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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Microbiol.</journal-id>
<journal-title>Frontiers in Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">1664-302X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmicb.2018.00942</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Microbiology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Distribution of Major Pilin Subunit Genes Among Atypical Enteropathogenic <italic>Escherichia coli</italic> and Influence of Growth Media on Expression of the <italic>ecp</italic> Operon</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Munhoz</surname> <given-names>Danielle D.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/500514/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Nara</surname> <given-names>J&#x00FA;lia M.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x2020;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Freitas</surname> <given-names>Nat&#x00E1;lia C.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Moraes</surname> <given-names>Claudia T. P.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/217866/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Nunes</surname> <given-names>Kamila O.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/460846/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Yamamoto</surname> <given-names>Bruno B.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Vasconcellos</surname> <given-names>Francielli M.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Mart&#x00ED;nez-Laguna</surname> <given-names>Ygnacio</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Gir&#x00F3;n</surname> <given-names>Jorge A.</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/254002/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Martins</surname> <given-names>Fernando H.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/503529/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Abe</surname> <given-names>Cecilia M.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/503347/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Elias</surname> <given-names>Waldir P.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/463133/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Piazza</surname> <given-names>Roxane M. F.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/190709/overview"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Laborat&#x00F3;rio de Bacteriologia, Instituto Butantan</institution>, <addr-line>S&#x00E3;o Paulo</addr-line>, <country>Brazil</country></aff>
<aff id="aff2"><sup>2</sup><institution>Centro de Detecci&#x00F3;n Biomolecular, Benem&#x00E9;rita Universidad Aut&#x00F3;noma de Puebla</institution>, <addr-line>Puebla</addr-line>, <country>Mexico</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Lorenza Putignani, Bambino Ges&#x00F9; Ospedale Pediatrico (IRCCS), Italy</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Elena Mazzolini, Istituto Zooprofilattico Sperimentale delle Venezie, Italy; Abigail Clements, Imperial College London, United Kingdom</p></fn>
<corresp id="c001">&#x002A;Correspondence: Waldir P. Elias, <email>waldir.elias@butantan.gov.br</email> Roxane M. F. Piazza, <email>roxane.piazza@butantan.gov.br</email></corresp>
<fn fn-type="other" id="fn002"><p><sup>&#x2020;</sup>Present address: <italic>J&#x00FA;lia M. Nara, Laborat&#x00F3;rio de Doen&#x00E7;as de Su&#x00ED;nos &#x201C;Washington Sugay", Instituto Biol&#x00F3;gico, S&#x00E3;o Paulo, Brazil</italic></p></fn>
<fn fn-type="other" id="fn003"><p>This article was submitted to Infectious Diseases, a section of the journal Frontiers in Microbiology</p></fn></author-notes>
<pub-date pub-type="epub">
<day>15</day>
<month>05</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="collection">
<year>2018</year>
</pub-date>
<volume>9</volume>
<elocation-id>942</elocation-id>
<history>
<date date-type="received">
<day>17</day>
<month>07</month>
<year>2017</year>
</date>
<date date-type="accepted">
<day>23</day>
<month>04</month>
<year>2018</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2018 Munhoz, Nara, Freitas, Moraes, Nunes, Yamamoto, Vasconcellos, Mart&#x00ED;nez-Laguna, Gir&#x00F3;n, Martins, Abe, Elias and Piazza.</copyright-statement>
<copyright-year>2018</copyright-year>
<copyright-holder>Munhoz, Nara, Freitas, Moraes, Nunes, Yamamoto, Vasconcellos, Mart&#x00ED;nez-Laguna, Gir&#x00F3;n, Martins, Abe, Elias and Piazza</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p>Atypical enteropathogenic <italic>Escherichia coli</italic> (aEPEC) strains are unable to produce the bundle-forming pilus (BFP), which is responsible for the localized adherence pattern, a characteristic of the pathogenicity of typical EPEC strains. The lack of BFP in aEPEC strains suggests that other fimbrial or non-fimbrial adhesins are involved in their adhesion to the host cells. The aim of this study was to investigate the distribution of major subunit fimbrial genes known to be important adherence factors produced by several <italic>E. coli</italic> pathotypes in a collection of 72 aEPEC strains. Our results demonstrate that a high percentage (94&#x2013;100%) of aEPEC strains harbored <italic>ecpA, fimA, hcpA</italic>, and <italic>lpfA</italic> fimbrial genes. Other fimbrial genes including <italic>pilS, pilV, sfpA, daaC, papA</italic>, and <italic>sfa</italic> were detected at lower frequencies (1&#x2013;8%). Genes encoding fimbrial subunits, which are characteristic of enteroaggregative <italic>E. coli</italic> or enterotoxigenic <italic>E. coli</italic> were not found. No correlation was found between fimbrial gene profiles and adherence phenotypes. Since all aEPEC strains contained <italic>ecpA</italic>, the major pilin gene of the <italic>E. coli</italic> common pilus (ECP), a subset of <italic>ecpA</italic>+ strains was analyzed for transcription of <italic>ecpRABCDE</italic> and production of ECP upon growth in three different culture conditions at 37&#x00B0;C. Transcription of <italic>ecpRABCDE</italic> occurred in all conditions; however, ECP production was medium dependent. In all, the data suggest that aEPEC strains are highly heterogeneous in terms of their fimbrial gene profiles. Despite lacking BFP production, other mechanisms of cell adherence exist in aEPEC strains to ensure host colonization, e.g., mediated by other prevalent pili such as ECP. Moreover, the production of ECP by aEPEC strains might be influenced by yet unknown post-transcriptional factors.</p>
</abstract>
<kwd-group>
<kwd>diarrhea</kwd>
<kwd>atypical EPEC</kwd>
<kwd>adhesion</kwd>
<kwd>fimbriae</kwd>
<kwd>ECP</kwd>
</kwd-group>
<contract-num rid="cn001">2004/12136-5</contract-num>
<contract-num rid="cn001">2009/14845-7</contract-num>
<contract-num rid="cn001">2013/06589-6</contract-num>
<contract-num rid="cn002">301302/2013-8</contract-num>
<contract-sponsor id="cn001">Funda&#x00E7;&#x00E3;o de Amparo &#x00E0; Pesquisa do Estado de S&#x00E3;o Paulo<named-content content-type="fundref-id">10.13039/501100001807</named-content></contract-sponsor>
<contract-sponsor id="cn002">Conselho Nacional de Desenvolvimento Cient&#x00ED;fico e Tecnol&#x00F3;gico<named-content content-type="fundref-id">10.13039/501100003593</named-content></contract-sponsor>
<counts>
<fig-count count="3"/>
<table-count count="2"/>
<equation-count count="0"/>
<ref-count count="55"/>
<page-count count="10"/>
<word-count count="0"/>
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</front>
<body>
<sec><title>Introduction</title>
<p>Bacterial adherence to host tissues is a multifactorial process involving distinct fimbrial and non-fimbrial adhesins that act in concert at different stages during infection. So far, a variety of fimbrial types has been identified and characterized in bacteria (<xref ref-type="bibr" rid="B32">Ofek et al., 2003</xref>; <xref ref-type="bibr" rid="B24">Jonson et al., 2005</xref>). The chromosomes of commensal and pathogenic <italic>Escherichia coli</italic> typically harbor between 12 and 16 different pili operons but the function of the majority of these pili systems and whether they are expressed or not remain uncharacterized (<xref ref-type="bibr" rid="B8">Brunder et al., 2001</xref>; <xref ref-type="bibr" rid="B11">Doughty et al., 2002</xref>; <xref ref-type="bibr" rid="B50">Torres et al., 2002</xref>, <xref ref-type="bibr" rid="B51">2004</xref>; <xref ref-type="bibr" rid="B36">Rend&#x00F3;n et al., 2007</xref>; <xref ref-type="bibr" rid="B54">Xicohtencatl-Cortes et al., 2007</xref>; <xref ref-type="bibr" rid="B41">Salda&#x00F1;a et al., 2009b</xref>; <xref ref-type="bibr" rid="B42">Samadder et al., 2009</xref>; <xref ref-type="bibr" rid="B38">Ross et al., 2015</xref>). Epidemiological data gathered around the world indicate that some pili types define some of the different classes of pathogenic <italic>E. coli</italic> and are associated with their adhesive potential and virulence. For example, the plasmid-encoded bundle-forming pilus (BFP), colonization factors (CFs), and aggregative adherence fimbriae (AAF) are found in enteropathogenic (EPEC), enterotoxigenic (ETEC), and enteroaggregative (EAEC) <italic>E. coli</italic> strains, respectively (<xref ref-type="bibr" rid="B12">Gir&#x00F3;n et al., 1991</xref>; <xref ref-type="bibr" rid="B31">Nataro et al., 1992</xref>; <xref ref-type="bibr" rid="B10">Czeczulin et al., 1997</xref>; <xref ref-type="bibr" rid="B5">Bernier et al., 2002</xref>; <xref ref-type="bibr" rid="B35">Qadri et al., 2005</xref>; <xref ref-type="bibr" rid="B7">Boisen et al., 2008</xref>; <xref ref-type="bibr" rid="B25">J&#x00F8;nsson et al., 2015</xref>). Type 1 pili, the long polar fimbriae (LPF), and the <italic>E. coli</italic> common pilus (ECP) are among the ubiquitous fimbrial adhesins of <italic>E. coli</italic> pathotypes. The ECP that has been detected in enterohemorrhagic <italic>E. coli</italic> (EHEC), EPEC, EAEC, ETEC, uropathogenic and avian pathogenic <italic>E. coli</italic> (<xref ref-type="bibr" rid="B36">Rend&#x00F3;n et al., 2007</xref>; <xref ref-type="bibr" rid="B6">Blackburn et al., 2009</xref>; <xref ref-type="bibr" rid="B40">Salda&#x00F1;a et al., 2009a</xref>, <xref ref-type="bibr" rid="B39">2014</xref>; <xref ref-type="bibr" rid="B3">Avelino et al., 2010</xref>; <xref ref-type="bibr" rid="B20">Hernandes et al., 2011</xref>; <xref ref-type="bibr" rid="B47">Stacy et al., 2014</xref>). In typical EPEC (tEPEC) strains, ECP appears to act synergistically with BFP during formation of the localized adhesion (LA) pattern (<xref ref-type="bibr" rid="B40">Salda&#x00F1;a et al., 2009a</xref>).</p>
