Shiga Toxin (Stx) Classification, Structure, and Function

Shiga toxin (Stx) is one of the most potent bacterial toxins known. Stx is found in Shigella dysenteriae 1 and in some serogroups of Escherichia coli (called Stx1 in E. coli). In addition to or instead of Stx1, some E. coli strains produce a second type of Stx, Stx2, that has the same mode of action as Stx/Stx1 but is antigenically distinct. Because subtypes of each toxin have been identified, the prototype toxin for each group is now designated Stx1a or Stx2a. The Stxs consist of two major subunits, an A subunit that joins noncovalently to a pentamer of five identical B subunits. The A subunit of the toxin injures the eukaryotic ribosome and halts protein synthesis in target cells. The function of the B pentamer is to bind to the cellular receptor, globotriaosylceramide, Gb3, found primarily on endothelial cells. The Stxs traffic in a retrograde manner within the cell, such that the A subunit of the toxin reaches the cytosol only after the toxin moves from the endosome to the Golgi and then to the endoplasmic reticulum. In humans infected with Stx-producing E. coli, the most serious manifestation of the disease, hemolytic-uremic syndrome, is more often associated with strains that produce Stx2a rather than Stx1a, and that relative toxicity is replicated in mice and baboons. Stx1a and Stx2a also exhibit differences in cytotoxicity to various cell types, bind dissimilarly to receptor analogs or mimics, induce differential chemokine responses, and have several distinctive structural characteristics.

[1]  P. Griffin,et al.  Outbreaks of non-O157 Shiga toxin-producing Escherichia coli infection: USA , 2014, Epidemiology and Infection.

[2]  A. Friedrich,et al.  Escherichia coli harboring Shiga toxin 2 gene variants: frequency and association with clinical symptoms. , 2002, The Journal of infectious diseases.

[3]  M. James,et al.  Crystal structure of the holotoxin from Shigella dysenteriae at 2.5 A resolution. , 1994, Nature structural biology.

[4]  Katharina Gaus,et al.  Shiga toxin induces tubular membrane invaginations for its uptake into cells , 2007, Nature.

[5]  C. Ackerley,et al.  Translocation of verotoxin-1 across T84 monolayers: mechanism of bacterial toxin penetration of epithelium. , 1997, American journal of physiology. Gastrointestinal and liver physiology.

[6]  B. Magun,et al.  Ricin and Shiga Toxins: Effects on Host Cell Signal Transduction , 2011, Current topics in microbiology and immunology.

[7]  S. Homans,et al.  Localization of the Binding Site for the Oligosaccharide Moiety of Gb3 on Verotoxin 1 Using NMR Residual Dipolar Coupling Measurements , 2000 .

[8]  K. Sandvig,et al.  Endocytosis and retrograde transport of Shiga toxin. , 2010, Toxicon : official journal of the International Society on Toxinology.

[9]  J. Mekalanos,et al.  Iron regulation of Shiga-like toxin expression in Escherichia coli is mediated by the fur locus , 1987, Journal of bacteriology.

[10]  Klaus Stark,et al.  Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany. , 2011, The New England journal of medicine.

[11]  Ken Hatano,et al.  Identification of the optimal structure required for a Shiga toxin neutralizer with oriented carbohydrates to function in the circulation. , 2005, The Journal of infectious diseases.

[12]  C. Ducrot,et al.  Association of Virulence Genotype with Phylogenetic Background in Comparison to Different Seropathotypes of Shiga Toxin-Producing Escherichia coli Isolates , 2005, Journal of Clinical Microbiology.

[13]  C. Lingwood,et al.  Globotriosyl ceramide is specifically recognized by the Escherichia coli verocytotoxin 2. , 1988, Biochemical and biophysical research communications.

[14]  G. Keusch,et al.  Pathogenesis of Shigella diarrhea: XVII. A mammalian cell membrane glycolipid, Gb3, is required but not sufficient to confer sensitivity to Shiga toxin. , 1994, The Journal of infectious diseases.

[15]  J. Gariépy,et al.  Charged and Hydrophobic Surfaces on the A Chain of Shiga-Like Toxin 1 Recognize the C-Terminal Domain of Ribosomal Stalk Proteins , 2012, PloS one.

