Shiga toxin-associated hemolytic uremic syndrome:  advances in pathogenesis and therapeutics.
OBJECTIVE
Diarrhea-associated hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) continues to be an important public health threat worldwide. Specific therapies are lacking and patient care remains largely supportive. This review discusses the lessons learned from recent events and summarizes key advances made toward understanding the basic mechanisms involved in the pathogenesis of typical HUS.


RESULTS
The recent German outbreak of a hybrid organism resulted in an unprecedented number of HUS cases and drastically changed the face of typical (diarrhea-associated) HUS. New findings on the roles of complement and the CXCR4/SDF-1 pathway in HUS pathogenesis are summarized and novel therapeutic strategies are highlighted.


CONCLUSIONS
A better understanding of STEC-mediated HUS underlies improved therapeutic approaches. New studies of the mechanistic basis of the disease, together with patient-based studies, have led to key findings with important clinical implications.
Department of Laboratory Medicine and Pathobiology, University of Toronto, and Keenan Research Centre, Li KaShing Knowledge Institute, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
Tania N
TN
Petruzziello-Pellegrini
Philip A
PA
Marsden
D000818:Animals; D054377:Chemokine CXCL12 / Q000378:metabolism; D003167:Complement Activation; D003967:Diarrhea / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D004927:Escherichia coli Infections / Q000150:complications / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D005838:Genotype; D006463:Hemolytic-Uremic Syndrome / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D010641:Phenotype; D019718:Receptors, CXCR4 / Q000378:metabolism; D022603:Shiga Toxins / Q000378:metabolism*; D054323:Shiga-Toxigenic Escherichia coli / Q000235:genetics / Q000276:immunology / Q000378:metabolism / Q000472:pathogenicity*; D015398:Signal Transduction
D054377:Chemokine CXCL12; D019718:Receptors, CXCR4; D022603:Shiga Toxins