<p>A subclass of EPEC strains lacking BFP genes has emerged in several regions of the world as an important cause of childhood diarrhea (reviewed in <xref ref-type="bibr" rid="B15">Gomes et al., 2016</xref>). This subclass is referred to as atypical EPEC (aEPEC) and does not produce the typical LA on cultured epithelial cells associated with BFP production (<xref ref-type="bibr" rid="B46">Scaletsky et al., 1984</xref>). Instead, aEPEC strains adhere poorly to cultured cells forming loose clusters, a pattern called localized-adherence like (LAL) (<xref ref-type="bibr" rid="B37">Rodrigues et al., 1996</xref>; <xref ref-type="bibr" rid="B45">Scaletsky et al., 1999</xref>). Some studies have demonstrated that aEPEC strains harbor a wide range of fimbrial genes in different combinations (<xref ref-type="bibr" rid="B17">Gomes et al., 2004</xref>; <xref ref-type="bibr" rid="B2">Afset et al., 2006</xref>; <xref ref-type="bibr" rid="B48">Tennant et al., 2009</xref>; <xref ref-type="bibr" rid="B43">Scaletsky et al., 2010</xref>; <xref ref-type="bibr" rid="B20">Hernandes et al., 2011</xref>; <xref ref-type="bibr" rid="B33">Piazza et al., 2013</xref>). However, only a few studies have characterized the expression of fimbrial genes in aEPEC strains (<xref ref-type="bibr" rid="B20">Hernandes et al., 2011</xref>; <xref ref-type="bibr" rid="B30">Nascimento et al., 2014</xref>). Thus, it is important to search for highly prevalent virulence markers in this pathotype in order to better understand their adherence mechanisms aiming to identify targets for diagnosis and/or prevention of aEPEC infections.</p>
<p>Therefore, the aim of the present study was to investigate the distribution of known pathogenic <italic>E. coli</italic> fimbrial adhesins genes in aEPEC strains displaying different adherence phenotypes. Since the <italic>ecpA</italic> gene was present in all the aEPEC strains tested, we also investigated the influence of growth media in the differential expression and production of ECP among these strains to gain knowledge on the regulation of ECP.</p>
</sec>
<sec id="s1" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec><title>Bacterial Strains</title>
<p>We studied all 72 aEPEC strains isolated from children with diarrhea in a case-control survey conducted between 2003 and 2004 in the city of Salvador, Brazil (<xref ref-type="bibr" rid="B9">Bueris et al., 2007</xref>). These strains were previously characterized as aEPEC showing the following features: <italic>eae<sup>+</sup></italic>/EAF<sup>-</sup>/<italic>stx<sup>-</sup>/</italic>BFP<sup>-</sup> (<xref ref-type="bibr" rid="B1">Abe et al., 2009</xref>; <xref ref-type="bibr" rid="B29">Nara et al., 2010</xref>). They belong to a wide range of serotypes, and exhibit distinct patterns of adherence: LAL, diffuse adherence (DA), aggregative adherence (AA), non-characteristic, and non-adherent (<xref ref-type="bibr" rid="B1">Abe et al., 2009</xref>). Strains used as controls in different assays are listed in Supplementary Table <xref ref-type="supplementary-material" rid="SM1">S1</xref>.</p>
</sec>
<sec><title>Detection of Fimbrial Genes</title>
<p>The following fimbriae-encoding genes were searched among the 72 aEPEC strains by PCR: <italic>fimA, fimH, papA, sfaD-E, bfpA, ecpA, espA, ldaH, aggA, aafA, agg3A, agg4A, pilS, pilV, lngA, cfaB, cooA, cotA, cstA, cofA, csaA, csfA, cssA, daaC, sfpA, hcpA, lpfA<sub>O113</sub>, lpfA1-1, lpfA1-2, lpfA1-3, lpfA1-5, lpfA2-1</italic>. Primer sequences, annealing temperatures and sizes of amplified fragments are listed in Supplementary Table <xref ref-type="supplementary-material" rid="SM1">S1</xref>. Amplification was performed in a total volume of 50 &#x03BC;L containing: dATP, dTTP, dCTP, and dGTP (0.1 mM each), 1.5 U <italic>Taq</italic> DNA polymerase, 5.0 &#x03BC;L 10x PCR buffer and 2 mM MgCl<sub>2</sub> (Invitrogen, Boston, MA, United States), 40 pmol of each primer, and 2.0 &#x03BC;L of DNA template, obtained from a colony from culture on Luria-Bertani (LB) agar boiled in 300 &#x03BC;L of water for 10 min. The PCR was carried out at 94&#x00B0;C for 5 min, 30 cycles of 94&#x00B0;C for 1 min, annealing temperature (see Supplementary Table <xref ref-type="supplementary-material" rid="SM1">S1</xref> for specific temperatures and incubation times), 72&#x00B0;C for 1 min, followed by a final extension for 5 min at 72&#x00B0;C. The PCR products were analyzed by agarose gel (0.7&#x2013;1%) electrophoresis after GelRed staining (Uniscience, Miami, FL, United States), and the images captured by the AlphaImage<sup>TM</sup> 2200 program (Alpha Innotech, San Leandro, CA, United States). Twenty-two LAL aEPEC strains were selected for PCR analysis of <italic>ecpRABCDE</italic> genes as described above.</p>
</sec>
<sec><title>Growth Conditions for Analysis of ECP Production</title>
<p>Among the 72 aEPEC strains tested, four LAL-producing aEPEC (BA2103, BA3378, BA4132, and BA4147) were selected for ECP production. For analysis of <italic>ecpRABCDE</italic> transcription and ECP production the strains were initially grown in LB at 37&#x00B0;C for 18 h. The bacterial cultures were then transferred to LB, Dulbecco&#x2019;s modified Eagle Medium (DMEM) or preconditioned DMEM (PC-DMEM) (1:100) followed by static incubation at 37&#x00B0;C until a final absorbance of 0.6 at 600 nm (A<sub>600</sub>). PC-DMEM was prepared by incubating DMEM (without antibiotics and fetal bovine serum) in the presence of monolayers of HeLa cells for 48 h at 37&#x00B0;C. The supernatant referred to as &#x201C;preconditioned medium&#x201D; was collected, adjusted to pH 7.4, and filtered through a 0.2 &#x03BC;m pore membrane (<xref ref-type="bibr" rid="B13">Gir&#x00F3;n et al., 2002</xref>). tEPEC E2348/69 and <italic>E. albertii</italic> 1551-2 strains (<xref ref-type="bibr" rid="B28">Levine et al., 1985</xref>; <xref ref-type="bibr" rid="B55">Yamamoto et al., 2017</xref>) were used as positive and negative controls of ECP production, respectively.</p>
</sec>
<sec><title>Transcription of <italic>ecp</italic> Operon</title>
<p>Strains BA2103, BA3378, BA4132 and BA4147, as well as appropriate control strains were grown in LB, DMEM and PC&#x2013;DMEM and centrifuged at 4,000 &#x00D7; <italic>g</italic> for 5 min. Pellets were resuspended in 1 mL of the respective culture media and subsequently used for RNA extraction using RNA Protect and RNeasy Mini kit (Qiagen, Hilden, Germany), according to the manufacturer&#x2019;s recommendations. cDNAs were synthesized using 1 &#x03BC;g of RNA for each strain, by Superscript III First-Strand Synthesis Systems kit for RT-PCR (Invitrogen, Boston, MA, United States), following the manufacturer&#x2019;s recommendations. The presence of <italic>ecpRABCDE</italic> genes in the cDNAs obtained were assessed by PCR as described in <bold>Table <xref ref-type="table" rid="T1">1</xref></bold>. PCR for the constitutive gene <italic>rpoA</italic> was included as control of cDNA integrity. All reactions were performed in triplicates in three independent experiments.</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p>Primer sequences of <italic>ecp</italic> operon and PCR conditions used to study <italic>ecp</italic> operon.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Gene</th>
<th valign="top" align="left">Sequence</th>
<th valign="top" align="center">Annealing temperature (&#x00B0;C)</th>
<th valign="top" align="center">Mg (mM)</th>
<th valign="top" align="center">Fragment (bp)</th>
<th valign="top" align="center">Reference</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"><italic>ecpA</italic></td>
<td valign="top" align="left">(F) ACCTCGGGAAGAAAAGCAA</td>
<td valign="top" align="center">56</td>
<td valign="top" align="center">2</td>
<td valign="top" align="center">640</td>
<td valign="top" align="center">This study<sup>&#x2217;</sup></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">(R) CAATTCCGTCCAGGAATAAA</td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td></tr>
<tr>
<td valign="top" align="left"><italic>ecpB</italic></td>
<td valign="top" align="left">(F) TCTGATGTACCAGCAGGG</td>
<td valign="top" align="center">47</td>
<td valign="top" align="center">1.5</td>
<td valign="top" align="center">780</td>
<td valign="top" align="center">This study<sup>&#x2217;</sup></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">(R) CTTTCAGTCCTGGGGAGA</td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td></tr>
<tr>
<td valign="top" align="left"><italic>ecpC</italic></td>
<td valign="top" align="left">(F) ACGACAATGCCTTTACGAG</td>
<td valign="top" align="center">57</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">1,130</td>
<td valign="top" align="center">This study<sup>&#x2217;</sup></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">(R) CGATCCATATGAAAGCTACG</td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td></tr>
<tr>
<td valign="top" align="left"><italic>ecpD</italic></td>
<td valign="top" align="left">(F) AGTTTGTGTTTGTCGAAAAC</td>
<td valign="top" align="center">56</td>
<td valign="top" align="center">1</td>
<td valign="top" align="center">760</td>
<td valign="top" align="center">This study<sup>&#x2217;</sup></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">(R) GCCGAGGCTAACGACGA</td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td></tr>
<tr>
<td valign="top" align="left"><italic>ecpE</italic></td>
<td valign="top" align="left">(F) CGGTGGATGGTGAACTACTT</td>
<td valign="top" align="center">60</td>
<td valign="top" align="center">2</td>
<td valign="top" align="center">458</td>
<td valign="top" align="center">This study<sup>&#x2217;</sup></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">(R) CGGACAGGAATCCGTTAATCT</td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td></tr>
<tr>
<td valign="top" align="left"><italic>ecpR</italic></td>
<td valign="top" align="left">(F) CTGTAAAAATTATAGGTTTG</td>
<td valign="top" align="center">57</td>
<td valign="top" align="center">2</td>
<td valign="top" align="center">683</td>
<td valign="top" align="center">This study<sup>&#x2217;</sup></td>
</tr>
<tr>
<td valign="top" align="left"></td>
<td valign="top" align="left">(R) ACCAGAGCTATTGCCAGA</td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td>
<td valign="top" align="center"></td></tr>
</tbody></table>
<table-wrap-foot>