[16]  Kristian Prydz,et al.  Retrograde transport of endocytosed Shiga toxin to the endoplasmic reticulum , 1992, Nature.

[17]  C. Lingwood,et al.  Glycosphingolipid receptor function is modified by fatty acid content. Verotoxin 1 and verotoxin 2c preferentially recognize different globotriaosyl ceramide fatty acid homologues. , 1994, The Journal of biological chemistry.

[18]  J. Brown,et al.  Identification of the carbohydrate receptor for Shiga toxin produced by Shigella dysenteriae type 1. , 1987, The Journal of biological chemistry.

[19]  D. Acheson,et al.  Translocation of Shiga toxin across polarized intestinal cells in tissue culture , 1996, Infection and immunity.

[20]  Mutations affecting the activity of the Shiga-like toxin I A-chain. , 1992, Biochemistry.

[21]  F. Gunzer,et al.  Molecular and functional analysis of Shiga toxin-induced response patterns in human vascular endothelial cells. , 2003, Blood.

[22]  L. Beutin,et al.  Isolation of Shigella sonnei lysogenic for a bacteriophage encoding gene for production of Shiga toxin , 1999, The Lancet.

[23]  D. Acheson,et al.  Maturational regulation of globotriaosylceramide, the Shiga-like toxin 1 receptor, in cultured human gut epithelial cells. , 1995, The Journal of clinical investigation.

[24]  T. Takeda,et al.  Serum Amyloid P Component Is the Shiga Toxin 2-neutralizing Factor in Human Blood* , 2001, The Journal of Biological Chemistry.

[25]  J. Thurman,et al.  Alternative pathway of complement in children with diarrhea-associated hemolytic uremic syndrome. , 2009, Clinical journal of the American Society of Nephrology : CJASN.

[26]  K. Mølbak,et al.  A verocytotoxin-producing E. coli outbreak with a surprisingly high risk of haemolytic uraemic syndrome, Denmark, September-October 2012. , 2013, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[27]  J. LaMarre,et al.  Binding of Escherichia coli verotoxins to cell surface protein on wild-type and globotriaosylceramide-deficient Vero cells. , 1998, Canadian journal of microbiology.

[28]  S. McEwen,et al.  Associations between Virulence Factors of Shiga Toxin-ProducingEscherichia coli and Disease in Humans , 1999, Journal of Clinical Microbiology.

[29]  M. Troxell,et al.  Mouse Model of Hemolytic-Uremic Syndrome Caused by Endotoxin-Free Shiga Toxin 2 (Stx2) and Protection from Lethal Outcome by Anti-Stx2 Antibody , 2008, Infection and Immunity.

[30]  A. Herr,et al.  Shiga Toxin Binding to Glycolipids and Glycans , 2012, PloS one.

[31]  M. Kim,et al.  Shiga toxins expressed by human pathogenic bacteria induce immune responses in host cells , 2013, Journal of Microbiology.

[32]  H. Uchida,et al.  The Detection of Shiga Toxins in the Kidney of a Patient with Hemolytic Uremic Syndrome , 1999, Pediatric Research.

[33]  M. P. Jackson,et al.  Cloning and sequencing of a Shiga-like toxin type II variant from Escherichia coli strain responsible for edema disease of swine , 1988, Journal of bacteriology.

[34]  S. Ostroff,et al.  Toxin genotypes and plasmid profiles as determinants of systemic sequelae in Escherichia coli O157:H7 infections. , 1989, The Journal of infectious diseases.

[35]  J. Samuel,et al.  Comparison of the relative toxicities of Shiga-like toxins type I and type II for mice , 1993, Infection and immunity.

[36]  J. Samuel,et al.  Comparison of the glycolipid receptor specificities of Shiga-like toxin type II and Shiga-like toxin type II variants , 1990, Infection and immunity.

[37]  K. Sandvig,et al.  The A‐subunit of surface‐bound Shiga toxin stimulates clathrin‐dependent uptake of the toxin , 2005, The FEBS journal.

