*; D004927:Escherichia coli Infections / Q000276:immunology / Q000382:microbiology*; D029968:Escherichia coli Proteins; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000096:biosynthesis*; D007156:Immunologic Memory; D007413:Intestinal Mucosa / Q000276:immunology / Q000382:microbiology; D008875:Middle Aged; D010446:Peptide Fragments / Q000494:pharmacology*
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D029968:Escherichia coli Proteins; D007070:Immunoglobulin A; D010446:Peptide Fragments; C050310:cholera toxin, B subunit (50-64); D002772:Cholera Toxin; C027538:heat-labile enterotoxin, E coli