<attrib><italic><sup>&#x2217;</sup>Primers designed using <italic>ecp</italic> operon sequence of tEPEC E2348/69 (GenBank accession number: <ext-link ext-link-type="DDBJ/EMBL/GenBank" xlink:href="NC_011601">NC_011601</ext-link>).</italic></attrib>
</table-wrap-foot>
</table-wrap>
</sec>
<sec><title>Production of ECP</title>
<p>The production of ECP was studied by immunofluorescence microscopy (IFM) in LAL aEPEC strains BA2103, BA3378, BA4132, and BA4147 growing in the three different media described above. Briefly, the 18 h bacterial cultures were centrifuged for 5 min at 900 &#x00D7; <italic>g</italic> and the pellets were resuspended in 10 &#x03BC;L of the respective medium and fixed on glass slides with 4% p-formaldehyde at 4&#x00B0;C for 18 h. The slides were washed twice with 0.01 M phosphate buffer saline pH 7.4 (PBS), blocked with 10% goat serum in PBS (GS&#x2013;PBS) for 1 h at room temperature, followed by incubation at 4&#x00B0;C for 18 h with rabbit anti-EcpA antibody (diluted 1:1,000 in GS&#x2013;PBS). The slides were washed twice with PBS and incubated with goat anti-rabbit IgG conjugated with FITC (Sigma-Aldrich, St. Louis, MO, United States) diluted 1:500 in GS&#x2013;PBS at room temperature for 1 h. After incubation, the slides were washed twice with PBS and mounted with Vectashield antifade mounting medium (Vector Laboratories, Burlingame, CA, United States) and covered with glass coverslips. The preparations were visualized under laser scanning confocal (LSM 510 META, Zeiss, Oberkochen, Germany) microscopes with original magnification of 1,000&#x00D7;. Triplicates of three independent experiments were performed.</p>
<p>We also determined ECP production in cultures of strain BA2103 obtained in LB, DMEM or PC&#x2013;DMEM by transmission electron microscopy (TEM) using immunogold-labeling method. Strains E2348/69 and 1551-2 were used as controls. Briefly, preparations were blocked with a solution of 0.2% BSA in PBS and then incubated with rabbit anti-EcpA at 1:100 dilution for 2 h at room temperature. Following this period, the preparations were incubated with goat anti-rabbit antibody labeled with 10 nm colloidal gold particles (Sigma-Aldrich, St. Louis, MO, United States) at 1:50 dilution for 2 h at room temperature. Preparations were negatively stained with 2% uranyl acetate in water, applied onto formvar-coated nickel grids and observed under TEM (LEO 906E &#x2013; Zeiss, Oberkochen, Germany) at 80 kV. Triplicates of three independent experiments were performed.</p>
</sec>
</sec>
<sec><title>Results</title>
<sec><title><italic>E. coli</italic> Fimbrial Genes Are Found in aEPEC Strains in Different Combinations</title>
<p>Fifteen fimbrial genes were detected in our collection: <italic>ecpA</italic> (100%), <italic>fimH</italic> and <italic>hcpA</italic> (97.2%), <italic>fimA</italic> (94.4%), <italic>lpfA1-2</italic> (68%), <italic>lpfA2-1</italic> (50%), <italic>lpfA1-1</italic> (19.4%), <italic>lpfA<sub>O113</sub></italic> (13.8%), <italic>lpfA1-3</italic> (11.1%), <italic>pilS</italic> and <italic>ldaH</italic> (8.3%), <italic>pilV</italic> (4.2%), <italic>papA and daaC</italic> (2.7%) and <italic>sfpA</italic> (1.4%) (<bold>Figure <xref ref-type="fig" rid="F1">1</xref></bold>). This large repertoire of fimbrial genes was distributed in different combinations among the 72 strains, demonstrating no correlation between fimbrial gene profiles and adherence pattern (<bold>Table <xref ref-type="table" rid="T2">2</xref></bold>). None of the aEPEC strains contained the following fimbrial genes: <italic>aggA, aafA, agg3A, agg4A, cooA, cotA, cstA, cofA, csaA, csfA, cssA, lngA, lpfA1-5</italic>, and <italic>sfa</italic> (<bold>Table <xref ref-type="table" rid="T2">2</xref></bold>).</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p>Distribution of the frequency of fimbrial genes among 72 aEPEC strains studied.</p></caption>
<graphic xlink:href="fmicb-09-00942-g001.tif"/>
</fig>
<table-wrap position="float" id="T2">
<label>Table 2</label>
<caption><p>Genetic fimbrial profile of aEPEC strains.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Strains</th>
<th valign="top" align="left">Fimbrial adhesins profile</th>
<th valign="top" align="center">Adherence pattern</th>
<th valign="top" align="center">Serotype</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">BA558</td>
<td valign="top" align="left"><italic>pilS, pilV, lpfA1-2, lpfA1-3, ecpA, hcpA</italic></td>
<td valign="top" align="center">LA</td>
<td valign="top" align="center">O111:H40</td>
</tr>
<tr>
<td valign="top" align="left">BA1652</td>
<td valign="top" align="left"><italic>fimA, fimH, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O131:H4</td>
</tr>
<tr>
<td valign="top" align="left">BA2853</td>
<td valign="top" align="left"><italic>fimA, fimH, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">ONT:H10</td>
</tr>
<tr>
<td valign="top" align="left">BA487</td>
<td valign="top" align="left"><italic>fimA, lpfA1-3, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O55:H7</td>
</tr>
<tr>
<td valign="top" align="left">BA714</td>
<td valign="top" align="left"><italic>fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O111:H-</td>
</tr>
<tr>
<td valign="top" align="left">BA2034</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">ONT:H10</td>
</tr>
<tr>
<td valign="top" align="left">BA3733</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O119:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA4095</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O4:H45</td>
</tr>
<tr>
<td valign="top" align="left">BA1649</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O111:H38</td>
</tr>
<tr>
<td valign="top" align="left">BA3378</td>
<td valign="top" align="left"><italic>fimA, fimH, pilS, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O104:H2</td>
</tr>
<tr>
<td valign="top" align="left">BA1250</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">ONT:H6</td>
</tr>
<tr>
<td valign="top" align="left">BA1324</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O34:H45</td>
</tr>
<tr>
<td valign="top" align="left">BA3157</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O119:H2</td>
</tr>
<tr>
<td valign="top" align="left">BA3574</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">ONT:H38</td>
</tr>
<tr>
<td valign="top" align="left">BA4047</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-3, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O1:H16</td>
</tr>
<tr>
<td valign="top" align="left">BA4077</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O64:H23</td>
</tr>
<tr>
<td valign="top" align="left">BA4147</td>
<td valign="top" align="left"><italic>fimA, fimH, papA, lpfA1-3, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O55:H7</td>
</tr>
<tr>
<td valign="top" align="left">BA320</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA1-3, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O55:H7</td>
</tr>
<tr>
<td valign="top" align="left">BA589</td>
<td valign="top" align="left"><italic>fimA, fimH, pilS, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O5:H2</td>
</tr>
<tr>
<td valign="top" align="left">BA3851</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">ONT:H38</td>
</tr>
<tr>
<td valign="top" align="left">BA4132</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O51:H48</td>
</tr>
<tr>
<td valign="top" align="left">BA3977</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA1-2, sfpA, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">ONT:H45</td>
</tr>
<tr>
<td valign="top" align="left">BA2103</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">LAL</td>
<td valign="top" align="center">O26:H11</td>
</tr>
<tr>
<td valign="top" align="left">BA92</td>
<td valign="top" align="left"><italic>fimA, fimH, ecpA, hcpA</italic></td>
<td valign="top" align="center">AA</td>
<td valign="top" align="center">O2:H16</td>
</tr>
<tr>
<td valign="top" align="left">BA4157</td>
<td valign="top" align="left"><italic>fimA, fimH, ecpA, hcpA</italic></td>
<td valign="top" align="center">AA</td>
<td valign="top" align="center">ONT:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA2482</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">AA</td>
<td valign="top" align="center">O119:H11</td>
</tr>
<tr>
<td valign="top" align="left">BA585</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA1-3, ecpA, hcpA</italic></td>
<td valign="top" align="center">AA</td>
<td valign="top" align="center">O157:H16</td>
</tr>
<tr>
<td valign="top" align="left">BA3690</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">AA</td>
<td valign="top" align="center">O111:H38</td>
</tr>
<tr>
<td valign="top" align="left">BA2145</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">AA</td>
<td valign="top" align="center">O105:H7</td>
</tr>
<tr>
<td valign="top" align="left">BA2297</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA<sub>O113</sub>, lpfA2-1, ecpA</italic></td>
<td valign="top" align="center">DA</td>
<td valign="top" align="center">O153:H11</td>
</tr>
<tr>
<td valign="top" align="left">BA2073</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA1-2, ecpA</italic></td>
<td valign="top" align="center">DA</td>
<td valign="top" align="center">ONT:H5</td>
</tr>
<tr>
<td valign="top" align="left">BA4009</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA<sub>O113</sub>, lpfA1-1, lpfA2-1, ecpA</italic></td>
<td valign="top" align="center">DA</td>
<td valign="top" align="center">O114:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA3170</td>
<td valign="top" align="left"><italic>fimA, fimH, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O145:H2</td>
</tr>
<tr>
<td valign="top" align="left">BA4182</td>
<td valign="top" align="left"><italic>fimA, fimH, ecpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O125:H6</td>
</tr>
<tr>
<td valign="top" align="left">BA462</td>
<td valign="top" align="left"><italic>fimA, fimH, ldaH, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O51:H40</td>
</tr>
<tr>
<td valign="top" align="left">BA2964</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O51:H40</td>
</tr>
<tr>
<td valign="top" align="left">BA4192</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O111:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA1768</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O51:H40</td>
</tr>
<tr>
<td valign="top" align="left">BA1887</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O111:H38</td>
</tr>
<tr>
<td valign="top" align="left">BA1444</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O115:H8</td>