[38]  B. Binnington,et al.  Differential intracellular transport and binding of verotoxin 1 and verotoxin 2 to globotriaosylceramide‐containing lipid assemblies , 2008, Journal of cellular physiology.

[39]  M. Smith,et al.  Oral Intoxication of Mice with Shiga Toxin Type 2a (Stx2a) and Protection by Anti-Stx2a Monoclonal Antibody 11E10 , 2013, Infection and Immunity.

[40]  P. Sansonetti,et al.  Role of Shiga toxin in the pathogenesis of bacillary dysentery, studied by using a Tox- mutant of Shigella dysenteriae 1 , 1988, Infection and immunity.

[41]  A. Friedrich,et al.  Shiga toxin activatable by intestinal mucus in Escherichia coli isolated from humans: predictor for a severe clinical outcome. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[42]  D. Acheson,et al.  Shiga Toxin Translocation across Intestinal Epithelial Cells Is Enhanced by Neutrophil Transmigration , 2001, Infection and Immunity.

[43]  A. Trofa,et al.  Dr. Kiyoshi Shiga: discoverer of the dysentery bacillus. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[44]  A. Friedrich,et al.  Shiga Toxin 1c-Producing Escherichia coli Strains: Phenotypic and Genetic Characterization and Association with Human Disease , 2003, Journal of Clinical Microbiology.

[45]  L. Hoelzle,et al.  Characterization of shiga toxin type 2 variant B‐subunit in Escherichia coli strains from asymptomatic human carriers by PCR‐RFLP , 2000, Letters in applied microbiology.

[46]  C. Lingwood,et al.  Glycolipid binding of purified and recombinant Escherichia coli produced verotoxin in vitro. , 1987, The Journal of biological chemistry.

[47]  G. Frankel,et al.  Interaction of Shiga toxin from Escherichia coli with human intestinal epithelial cell lines and explants: Stx2 induces epithelial damage in organ culture , 2004, Cellular microbiology.

[48]  L. Johannes,et al.  Functionally different pools of Shiga toxin receptor, globotriaosyl ceramide, in HeLa cells , 2006, The FEBS journal.

[49]  S. Kurosawa,et al.  Shiga Toxins and the Pathophysiology of Hemolytic Uremic Syndrome in Humans and Animals , 2012, Toxins.

[50]  V. L. Tesh,et al.  Distinct Physiologic and Inflammatory Responses Elicited in Baboons after Challenge with Shiga Toxin Type 1 or 2 from Enterohemorrhagic Escherichia coli , 2010, Infection and Immunity.

[51]  H. Collins,et al.  Morphologic evaluation of the effects of Shiga toxin and E coli Shiga-like toxin on the rabbit intestine. , 1986, The American journal of pathology.

[52]  R. Spooner,et al.  How ricin and Shiga toxin reach the cytosol of target cells: retrotranslocation from the endoplasmic reticulum. , 2012, Current topics in microbiology and immunology.

[53]  Randy J. Read,et al.  Crystal structure of the cell-binding B oligomer of verotoxin-1 from E. coli , 1992, Nature.

[54]  L. Johannes,et al.  Trafficking of Shiga toxin/Shiga-like toxin-1 in human glomerular microvascular endothelial cells and human mesangial cells. , 2006, Kidney international.

[55]  M. McKee,et al.  Enterohemorrhagic Escherichia coli O157:H7 requires intimin to colonize the gnotobiotic pig intestine and to adhere to HEp-2 cells , 1995, Infection and immunity.

[56]  J. Gariépy,et al.  A Role for the Protease-sensitive Loop Region of Shiga-like Toxin 1 in the Retrotranslocation of Its A1 Domain from the Endoplasmic Reticulum Lumen* , 2005, Journal of Biological Chemistry.

[57]  R. Dietrich,et al.  Identification and Characterization of a New Variant of Shiga Toxin 1 in Escherichia coli ONT:H19 of Bovine Origin , 2022 .

[58]  J. R. Peterson,et al.  Macropinocytosis in Shiga toxin 1 uptake by human intestinal epithelial cells and transcellular transcytosis. , 2009, American journal of physiology. Gastrointestinal and liver physiology.