</tr>
<tr>
<td valign="top" align="left">BA2062</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O171:H48</td>
</tr>
<tr>
<td valign="top" align="left">BA2459</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, lpfA2-1, ldaH, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O26:H11</td>
</tr>
<tr>
<td valign="top" align="left">BA1244</td>
<td valign="top" align="left"><italic>fimA, fimH, papA, pilS, pilV, lpfA1-2, lpfA1-3, lpfA2-1, daaC, ecpA, hcpA</italic></td>
<td valign="top" align="center">UND</td>
<td valign="top" align="center">O55:H7</td>
</tr>
<tr>
<td valign="top" align="left">BA4058</td>
<td valign="top" align="left"><italic>fimH, lpfA1-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O20:H-</td>
</tr>
<tr>
<td valign="top" align="left">BA179</td>
<td valign="top" align="left"><italic>fimA, fimH, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O23:H16</td>
</tr>
<tr>
<td valign="top" align="left">BA442</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O35:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA580</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O119:H2</td>
</tr>
<tr>
<td valign="top" align="left">BA2294</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O9:H33</td>
</tr>
<tr>
<td valign="top" align="left">BA2613</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O101:H33</td>
</tr>
<tr>
<td valign="top" align="left">BA3392</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ldaH, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O124:H11</td>
</tr>
<tr>
<td valign="top" align="left">BA3800</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ONT:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA852</td>
<td valign="top" align="left"><italic>fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O88:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA356</td>
<td valign="top" align="left"><italic>fimA, fimH, pilS, lpfA1-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O333:H7</td></tr>
<tr>
<td valign="top" align="left">BA365</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ONT:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA655</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O88:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA2065</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ONT:H5</td>
</tr>
<tr>
<td valign="top" align="left">BA2117</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ONT:H5</td>
</tr>
<tr>
<td valign="top" align="left">BA2975</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O88:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA2991</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ldaH, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O34:H-</td>
</tr>
<tr>
<td valign="top" align="left">BA3443</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O88:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA3836</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ONT:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA3148</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O35:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA956</td>
<td valign="top" align="left"><italic>fimA, fimH, pilS, pilV, lpfA1-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O111:H15</td>
</tr>
<tr>
<td valign="top" align="left">BA86</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, daaC, ecpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O76:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA151</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ONT:H9</td>
</tr>
<tr>
<td valign="top" align="left">BA3160</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ldaH, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O110:H-</td>
</tr>
<tr>
<td valign="top" align="left">BA2468</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">ONT:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA2775</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O113:H19</td>
</tr>
<tr>
<td valign="top" align="left">BA4013</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O88:H-</td>
</tr>
<tr>
<td valign="top" align="left">BA1738</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O80:H26</td>
</tr>
<tr>
<td valign="top" align="left">BA4135</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfA1-1, lpfA1-2, lpfA2-1, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O108:H25</td>
</tr>
<tr>
<td valign="top" align="left">BA2923</td>
<td valign="top" align="left"><italic>fimA, fimH, lpfAO113, lpfA1-2, lpfA1-3, lpfA2-1, ldaH, ecpA, hcpA</italic></td>
<td valign="top" align="center">NA</td>
<td valign="top" align="center">O34:H6</td></tr>
</tbody></table>
<table-wrap-foot>
<attrib><italic>LA, localized adherence; LAL, localized-adherence like; AA, aggregative adherence; DA, diffuse adherence; UND, undetermined; NA, non-adherent.</italic></attrib>
</table-wrap-foot>
</table-wrap>
</sec>
<sec><title>ECP Is Differentially Produced by aEPEC That Harbor a Functional <italic>ecp</italic> Operon</title>
<p>The 22 LAL <italic>ecpA+</italic> aEPEC strains contained also the <italic>ecpR, ecpB, ecpC, ecpD</italic>, and <italic>ecpE</italic>, suggesting that the ECP operon is highly conserved among aEPEC (data not shown). To better understand the correlation between the expression of <italic>ecpA</italic> and production of ECP in different culture conditions we selected four representative LAL aEPEC strains (BA2103, BA3378, BA4132, and BA4147), all of which display different fimbrial profiles (<bold>Table <xref ref-type="table" rid="T2">2</xref></bold>). All the six-<italic>ecp</italic> genes were expressed in the four strains regardless of the growth medium (Supplementary Figure <xref ref-type="supplementary-material" rid="SM2">S1</xref>). However, among the LB-grown bacteria only BA2103 produced ECP. When cultivated in DMEM and PC-DMEM three (BA2103, BA4132, and BA4147) of the four strains produced ECP. Despite the fact that the entire <italic>ecp</italic> operon was expressed in BA3378, this strain did not produce ECP in any of the growth conditions tested (<bold>Figure <xref ref-type="fig" rid="F2">2</xref></bold>). In general, a noteworthy increase in ECP production is apparent when the strains were grown in PC-DMEM in comparison to DMEM (<bold>Figure <xref ref-type="fig" rid="F2">2</xref></bold>). Confirmation of ECP production by strain BA2103 was demonstrated by TEM and immunogold labeling (<bold>Figure <xref ref-type="fig" rid="F3">3</xref></bold>).</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p>Growth medium-dependent production of ECP visualized by confocal microscopy. aEPEC strains BA2103, BA3378, BA4132, BA4147 grown in LB, DMEM, and PC-DMEM were reacted with rabbit anti-EcpA antibody and goat anti-rabbit IgG antibody conjugated with FITC. E2348/69 and 1551-2 were used as positive and negative controls of ECP production, respectively. Images were originally taken at 1,000&#x00D7; magnification.</p></caption>
<graphic xlink:href="fmicb-09-00942-g002.tif"/>
</fig>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p>Growth medium-dependent production of ECP visualized by TEM. aEPEC strain BA2103 grown in PC-DMEM, DMEM and LB was reacted with rabbit anti-EcpA antibody and goat anti-rabbit IgG antibody conjugated with 10 nm colloidal gold particles. E2348/69 and 1551-2 were used as positive and negative controls of ECP production, respectively. Bars: 0.2 &#x03BC;m.</p></caption>
<graphic xlink:href="fmicb-09-00942-g003.tif"/>
</fig>
</sec>
</sec>
<sec><title>Discussion</title>
<p>tEPEC adherence to enterocytes is multifactorial involving the formation of localized microcolonies on host epithelial cells, which is mediated by BFP, promoting bacterium-cell and bacterium&#x2013;bacterium interactions (<xref ref-type="bibr" rid="B12">Gir&#x00F3;n et al., 1991</xref>; <xref ref-type="bibr" rid="B49">Tobe and Sasakawa, 2001</xref>); followed by the interaction of the intimin adhesin with its receptor Tir triggering the attaching and effacing (A/E) lesion (<xref ref-type="bibr" rid="B23">Jerse et al., 1990</xref>; <xref ref-type="bibr" rid="B26">Kenny et al., 1997</xref>). On the other hand, the initial interaction of aEPEC with host epithelial cells is instead mediated by distinct cell surface appendages (<xref ref-type="bibr" rid="B21">Hernandes et al., 2006</xref>, <xref ref-type="bibr" rid="B20">2011</xref>; <xref ref-type="bibr" rid="B43">Scaletsky et al., 2010</xref>; <xref ref-type="bibr" rid="B16">Gomes et al., 2011</xref>; <xref ref-type="bibr" rid="B22">Hu and Torres, 2015</xref>).</p>
<p>Here, we evaluated a collection of 72 aEPEC for the presence and distribution of several <italic>E. coli</italic> major fimbrial subunit genes known to be involved in bacterial adhesion processes. In agreement with previous reports, none of the genes encoding EAEC fimbriae or the CFs of ETEC were present in the aEPEC strains studied (<xref ref-type="bibr" rid="B52">Vieira et al., 2001</xref>; <xref ref-type="bibr" rid="B17">Gomes et al., 2004</xref>; <xref ref-type="bibr" rid="B2">Afset et al., 2006</xref>). On the other hand, <italic>ecpA, fimA, fimH, hcpA, lpfA<sub>O113</sub></italic> and polymorphic variants of <italic>lpf</italic> (A1-1, A1-2, A1-3, and A2-1) genes were present in the majority (94&#x2013;100%) of the strains, while <italic>pilS, pilV, sfpA, daaC, papA</italic>, and <italic>sfa</italic> genes were detected at lower frequency (1&#x2013;8%) regardless of their adherence pattern. Since each strain studied displayed a specific genetic fimbrial profile, these data indicated that there was no correlation between fimbrial gene profile and adherence pattern phenotypes, as similarly elsewhere described (<xref ref-type="bibr" rid="B2">Afset et al., 2006</xref>; <xref ref-type="bibr" rid="B19">Hernandes et al., 2009</xref>; <xref ref-type="bibr" rid="B15">Gomes et al., 2016</xref>).</p>
<p>The high frequency of <italic>ecpA, hcpA, lpf, fimH</italic>, and <italic>fimA</italic> genes among aEPEC strains indicates that they have likely been conserved to play a role in aEPEC adhesion. It is possible that the acquisition of different gene combinations in specific lineages of <italic>E. coli</italic> may contribute to the emergence of virulent strains (<xref ref-type="bibr" rid="B2">Afset et al., 2006</xref>; <xref ref-type="bibr" rid="B4">Bando et al., 2009</xref>; <xref ref-type="bibr" rid="B44">Scaletsky et al., 2009</xref>). It remains to be determined if recent aEPEC clinical strains are also heterogeneous in terms of their fimbrial adhesins profile. The presence of <italic>papA, sfa, pilS, pilV, ldaH</italic>, and/or <italic>daaC</italic> genes in certain strains deserves further investigation regarding their role as adhesins in host colonization.</p>