[59]  M. McKee,et al.  Enterohemorrhagic Escherichia coli O157:H7 requires intimin to colonize the gnotobiotic pig intestine and to adhere to HEp-2 cells , 1995, Infection and immunity.

[60]  R. Field,et al.  Solution structure of the complex between the B-subunit homopentamer of verotoxin VT-1 from Escherichia coli and the trisaccharide moiety of globotriaosylceramide. , 1998, Biochemistry.

[61]  M. Breimer,et al.  Glycosphingolipids of human large intestine: detailed structural characterization with special reference to blood group compounds and bacterial receptor structures. , 1991, Journal of biochemistry.

[62]  M. James,et al.  Structure of Shiga Toxin Type 2 (Stx2) from Escherichia coli O157:H7* , 2004, Journal of Biological Chemistry.

[63]  A. O’Brien,et al.  Activation of Shiga toxin type 2d (Stx2d) by elastase involves cleavage of the C‐terminal two amino acids of the A2 peptide in the context of the appropriate B pentamer , 2002, Molecular microbiology.

[64]  A. Shevchenko,et al.  Glycosphingolipid Requirements for Endosome‐to‐Golgi Transport of Shiga Toxin , 2009, Traffic.

[65]  R. Norel,et al.  Two distinct binding sites for globotriaosyl ceramide on verotoxins: identification by molecular modelling and confirmation using deoxy analogues and a new glycolipid receptor for all verotoxins. , 1996, Chemistry & biology.

[66]  J. Brown,et al.  The mode of action of Shiga toxin on peptide elongation of eukaryotic protein synthesis. , 1987, The Biochemical journal.

[67]  A. O’Brien,et al.  Activation of Shiga-like toxins by mouse and human intestinal mucus correlates with virulence of enterohemorrhagic Escherichia coli O91:H21 isolates in orally infected, streptomycin-treated mice , 1996, Infection and immunity.

[68]  A. Melton,et al.  Virulence of enterohemorrhagic Escherichia coli O91:H21 clinical isolates in an orally infected mouse model , 1993, Infection and immunity.

[69]  C. Ackerley,et al.  A Major Fraction of Glycosphingolipids in Model and Cellular Cholesterol-containing Membranes Is Undetectable by Their Binding Proteins* , 2010, The Journal of Biological Chemistry.

[70]  S. Homans,et al.  Solution structure of the carbohydrate-binding B-subunit homopentamer of verotoxin VT-1 from E. coli , 1997, Nature Structural Biology.

[71]  A. Caprioli,et al.  Flow cytometry detection of Shiga toxins in the blood from children with hemolytic uremic syndrome , 2004, Cytometry. Part B, Clinical cytometry.

[72]  A. Weiss,et al.  Shiga Toxin Subtypes Display Dramatic Differences in Potency , 2011, Infection and Immunity.

[73]  J. Samuel,et al.  The specific activities of Shiga-like toxin type II (SLT-II) and SLT-II-related toxins of enterohemorrhagic Escherichia coli differ when measured by Vero cell cytotoxicity but not by mouse lethality , 1994, Infection and immunity.

[74]  J. Wells,et al.  Hemorrhagic colitis associated with a rare Escherichia coli serotype. , 1983, The New England journal of medicine.

[75]  K. Sandvig,et al.  Furin-induced Cleavage and Activation of Shiga Toxin (*) , 1995, The Journal of Biological Chemistry.

[76]  S. Lauwers,et al.  Identification of New Verocytotoxin Type 2 Variant B-Subunit Genes in Human and Animal Escherichia coliIsolates , 1998, Journal of Clinical Microbiology.

[77]  H. Mason,et al.  Plant Cell-Based Intimin Vaccine Given Orally to Mice Primed with Intimin Reduces Time of Escherichia coli O157:H7 Shedding in Feces , 2004, Infection and Immunity.

[78]  A. Caprioli,et al.  A New Shiga Toxin 2 Variant (Stx2f) fromEscherichia coli Isolated from Pigeons , 2000, Applied and Environmental Microbiology.