<p>Amongst the genes studied, <italic>ecpA</italic> was detected in 100% of our aEPEC collection. The ECP mediates host cell adherence and colonization by both pathogenic and commensal <italic>E. coli</italic> strains (<xref ref-type="bibr" rid="B36">Rend&#x00F3;n et al., 2007</xref>). While the role of the ECP in adherence to epithelial cells has been demonstrated for several <italic>E. coli</italic> pathotypes, its involvement in the LAL phenotype by aEPEC has not been investigated. The high prevalence of this gene among aEPEC strains and other <italic>E. coli</italic> pathotypes isolated from several studies was previously described (<xref ref-type="bibr" rid="B34">Pouttu et al., 2001</xref>; <xref ref-type="bibr" rid="B36">Rend&#x00F3;n et al., 2007</xref>; <xref ref-type="bibr" rid="B6">Blackburn et al., 2009</xref>; <xref ref-type="bibr" rid="B43">Scaletsky et al., 2010</xref>). The presence of all the genes responsible for ECP biogenesis in aEPEC has not yet been investigated. Here, we found that all the six-<italic>ecp</italic> genes were present in the 22 LAL-aEPEC strains studied suggesting that the <italic>ecp</italic> operon is highly conserved.</p>
<p>The expression of the <italic>ecpRABCDE</italic> operon and production of ECP was investigated in four aEPEC growing in rich and minimal culture media. The production of virulence markers is still necessary to be evaluated in order to elect an antigen for diagnosis and/or prevention of aEPEC infection. We found that all the strains transcribed the <italic>ecp</italic> genes when cultured in the three growth conditions tested. In terms of ECP production, only BA2103 produced ECP when the strains were grown in LB rich medium. These data are in agreement with previous reports that showed that some ETEC and EHEC strains do not produce ECP in CF antigen agar and LB, respectively (<xref ref-type="bibr" rid="B36">Rend&#x00F3;n et al., 2007</xref>; <xref ref-type="bibr" rid="B6">Blackburn et al., 2009</xref>). Three strains produced ECP when cultivated in DMEM and PC-DMEM. Interestingly, an apparent increase in the number of bacteria producing ECP was noted when the strains were cultured in PC-DMEM in comparison with DMEM, as the reactivity of the anti-EcpA antibody was remarkably more intense in PC-DMEM grown bacteria. This data suggest that eukaryotic cell-derived molecules present in PC-DMEM might trigger expression of the <italic>ecp</italic> operon and synthesis of ECP by aEPEC.</p>
<p>As production of ECP was not detected in aEPEC BA3378 in any growth condition tested, it is possible that this strain produces a variant of EcpA, which is not recognized by the anti-ECP employed, or is under strict regulation. Thus, post-transcriptional factors possibly regulate ECP production in some strains, as in BA3378 of our study. In fact, the operon regulator EcpR/MatA was shown to have dual role in the control of operon expression in a neonatal meningitis <italic>Escherichia coli</italic> (NMEC) strain (IHE 3034) via <italic>mat</italic> promoter, either by a positive autoregulatory circuit or repressing the negative control exerted by H-NS (<xref ref-type="bibr" rid="B27">Lehti et al., 2013</xref>). EcpR/MatA is also able to increase the stability of the processed <italic>ecpA</italic> mRNA under some conditions as low growth temperature, acidic pH or elevated levels of acetate (<xref ref-type="bibr" rid="B27">Lehti et al., 2013</xref>). The disparity in stability may be due to temperature-dependent conformation of <italic>ecpA</italic> transcript as shown for mRNA of the major cold-shock protein CspA (<xref ref-type="bibr" rid="B14">Giuliodori et al., 2010</xref>). Small RNAs (sRNAs) could be another post-transcriptional system involved in ECP production, which generally demands the RNA chaperone Hfq and use different mechanisms, like binding to the ribosome-binding site (RBS) and blocking translation, binding to an anti-RBS hairpin and activating translation, or by the recruitment of RNases destabilizing transcripts (<xref ref-type="bibr" rid="B53">Waters and Storz, 2009</xref>). Also, <xref ref-type="bibr" rid="B18">Gruber and Sperandio (2015)</xref> recently reported that in EHEC, GlmY and GlmZ selectively destabilize parts of the <italic>LEE4</italic> and <italic>LEE5</italic> transcripts playing an important role in the post-transcriptional regulation of A/E lesion formation. Genes within the GlmY and GlmZ regulon include stress-related genes, virulence factors, genes involved in osmoregulation and adhesins, which is the case of ECP. The role of these post-transcriptional regulators in ECP production by our strains is currently under investigation by our group.</p>
<p>The reactivity of anti-EcpA antibody was remarkably more intense in bacterial cell grown in PC-DMEM than in DMEM. Similar to tEPEC strains, in which ECP and BFP act in combination to promote adherence, it is reasonable to suggest that ECP could act together with other adhesins of aEPEC to favor gut colonization and survival in and outside the host. Also, the high prevalence of ECP among aEPEC indicates that this adherence factor has been maintained during evolution to ensure intestinal colonization.</p>
<p>In summary, our data demonstrated that different <italic>E. coli</italic> fimbrial genes profiles are present in the aEPEC strains studied and that there is no correlation between these profiles and adherence patterns. The high prevalence of ECP, HCP, and type 1 fimbriae among aEPEC suggest that they are likely to contribute to cell adhesion. We also demonstrated that culture conditions influenced ECP production by aEPEC strains, likely attributed to post-transcriptional regulation.</p>
</sec>
<sec><title>Author Contributions</title>
<p>DM, JN, KN, BY, FV, YM-L, FM, CA, WE, and RP: conception and design. DM, JN, NF, CM, KN, BY, FV, FM, and CA: acquisition and analysis. DM, JN, NF, CM, KN, BY, FV, YM-L, JG, FM, CA, WE, and RP: interpretation and substantial contributions. DM, CM, YM-L, JG, FM, CA, WE, and RP: drafting the work or revising it critically. DM, JG, CA, WE, and RP: final approval of the version to be published.</p>
</sec>
<sec><title>Conflict of Interest Statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</body>
<back>
<fn-group>
<fn fn-type="financial-disclosure">
<p><bold>Funding.</bold> This work was supported by grants from S&#x00E3;o Paulo Research Foundation (2004/12136-5, 2009/14845-7, 2010/11624-5, and 2013/06589-6) and Conselho Nacional de Desenvolvimento Cient&#x00ED;fico e Tecnol&#x00F3;gico (301302/2013-8). DM, JN, NF, FV, and FM were recipients of fellowships from the S&#x00E3;o Paulo Research Foundation.</p></fn>
</fn-group>
<ack>
<p>The authors thank Beatriz E. C. Guth and Tania A. T. Gomes (UNIFESP, Brazil) for kindly providing some control strains for gene searching and ECP production and Henrique K. Rofatto and Alexsander S. de Souza for the confocal microscopy analysis.</p>
</ack>
<sec sec-type="supplementary material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fmicb.2018.00942/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fmicb.2018.00942/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Table_1.pdf" id="SM1" mimetype="application/pdf" xmlns:xlink="http://www.w3.org/1999/xlink"/>
<supplementary-material xlink:href="Image_1.PDF" id="SM2" mimetype="application/pdf" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Abe</surname> <given-names>C. M.</given-names></name> <name><surname>Trabulsi</surname> <given-names>L. R.</given-names></name> <name><surname>Blanco</surname> <given-names>J.</given-names></name> <name><surname>Blanco</surname> <given-names>M.</given-names></name> <name><surname>Dahbi</surname> <given-names>G.</given-names></name> <name><surname>Blanco</surname> <given-names>J. E.</given-names></name><etal/></person-group> (<year>2009</year>). <article-title>Virulence features of atypical enteropathogenic <italic>Escherichia coli</italic> identified by the eae(+) EAF-negative stx(-) genetic profile.</article-title> <source><italic>Diagn. Microbiol. Infect. Dis.</italic></source> <volume>64</volume> <fpage>357</fpage>&#x2013;<lpage>365</lpage>. <pub-id pub-id-type="doi">10.1016/j.diagmicrobio.2009.03.025</pub-id> <pub-id pub-id-type="pmid">19442475</pub-id></citation></ref>
<ref id="B2"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Afset</surname> <given-names>J. E.</given-names></name> <name><surname>Bruant</surname> <given-names>G.</given-names></name> <name><surname>Brousseau</surname> <given-names>R.</given-names></name> <name><surname>Harel</surname> <given-names>J.</given-names></name> <name><surname>Anderssen</surname> <given-names>E.</given-names></name> <name><surname>Bevanger</surname> <given-names>L.</given-names></name><etal/></person-group> (<year>2006</year>). <article-title>Identification of virulence genes linked with diarrhea due to atypical enteropathogenic <italic>Escherichia coli</italic> by DNA microarray analysis and PCR.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>44</volume> <fpage>3703</fpage>&#x2013;<lpage>3711</lpage>. <pub-id pub-id-type="doi">10.1128/JCM.00429-06</pub-id> <pub-id pub-id-type="pmid">17021100</pub-id></citation></ref>
<ref id="B3"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Avelino</surname> <given-names>F.</given-names></name> <name><surname>Salda&#x00F1;a</surname> <given-names>Z.</given-names></name> <name><surname>Islam</surname> <given-names>S.</given-names></name> <name><surname>Monteiro-Neto</surname> <given-names>V.</given-names></name> <name><surname>Dall&#x2019;Agnol</surname> <given-names>M.</given-names></name> <name><surname>Eslava</surname> <given-names>C. A.</given-names></name><etal/></person-group> (<year>2010</year>). <article-title>The majority of enteroaggregative <italic>Escherichia coli</italic> strains produce the <italic>E. coli</italic> common pilus when adhering to cultured epithelial cells.</article-title> <source><italic>Int. J. Med. Microbiol.</italic></source> <volume>300</volume> <fpage>440</fpage>&#x2013;<lpage>448</lpage>. <pub-id pub-id-type="doi">10.1016/j.ijmm.2010.02.002</pub-id> <pub-id pub-id-type="pmid">20452276</pub-id></citation></ref>
<ref id="B4"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bando</surname> <given-names>S. Y.</given-names></name> <name><surname>Andrade</surname> <given-names>F. B.</given-names></name> <name><surname>Guth</surname> <given-names>B. E.</given-names></name> <name><surname>Elias</surname> <given-names>W. P.</given-names></name> <name><surname>Moreira-Filho</surname> <given-names>C. A.</given-names></name> <name><surname>Pestana de Castro</surname> <given-names>A. F.</given-names></name></person-group> (<year>2009</year>). <article-title>Atypical enteropathogenic <italic>Escherichia coli</italic> genomic background allows the acquisition of non-EPEC virulence factors.</article-title> <source><italic>FEMS Microbiol. Lett.</italic></source> <volume>299</volume> <fpage>22</fpage>&#x2013;<lpage>30</lpage>. <pub-id pub-id-type="doi">10.1111/j.1574-6968.2009.01735.x</pub-id> <pub-id pub-id-type="pmid">19702881</pub-id></citation></ref>
<ref id="B5"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bernier</surname> <given-names>C.</given-names></name> <name><surname>Gounon</surname> <given-names>P.</given-names></name> <name><surname>Le Bougu&#x00E9;nec</surname> <given-names>C.</given-names></name></person-group> (<year>2002</year>). <article-title>Identification of an aggregative adhesion fimbria (AAF) type III-encoding operon in enteroaggregative <italic>Escherichia coli</italic> as a sensitive probe for detecting the AAF-encoding operon family.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>70</volume> <fpage>4302</fpage>&#x2013;<lpage>4311</lpage>. <pub-id pub-id-type="doi">10.1128/IAI.70.8.4302-4311.2002</pub-id> <pub-id pub-id-type="pmid">12117939</pub-id></citation></ref>
<ref id="B6"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Blackburn</surname> <given-names>D.</given-names></name> <name><surname>Husband</surname> <given-names>A.</given-names></name> <name><surname>Salda&#x00F1;a</surname> <given-names>Z.</given-names></name> <name><surname>Nada</surname> <given-names>R. A.</given-names></name> <name><surname>Klena</surname> <given-names>J.</given-names></name> <name><surname>Qadri</surname> <given-names>F.</given-names></name><etal/></person-group> (<year>2009</year>). <article-title>Distribution of the <italic>Escherichia coli</italic> common pilus among diverse strains of human enterotoxigenic <italic>E. coli</italic>.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>47</volume> <fpage>1781</fpage>&#x2013;<lpage>1784</lpage>. <pub-id pub-id-type="doi">10.1128/JCM.00260-09</pub-id> <pub-id pub-id-type="pmid">19357209</pub-id></citation></ref>
<ref id="B7"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Boisen</surname> <given-names>N.</given-names></name> <name><surname>Struve</surname> <given-names>C.</given-names></name> <name><surname>Scheutz</surname> <given-names>F.</given-names></name> <name><surname>Krogfelt</surname> <given-names>K. A.</given-names></name> <name><surname>Nataro</surname> <given-names>J. P.</given-names></name></person-group> (<year>2008</year>). <article-title>New adhesin of enteroaggregative <italic>Escherichia coli</italic> related to the AFA/Dr/AAF family.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>76</volume> <fpage>3281</fpage>&#x2013;<lpage>3292</lpage>. <pub-id pub-id-type="doi">10.1128/IAI.01646-07</pub-id> <pub-id pub-id-type="pmid">18443096</pub-id></citation></ref>
<ref id="B8"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Brunder</surname> <given-names>W.</given-names></name> <name><surname>Khan</surname> <given-names>A. S.</given-names></name> <name><surname>Hacker</surname> <given-names>J.</given-names></name> <name><surname>Karch</surname> <given-names>H.</given-names></name></person-group> (<year>2001</year>). <article-title>Novel type of fimbriae encoded by the large plasmid of sorbitol-fermenting enterohemorrhagic <italic>Escherichia coli</italic> O157:H(-).</article-title> <source><italic>Infect. Immun.</italic></source> <volume>69</volume> <fpage>4447</fpage>&#x2013;<lpage>4457</lpage>. <pub-id pub-id-type="doi">10.1128/IAI.69.7.4447-4457.2001</pub-id> <pub-id pub-id-type="pmid">11401985</pub-id></citation></ref>
<ref id="B9"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bueris</surname> <given-names>V.</given-names></name> <name><surname>Sircili</surname> <given-names>M. P.</given-names></name> <name><surname>Taddei</surname> <given-names>C. R.</given-names></name> <name><surname>dos Santos</surname> <given-names>M. F.</given-names></name> <name><surname>Franzolin</surname> <given-names>M. R.</given-names></name> <name><surname>Martinez</surname> <given-names>M. B.</given-names></name><etal/></person-group> (<year>2007</year>). <article-title>Detection of diarrheagenic <italic>Escherichia coli</italic> from children with and without diarrhea in Salvador, Bahia, Brazil.</article-title> <source><italic>Mem. Inst. Oswaldo Cruz</italic></source> <volume>102</volume> <fpage>839</fpage>&#x2013;<lpage>844</lpage>. <pub-id pub-id-type="doi">10.1590/S0074-02762007005000116</pub-id> <pub-id pub-id-type="pmid">17992362</pub-id></citation></ref>
<ref id="B10"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Czeczulin</surname> <given-names>J. R.</given-names></name> <name><surname>Balepur</surname> <given-names>S.</given-names></name> <name><surname>Hicks</surname> <given-names>S.</given-names></name> <name><surname>Phillips</surname> <given-names>A.</given-names></name> <name><surname>Hall</surname> <given-names>R.</given-names></name> <name><surname>Kothary</surname> <given-names>M. H.</given-names></name><etal/></person-group> (<year>1997</year>). <article-title>Aggregative adherence fimbria II, a second fimbrial antigen mediating aggregative adherence in enteroaggregative <italic>Escherichia coli</italic>.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>65</volume> <fpage>4135</fpage>&#x2013;<lpage>4145</lpage>. <pub-id pub-id-type="pmid">9317019</pub-id></citation></ref>
<ref id="B11"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Doughty</surname> <given-names>S.</given-names></name> <name><surname>Sloan</surname> <given-names>J.</given-names></name> <name><surname>Bennett-Wood</surname> <given-names>V.</given-names></name> <name><surname>Robertson</surname> <given-names>M.</given-names></name> <name><surname>Robins-Browne</surname> <given-names>R. M.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name></person-group> (<year>2002</year>). <article-title>Identification of a novel fimbrial gene cluster related to long polar fimbriae in locus of enterocyte effacement-negative strains of enterohemorrhagic <italic>Escherichia coli</italic>.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>70</volume> <fpage>6761</fpage>&#x2013;<lpage>6769</lpage>. <pub-id pub-id-type="doi">10.1128/IAI.70.12.6761-6769.2002</pub-id> <pub-id pub-id-type="pmid">12438351</pub-id></citation></ref>
<ref id="B12"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gir&#x00F3;n</surname> <given-names>J. A.</given-names></name> <name><surname>Ho</surname> <given-names>A. S.</given-names></name> <name><surname>Schoolnik</surname> <given-names>G. K.</given-names></name></person-group> (<year>1991</year>). <article-title>An inducible bundle-forming pilus of enteropathogenic <italic>Escherichia coli</italic>.</article-title> <source><italic>Science</italic></source> <volume>254</volume> <fpage>710</fpage>&#x2013;<lpage>713</lpage>. <pub-id pub-id-type="doi">10.1126/science.1683004</pub-id> <pub-id pub-id-type="pmid">1683004</pub-id></citation></ref>
<ref id="B13"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gir&#x00F3;n</surname> <given-names>J. A.</given-names></name> <name><surname>Torres</surname> <given-names>A. G.</given-names></name> <name><surname>Freer</surname> <given-names>E.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name></person-group> (<year>2002</year>). <article-title>The flagella of enteropathogenic <italic>Escherichia coli</italic> mediate adherence to epithelial cells.</article-title> <source><italic>Mol. Microbiol.</italic></source> <volume>44</volume> <fpage>361</fpage>&#x2013;<lpage>379</lpage>. <pub-id pub-id-type="doi">10.1046/j.1365-2958.2002.02899.x</pub-id> <pub-id pub-id-type="pmid">11972776</pub-id></citation></ref>
<ref id="B14"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Giuliodori</surname> <given-names>A. M.</given-names></name> <name><surname>Di Pietro</surname> <given-names>F.</given-names></name> <name><surname>Marzi</surname> <given-names>S.</given-names></name> <name><surname>Masquida</surname> <given-names>B.</given-names></name> <name><surname>Wagner</surname> <given-names>R.</given-names></name> <name><surname>Romby</surname> <given-names>P.</given-names></name><etal/></person-group> (<year>2010</year>). <article-title>The CspA mRNA is a thermosensor that modulates translation of the cold-shock protein CspA.</article-title> <source><italic>Mol. Cell</italic></source> <volume>37</volume> <fpage>21</fpage>&#x2013;<lpage>33</lpage>. <pub-id pub-id-type="doi">10.1016/j.molcel.2009.11.033</pub-id> <pub-id pub-id-type="pmid">20129052</pub-id></citation></ref>
<ref id="B15"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gomes</surname> <given-names>T. A.</given-names></name> <name><surname>Elias</surname> <given-names>W. P.</given-names></name> <name><surname>Scaletsky</surname> <given-names>I. C.</given-names></name> <name><surname>Guth</surname> <given-names>B. E.</given-names></name> <name><surname>Rodrigues</surname> <given-names>J. F.</given-names></name> <name><surname>Piazza</surname> <given-names>R. M.</given-names></name><etal/></person-group> (<year>2016</year>). <article-title>Diarrheagenic <italic>Escherichia coli</italic>.</article-title> <source><italic>Braz. J. Microbiol.</italic></source> <volume>47(Suppl. 1)</volume> <fpage>3</fpage>&#x2013;<lpage>30</lpage>. <pub-id pub-id-type="doi">10.1016/j.bjm.2016.10.015</pub-id> <pub-id pub-id-type="pmid">27866935</pub-id></citation></ref>
<ref id="B16"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gomes</surname> <given-names>T. A.</given-names></name> <name><surname>Hernandes</surname> <given-names>R. T.</given-names></name> <name><surname>Torres</surname> <given-names>A. G.</given-names></name> <name><surname>Salvador</surname> <given-names>F. A.</given-names></name> <name><surname>Guth</surname> <given-names>B. E.</given-names></name> <name><surname>Vaz</surname> <given-names>T. M.</given-names></name><etal/></person-group> (<year>2011</year>). <article-title>Adhesin-encoding genes from Shiga toxin-producing <italic>Escherichia coli</italic> are more prevalent in atypical than in typical enteropathogenic <italic>E. coli</italic>.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>49</volume> <fpage>3334</fpage>&#x2013;<lpage>3337</lpage>. <pub-id pub-id-type="doi">10.1128/JCM.00779-11</pub-id> <pub-id pub-id-type="pmid">21795517</pub-id></citation></ref>