[79]  R. Dubos,et al.  PREPARATION AND PROPERTIES OF SHIGA TOXIN AND TOXOID , 1946, The Journal of experimental medicine.

[80]  D. Karpman,et al.  Complement activation on platelet-leukocyte complexes and microparticles in enterohemorrhagic Escherichia coli-induced hemolytic uremic syndrome. , 2011, Blood.

[81]  W. Yam,et al.  A Newly Discovered Verotoxin Variant, VT2g, Produced by Bovine Verocytotoxigenic Escherichia coli , 2003, Applied and Environmental Microbiology.

[82]  V. L. Tesh The induction of apoptosis by Shiga toxins and ricin. , 2012, Current topics in microbiology and immunology.

[83]  M. McKee,et al.  Two copies of Shiga-like toxin II-related genes common in enterohemorrhagic Escherichia coli strains are responsible for the antigenic heterogeneity of the O157:H- strain E32511 , 1991, Infection and immunity.

[84]  M. Nagata,et al.  Localization of Shiga toxins of enterohaemorrhagic Escherichia coli in kidneys of paediatric and geriatric patients with fatal haemolytic uraemic syndrome. , 2001, Microbial pathogenesis.

[85]  K. Sandvig,et al.  Retrograde transport of protein toxins through the Golgi apparatus , 2013, Histochemistry and Cell Biology.

[86]  C. Lingwood,et al.  Binding of verocytotoxin 1 to its receptor is influenced by differences in receptor fatty acid content. , 1992, Biochemistry.

[87]  M. Thompson,et al.  Production of Shigella dysenteriae type 1-like cytotoxin by Escherichia coli. , 1982, The Journal of infectious diseases.

[88]  D. Acheson,et al.  Hemolytic uremic syndrome: epidemiology, pathophysiology, and therapy , 2002, Pediatric Nephrology.

[89]  L. Beutin,et al.  Heterogeneity of the amino-acid sequences of Escherichia coli Shiga-like toxin type-I operons. , 1995, Gene.

[90]  R. N. Smith,et al.  Fabry disease in mice protects against lethal disease caused by Shiga toxin-expressing enterohemorrhagic Escherichia coli. , 2006, The Journal of infectious diseases.

[91]  P. Marsden,et al.  New insights into Shiga toxin-mediated endothelial dysfunction in hemolytic uremic syndrome , 2013, Virulence.

[92]  C. Tacket,et al.  Phase 1 Safety and Pharmacokinetic Study of Chimeric Murine-Human Monoclonal Antibody cαStx2 Administered Intravenously to Healthy Adult Volunteers , 2005, Antimicrobial Agents and Chemotherapy.

[93]  Tetsuya Mori,et al.  Activation of Src Family Kinase Yes Induced by Shiga Toxin Binding to Globotriaosyl Ceramide (Gb3/CD77) in Low Density, Detergent-insoluble Microdomains* , 1999, The Journal of Biological Chemistry.

[94]  M. Donowitz,et al.  Role of lipid rafts in Shiga toxin 1 interaction with the apical surface of Caco-2 cells. , 2001, Journal of cell science.

[95]  R J Read,et al.  Structure of the shiga-like toxin I B-pentamer complexed with an analogue of its receptor Gb3. , 1998, Biochemistry.

[96]  C. Lingwood,et al.  Differential carbohydrate epitope recognition of globotriaosyl ceramide by verotoxins and a monoclonal antibody. , 2004, European journal of biochemistry.

[97]  F. Scheutz,et al.  Subtyping Method for Escherichia coli Shiga Toxin (Verocytotoxin) 2 Variants and Correlations to Clinical Manifestations , 2007, Journal of Clinical Microbiology.

[98]  H. Conradi Ueber lösliche, durch aseptische Autolyse erhaltene Giftstoffe von Ruhr- und Typhusbazillen , 1903 .

[99]  C. Lingwood,et al.  Preparation of VT1 and VT2 hybrid toxins from their purified dissociated subunits. Evidence for B subunit modulation of a subunit function. , 1991, The Journal of biological chemistry.

[100]  H. Karch,et al.  Identification, Characterization, and Distribution of a Shiga Toxin 1 Gene Variant (stx1c) in Escherichia coli Strains Isolated from Humans , 2002, Journal of Clinical Microbiology.