<ref id="B17"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gomes</surname> <given-names>T. A.</given-names></name> <name><surname>Irino</surname> <given-names>K.</given-names></name> <name><surname>Gir&#x00E3;o</surname> <given-names>D. M.</given-names></name> <name><surname>Gir&#x00E3;o</surname> <given-names>V. B.</given-names></name> <name><surname>Guth</surname> <given-names>B. E.</given-names></name> <name><surname>Vaz</surname> <given-names>T. M.</given-names></name><etal/></person-group> (<year>2004</year>). <article-title>Emerging enteropathogenic <italic>Escherichia coli</italic> strains?</article-title> <source><italic>Emerg. Infect. Dis.</italic></source> <volume>10</volume> <fpage>1851</fpage>&#x2013;<lpage>1855</lpage>. <pub-id pub-id-type="doi">10.3201/eid1010.031093</pub-id> <pub-id pub-id-type="pmid">15504277</pub-id></citation></ref>
<ref id="B18"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gruber</surname> <given-names>C. C.</given-names></name> <name><surname>Sperandio</surname> <given-names>V.</given-names></name></person-group> (<year>2015</year>). <article-title>Global analysis of posttranscriptional regulation by GlmY and GlmZ in enterohemorrhagic <italic>Escherichia coli</italic> O157:H7.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>83</volume> <fpage>1286</fpage>&#x2013;<lpage>1295</lpage>. <pub-id pub-id-type="doi">10.1128/IAI.02918-14</pub-id> <pub-id pub-id-type="pmid">25605763</pub-id></citation></ref>
<ref id="B19"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hernandes</surname> <given-names>R. T.</given-names></name> <name><surname>Elias</surname> <given-names>W. P.</given-names></name> <name><surname>Vieira</surname> <given-names>M. A.</given-names></name> <name><surname>Gomes</surname> <given-names>T. A.</given-names></name></person-group> (<year>2009</year>). <article-title>An overview of atypical enteropathogenic <italic>Escherichia coli</italic>.</article-title> <source><italic>FEMS Microbiol. Lett.</italic></source> <volume>297</volume> <fpage>137</fpage>&#x2013;<lpage>149</lpage>. <pub-id pub-id-type="doi">10.1111/j.1574-6968.2009.01664.x</pub-id> <pub-id pub-id-type="pmid">19527295</pub-id></citation></ref>
<ref id="B20"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hernandes</surname> <given-names>R. T.</given-names></name> <name><surname>Velsko</surname> <given-names>I.</given-names></name> <name><surname>Sampaio</surname> <given-names>S. C.</given-names></name> <name><surname>Elias</surname> <given-names>W. P.</given-names></name> <name><surname>Robins-Browne</surname> <given-names>R. M.</given-names></name> <name><surname>Gomes</surname> <given-names>T. A.</given-names></name><etal/></person-group> (<year>2011</year>). <article-title>Fimbrial adhesins produced by atypical enteropathogenic <italic>Escherichia coli</italic> strains.</article-title> <source><italic>Appl. Environ. Microbiol.</italic></source> <volume>77</volume> <fpage>8391</fpage>&#x2013;<lpage>8399</lpage>. <pub-id pub-id-type="doi">10.1128/AEM.05376-11</pub-id> <pub-id pub-id-type="pmid">21926222</pub-id></citation></ref>
<ref id="B21"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hernandes</surname> <given-names>R. T.</given-names></name> <name><surname>Vieira</surname> <given-names>M. A.</given-names></name> <name><surname>Carneiro</surname> <given-names>S. M.</given-names></name> <name><surname>Salvador</surname> <given-names>F. A.</given-names></name> <name><surname>Gomes</surname> <given-names>T. A.</given-names></name></person-group> (<year>2006</year>). <article-title>Characterization of atypical enteropathogenic <italic>Escherichia coli</italic> strains that express typical localized adherence in HeLa cells in the absence of the bundle-forming pilus.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>44</volume> <fpage>4214</fpage>&#x2013;<lpage>4217</lpage>. <pub-id pub-id-type="doi">10.1128/JCM.01022-06</pub-id> <pub-id pub-id-type="pmid">16957035</pub-id></citation></ref>
<ref id="B22"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hu</surname> <given-names>J.</given-names></name> <name><surname>Torres</surname> <given-names>A. G.</given-names></name></person-group> (<year>2015</year>). <article-title>Enteropathogenic <italic>Escherichia coli</italic>: foe or innocent bystander?</article-title> <source><italic>Clin. Microbiol. Infect.</italic></source> <volume>21</volume> <fpage>729</fpage>&#x2013;<lpage>734</lpage>. <pub-id pub-id-type="doi">10.1016/j.cmi.2015.01.015</pub-id> <pub-id pub-id-type="pmid">25726041</pub-id></citation></ref>
<ref id="B23"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Jerse</surname> <given-names>A. E.</given-names></name> <name><surname>Yu</surname> <given-names>J.</given-names></name> <name><surname>Tall</surname> <given-names>B. D.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name></person-group> (<year>1990</year>). <article-title>A genetic locus of enteropathogenic <italic>Escherichia coli</italic> necessary for the production of attaching and effacing lesions on tissue culture cells.</article-title> <source><italic>Proc. Natl. Acad. Sci. U.S.A.</italic></source> <volume>87</volume> <fpage>7839</fpage>&#x2013;<lpage>7843</lpage>. <pub-id pub-id-type="doi">10.1073/pnas.87.20.7839</pub-id> <pub-id pub-id-type="pmid">2172966</pub-id></citation></ref>
<ref id="B24"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Jonson</surname> <given-names>A. B.</given-names></name> <name><surname>Normark</surname> <given-names>S.</given-names></name> <name><surname>Rhen</surname> <given-names>M.</given-names></name></person-group> (<year>2005</year>). <article-title>Fimbriae, pili, flagella and bacterial virulence.</article-title> <source><italic>Contrib. Microbiol.</italic></source> <volume>12</volume> <fpage>67</fpage>&#x2013;<lpage>89</lpage>. <pub-id pub-id-type="doi">10.1159/000081690</pub-id> <pub-id pub-id-type="pmid">15496777</pub-id></citation></ref>
<ref id="B25"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>J&#x00F8;nsson</surname> <given-names>R.</given-names></name> <name><surname>Struve</surname> <given-names>C.</given-names></name> <name><surname>Boisen</surname> <given-names>N.</given-names></name> <name><surname>Mateiu</surname> <given-names>R. V.</given-names></name> <name><surname>Santiago</surname> <given-names>A. E.</given-names></name> <name><surname>Jenssen</surname> <given-names>H.</given-names></name><etal/></person-group> (<year>2015</year>). <article-title>Novel aggregative adherence fimbria variant of enteroaggregative <italic>Escherichia coli</italic>.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>83</volume> <fpage>1396</fpage>&#x2013;<lpage>1405</lpage>. <pub-id pub-id-type="doi">10.1128/IAI.02820-14</pub-id> <pub-id pub-id-type="pmid">25624357</pub-id></citation></ref>
<ref id="B26"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kenny</surname> <given-names>B.</given-names></name> <name><surname>DeVinney</surname> <given-names>R.</given-names></name> <name><surname>Stein</surname> <given-names>M.</given-names></name> <name><surname>Reinscheid</surname> <given-names>D. J.</given-names></name> <name><surname>Frey</surname> <given-names>E. A.</given-names></name> <name><surname>Finlay</surname> <given-names>B. B.</given-names></name></person-group> (<year>1997</year>). <article-title>Enteropathogenic <italic>E. coli</italic> (EPEC) transfers its receptor for intimate adherence into mammalian cells.</article-title> <source><italic>Cell</italic></source> <volume>91</volume> <fpage>511</fpage>&#x2013;<lpage>520</lpage>. <pub-id pub-id-type="doi">10.1016/S0092-8674(00)80437-7</pub-id> <pub-id pub-id-type="pmid">9390560</pub-id></citation></ref>
<ref id="B27"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lehti</surname> <given-names>T. A.</given-names></name> <name><surname>Bauchart</surname> <given-names>P.</given-names></name> <name><surname>Kukkonen</surname> <given-names>M.</given-names></name> <name><surname>Dobrindt</surname> <given-names>U.</given-names></name> <name><surname>Korhonen</surname> <given-names>T. K.</given-names></name> <name><surname>Westerlund-Wikstr&#x00F6;m</surname> <given-names>B.</given-names></name></person-group> (<year>2013</year>). <article-title>Phylogenetic group-associated differences in regulation of the common colonization factor Mat fimbria in <italic>Escherichia coli</italic>.</article-title> <source><italic>Mol. Microbiol.</italic></source> <volume>87</volume> <fpage>1200</fpage>&#x2013;<lpage>1222</lpage>. <pub-id pub-id-type="doi">10.1111/mmi.12161</pub-id> <pub-id pub-id-type="pmid">23347101</pub-id></citation></ref>
<ref id="B28"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Levine</surname> <given-names>M. M.</given-names></name> <name><surname>Nataro</surname> <given-names>J. P.</given-names></name> <name><surname>Karch</surname> <given-names>H.</given-names></name> <name><surname>Baldini</surname> <given-names>M. M.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name> <name><surname>Black</surname> <given-names>R. E.</given-names></name><etal/></person-group> (<year>1985</year>). <article-title>The diarrheal response of humans to some classic serotypes of enteropathogenic <italic>Escherichia coli</italic> is dependent on a plasmid encoding an enteroadhesiveness factor.</article-title> <source><italic>Infect. Dis.</italic></source> <volume>152</volume> <fpage>550</fpage>&#x2013;<lpage>559</lpage>. <pub-id pub-id-type="doi">10.1093/infdis/152.3.550</pub-id> <pub-id pub-id-type="pmid">2863318</pub-id></citation></ref>