[101]  L. Beutin,et al.  Isolation of a Lysogenic Bacteriophage Carrying thestx1OX3 Gene, Which Is Closely Associated with Shiga Toxin-Producing Escherichia coli Strains from Sheep and Humans , 2001, Journal of Clinical Microbiology.

[102]  K. Matsuoka,et al.  Structural Analysis of the Interaction between Shiga Toxin B Subunits and Linear Polymers Bearing Clustered Globotriose Residues , 2006, Infection and Immunity.

[103]  K. Kashiwagi,et al.  Comparison of the modes of action of a Vero toxin (a Shiga-like toxin) from Escherichia coli, of ricin, and of alpha-sarcin. , 1992, Archives of biochemistry and biophysics.

[104]  L. Teel,et al.  Development of a hybrid Shiga holotoxoid vaccine to elicit heterologous protection against Shiga toxins types 1 and 2. , 2006, Vaccine.

[105]  Kazuro Furukawa,et al.  Targeted Disruption of Gb3/CD77 Synthase Gene Resulted in the Complete Deletion of Globo-series Glycosphingolipids and Loss of Sensitivity to Verotoxins* , 2006, Journal of Biological Chemistry.

[106]  E. Mintz,et al.  Emergence of Shiga toxin 1 genes within Shigella dysenteriae type 4 isolates from travelers returning from the Island of Hispañola. , 2007, The American journal of tropical medicine and hygiene.

[107]  P. Kahn,et al.  Identification of amino acids critical for the cytotoxicity of Shiga toxin 1 and 2 in Saccharomyces cerevisiae. , 2011, Toxicon : official journal of the International Society on Toxinology.

[108]  P. Manning,et al.  Polymerase chain reaction amplification, cloning and sequencing of variant Escherichia coli Shiga-like toxin type II operons. , 1993, Microbial pathogenesis.

[109]  M. Mehran,et al.  Safety and Pharmacokinetics of Chimeric Anti-Shiga Toxin 1 and Anti-Shiga Toxin 2 Monoclonal Antibodies in Healthy Volunteers , 2009, Antimicrobial Agents and Chemotherapy.

[110]  Richard J. H. Smith,et al.  Familial Atypical Hemolytic Uremic Syndrome: A Review of Its Genetic and Clinical Aspects , 2012, Clinical & developmental immunology.

[111]  D. Friedmann,et al.  Molecular Basis of Differential B-Pentamer Stability of Shiga Toxins 1 and 2 , 2010, PloS one.

[112]  C. Lingwood,et al.  Detergent-resistant globotriaosyl ceramide may define verotoxin/glomeruli-restricted hemolytic uremic syndrome pathology. , 2009, Kidney international.

[113]  Stefano Morabito,et al.  Multicenter Evaluation of a Sequence-Based Protocol for Subtyping Shiga Toxins and Standardizing Stx Nomenclature , 2012, Journal of Clinical Microbiology.

[114]  T. Obrig,et al.  Specific interaction of Escherichia coli O157:H7-derived Shiga-like toxin II with human renal endothelial cells. , 1995, The Journal of infectious diseases.

[115]  M. Saleem,et al.  Current evidence for the role of complement in the pathogenesis of Shiga toxin haemolytic uraemic syndrome , 2014, Pediatric Nephrology.

[116]  J. Gariépy,et al.  The catalytic subunit of shiga-like toxin 1 interacts with ribosomal stalk proteins and is inhibited by their conserved C-terminal domain. , 2008, Journal of molecular biology.

[117]  D. Leyva-Illades,et al.  Differential Response of the Human Renal Proximal Tubular Epithelial Cell Line HK-2 to Shiga Toxin Types 1 and 2 , 2011, Infection and Immunity.

[118]  M. Morigi,et al.  Shiga toxin-associated hemolytic uremic syndrome: pathophysiology of endothelial dysfunction , 2010, Pediatric Nephrology.

[119]  A. O’Brien,et al.  When a healthy diet turns deadly , 2013, Gut microbes.

[120]  G. Armstrong,et al.  Affinities of Shiga toxins 1 and 2 for univalent and oligovalent Pk-trisaccharide analogs measured by electrospray ionization mass spectrometry. , 2007, Glycobiology.

[121]  T. L. Hale,et al.  Cytotoxicity of Shigella dysenteriae 1 for cultured mammalian cells. , 1980, The American journal of clinical nutrition.

[122]  H Nakajima,et al.  Kinetic Analysis of Binding between Shiga Toxin and Receptor Glycolipid Gb3Cer by Surface Plasmon Resonance* , 2001, The Journal of Biological Chemistry.

[123]  Mark A. Smith,et al.  Dietary choice affects Shiga toxin-producing Escherichia coli (STEC) O157:H7 colonization and disease , 2013, Proceedings of the National Academy of Sciences.

[124]  N. Taneja,et al.  Detection of Shiga toxin variants among Shiga toxin–forming Escherichia coli isolates from animal stool, meat and human stool samples in India , 2012, Journal of applied microbiology.

[125]  J. Mekalanos,et al.  Evidence that glutamic acid 167 is an active-site residue of Shiga-like toxin I. , 1988, Proceedings of the National Academy of Sciences of the United States of America.

[126]  C. Lingwood,et al.  Membrane cytosolic translocation of verotoxin A1 subunit in target cells. , 2007, Microbiology.

[127]  C. MacKenzie,et al.  A Mutational Analysis of the Globotriaosylceramide-binding Sites of Verotoxin VT1* , 2002, The Journal of Biological Chemistry.

[128]  A. O’Brien,et al.  Elastase in Intestinal Mucus Enhances the Cytotoxicity of Shiga Toxin Type 2d* , 2000, The Journal of Biological Chemistry.

[129]  S. Formal,et al.  ESCHERICHIA COLI 0157:H7 STRAINS ASSOCIATED WITH HAEMORRHAGIC COLITIS IN THE UNITED STATES PRODUCE A SHIGELLA DYSENTERIAE 1 (SHIGA) LIKE CYTOTOXIN , 1983, The Lancet.

[130]  M. James,et al.  Binding of adenine to Stx2, the protein toxin from Escherichia coli O157:H7. , 2006, Acta crystallographica. Section F, Structural biology and crystallization communications.

[131]  R. Read,et al.  The identification of three biologically relevant globotriaosyl ceramide receptor binding sites on the Verotoxin 1 B subunit , 1999, Molecular microbiology.

[132]  S. High,et al.  Eeyarestatin 1 Interferes with Both Retrograde and Anterograde Intracellular Trafficking Pathways , 2011, PloS one.

[133]  A. Weiss,et al.  Escherichia coli Serogroup O107/O117 Lipopolysaccharide Binds and Neutralizes Shiga Toxin 2 , 2004, Journal of bacteriology.

[134]  M. Petric,et al.  SPORADIC CASES OF HAEMOLYTIC-URAEMIC SYNDROME ASSOCIATED WITH FAECAL CYTOTOXIN AND CYTOTOXIN-PRODUCING ESCHERICHIA COLI IN STOOLS , 1983, The Lancet.

[135]  S. Yamasaki,et al.  Genetic and Immunological Analysis of a Novel Variant of Shiga Toxin 1 from Bovine Escherichia coli Strains and Development of Bead‐ELISA to Detect the Variant Toxin , 2003, Microbiology and immunology.

[136]  J. Kaper,et al.  Shiga toxin binding in normal and inflamed human intestinal mucosa. , 2007, Microbes and infection.

[137]  J. Rodriguez-Canales,et al.  Human Intestinal Tissue and Cultured Colonic Cells Contain Globotriaosylceramide Synthase mRNA and the Alternate Shiga Toxin Receptor Globotetraosylceramide , 2010, Infection and Immunity.

[138]  C. Pai,et al.  Experimental infection of infant rabbits with verotoxin-producing Escherichia coli , 1986, Infection and immunity.

[139]  C. Lingwood,et al.  Globotetraosylceramide is recognized by the pig edema disease toxin. , 1989, The Journal of biological chemistry.