<ref id="B29"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Nara</surname> <given-names>J. M.</given-names></name> <name><surname>Cianciarullo</surname> <given-names>A. M.</given-names></name> <name><surname>Culler</surname> <given-names>H. F.</given-names></name> <name><surname>Bueris</surname> <given-names>V.</given-names></name> <name><surname>Horton</surname> <given-names>D. S.</given-names></name> <name><surname>Menezes</surname> <given-names>M. A.</given-names></name><etal/></person-group> (<year>2010</year>). <article-title>Differentiation of typical and atypical enteropathogenic <italic>Escherichia coli</italic> using colony immunoblot for detection of bundle-forming pilus expression.</article-title> <source><italic>J. Appl. Microbiol.</italic></source> <volume>109</volume> <fpage>35</fpage>&#x2013;<lpage>43</lpage>. <pub-id pub-id-type="doi">10.1111/j.1365-2672.2009.04625.x</pub-id> <pub-id pub-id-type="pmid">19968733</pub-id></citation></ref>
<ref id="B30"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Nascimento</surname> <given-names>H. H.</given-names></name> <name><surname>Silva</surname> <given-names>L. E.</given-names></name> <name><surname>Souza</surname> <given-names>R. T.</given-names></name> <name><surname>Silva</surname> <given-names>N. P.</given-names></name> <name><surname>Scaletsky</surname> <given-names>I. C.</given-names></name></person-group> (<year>2014</year>). <article-title>Phenotypic and genotypic characteristics associated with biofilm formation in clinical isolates of atypical enteropathogenic <italic>Escherichia coli</italic> (aEPEC) strains.</article-title> <source><italic>BMC Microbiol.</italic></source> <volume>14</volume>:<issue>184</issue>. <pub-id pub-id-type="doi">10.1186/1471-2180-14-184</pub-id> <pub-id pub-id-type="pmid">25012525</pub-id></citation></ref>
<ref id="B31"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Nataro</surname> <given-names>J. P.</given-names></name> <name><surname>Deng</surname> <given-names>Y.</given-names></name> <name><surname>Maneval</surname> <given-names>D. R.</given-names></name> <name><surname>German</surname> <given-names>A. L.</given-names></name> <name><surname>Martin</surname> <given-names>W. C.</given-names></name> <name><surname>Levine</surname> <given-names>M. M.</given-names></name></person-group> (<year>1992</year>). <article-title>Aggregative adherence fimbriae I of enteroaggregative <italic>Escherichia coli</italic> mediate adherence to HEp-2 cells and hemagglutination of human erythrocytes.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>60</volume> <fpage>2297</fpage>&#x2013;<lpage>2304</lpage>. <pub-id pub-id-type="pmid">1350273</pub-id></citation></ref>
<ref id="B32"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ofek</surname> <given-names>I.</given-names></name> <name><surname>Hasty</surname> <given-names>D. L.</given-names></name> <name><surname>Doyle</surname> <given-names>R. J.</given-names></name></person-group> (<year>2003</year>). <source><italic>Bacterial Adhesion to Animal Cells and Tissues.</italic></source> <publisher-loc>Washington, DC</publisher-loc>: <publisher-name>American Society for Microbiology Press</publisher-name>. <pub-id pub-id-type="doi">10.1128/9781555817800</pub-id></citation></ref>
<ref id="B33"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Piazza</surname> <given-names>R. M.</given-names></name> <name><surname>Delannoy</surname> <given-names>S.</given-names></name> <name><surname>Fach</surname> <given-names>P.</given-names></name> <name><surname>Saridakis</surname> <given-names>H. O.</given-names></name> <name><surname>Pedroso</surname> <given-names>M. Z.</given-names></name> <name><surname>Rocha</surname> <given-names>L. B.</given-names></name><etal/></person-group> (<year>2013</year>). <article-title>Molecular and phenotypic characterization of <italic>Escherichia coli</italic> O26:H8 among diarrheagenic <italic>E. coli</italic> O26 strains isolated in Brazil.</article-title> <source><italic>Appl. Environ. Microbiol.</italic></source> <volume>79</volume> <fpage>6847</fpage>&#x2013;<lpage>6854</lpage>. <pub-id pub-id-type="doi">10.1128/AEM.01693-13</pub-id> <pub-id pub-id-type="pmid">23974139</pub-id></citation></ref>
<ref id="B34"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Pouttu</surname> <given-names>R.</given-names></name> <name><surname>Westerlund-Wikstr&#x00F6;m</surname> <given-names>B.</given-names></name> <name><surname>L&#x00E5;ng</surname> <given-names>H.</given-names></name> <name><surname>Alsti</surname> <given-names>K.</given-names></name> <name><surname>Virkola</surname> <given-names>R.</given-names></name> <name><surname>Saarela</surname> <given-names>U.</given-names></name><etal/></person-group> (<year>2001</year>). <article-title>matB, a common fimbrillin gene of <italic>Escherichia coli</italic>, expressed in a genetically conserved, virulent clonal group.</article-title> <source><italic>J. Bacteriol.</italic></source> <volume>183</volume> <fpage>4727</fpage>&#x2013;<lpage>4736</lpage>. <pub-id pub-id-type="doi">10.1128/JB.183.16.4727-4736.2001</pub-id> <pub-id pub-id-type="pmid">11466275</pub-id></citation></ref>
<ref id="B35"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Qadri</surname> <given-names>F.</given-names></name> <name><surname>Svennerholm</surname> <given-names>A. M.</given-names></name> <name><surname>Faruque</surname> <given-names>A. S.</given-names></name> <name><surname>Sack</surname> <given-names>R. B.</given-names></name></person-group> (<year>2005</year>). <article-title>Enterotoxigenic <italic>Escherichia coli</italic> in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention.</article-title> <source><italic>Clin. Microbiol. Rev.</italic></source> <volume>18</volume> <fpage>465</fpage>&#x2013;<lpage>483</lpage>. <pub-id pub-id-type="doi">10.1128/CMR.18.3.465-483.2005</pub-id> <pub-id pub-id-type="pmid">16020685</pub-id></citation></ref>
<ref id="B36"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rend&#x00F3;n</surname> <given-names>M. A.</given-names></name> <name><surname>Salda&#x00F1;a</surname> <given-names>Z.</given-names></name> <name><surname>Erdem</surname> <given-names>A. L.</given-names></name> <name><surname>Monteiro-Neto</surname> <given-names>V.</given-names></name> <name><surname>V&#x00E1;zquez</surname> <given-names>A.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name><etal/></person-group> (<year>2007</year>). <article-title>Commensal and pathogenic <italic>Escherichia coli</italic> use a common pilus adherence factor for epithelial cell colonization.</article-title> <source><italic>Proc. Natl. Acad. Sci. U.S.A.</italic></source> <volume>104</volume> <fpage>10637</fpage>&#x2013;<lpage>10642</lpage>. <pub-id pub-id-type="doi">10.1073/pnas.0704104104</pub-id> <pub-id pub-id-type="pmid">17563352</pub-id></citation></ref>
<ref id="B37"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rodrigues</surname> <given-names>J.</given-names></name> <name><surname>Scaletsky</surname> <given-names>I. C.</given-names></name> <name><surname>Campos</surname> <given-names>L. C.</given-names></name> <name><surname>Gomes</surname> <given-names>T. A.</given-names></name> <name><surname>Whittam</surname> <given-names>T. S.</given-names></name> <name><surname>Trabulsi</surname> <given-names>L. R.</given-names></name></person-group> (<year>1996</year>). <article-title>Clonal structure and virulence factors in strains of <italic>Escherichia coli</italic> of the classic serogroup O55.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>64</volume> <fpage>2680</fpage>&#x2013;<lpage>2686</lpage>. <pub-id pub-id-type="pmid">8698495</pub-id></citation></ref>
<ref id="B38"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ross</surname> <given-names>B. N.</given-names></name> <name><surname>Rojas-Lopez</surname> <given-names>M.</given-names></name> <name><surname>Cieza</surname> <given-names>R. J.</given-names></name> <name><surname>McWilliams</surname> <given-names>B. D.</given-names></name> <name><surname>Torres</surname> <given-names>A. G.</given-names></name></person-group> (<year>2015</year>). <article-title>The role of long polar fimbriae in <italic>Escherichia coli</italic> O104:H4 adhesion and colonization.</article-title> <source><italic>PLoS One</italic></source> <volume>10</volume>:<issue>e141845</issue>. <pub-id pub-id-type="doi">10.1371/journal.pone.0141845</pub-id> <pub-id pub-id-type="pmid">26517878</pub-id></citation></ref>
<ref id="B39"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Salda&#x00F1;a</surname> <given-names>Z.</given-names></name> <name><surname>De la Cruz</surname> <given-names>M. A.</given-names></name> <name><surname>Carrillo-Casas</surname> <given-names>E. M.</given-names></name> <name><surname>Dur&#x00E1;n</surname> <given-names>L.</given-names></name> <name><surname>Zhang</surname> <given-names>Y.</given-names></name> <name><surname>Hern&#x00E1;ndez-Castro</surname> <given-names>R.</given-names></name><etal/></person-group> (<year>2014</year>). <article-title>Production of the <italic>Escherichia coli</italic> common pilus by uropathogenic <italic>E. coli</italic> is associated with adherence to HeLa and HTB-4 cells and invasion of mouse bladder urothelium.</article-title> <source><italic>PLoS One</italic></source> <volume>9</volume>:<issue>e101200</issue>. <pub-id pub-id-type="doi">10.1371/journal.pone.0101200</pub-id> <pub-id pub-id-type="pmid">25036370</pub-id></citation></ref>
<ref id="B40"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Salda&#x00F1;a</surname> <given-names>Z.</given-names></name> <name><surname>Erdem</surname> <given-names>A. L.</given-names></name> <name><surname>Sch&#x00FC;ller</surname> <given-names>S.</given-names></name> <name><surname>Okeke</surname> <given-names>I. N.</given-names></name> <name><surname>Lucas</surname> <given-names>M.</given-names></name> <name><surname>Sivananthan</surname> <given-names>A.</given-names></name><etal/></person-group> (<year>2009a</year>). <article-title>The <italic>Escherichia coli</italic> common pilus and the bundle-forming pilus act in concert during the formation of localized adherence by enteropathogenic <italic>E. coli</italic>.</article-title> <source><italic>J. Bacteriol.</italic></source> <volume>191</volume> <fpage>3451</fpage>&#x2013;<lpage>3461</lpage>. <pub-id pub-id-type="doi">10.1128/JB.01539-08</pub-id> <pub-id pub-id-type="pmid">19218393</pub-id></citation></ref>
<ref id="B41"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Salda&#x00F1;a</surname> <given-names>Z.</given-names></name> <name><surname>Xicohtencatl-Cortes</surname> <given-names>J.</given-names></name> <name><surname>Avelino</surname> <given-names>F.</given-names></name> <name><surname>Phillips</surname> <given-names>A. D.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name> <name><surname>Puente</surname> <given-names>J. L.</given-names></name><etal/></person-group> (<year>2009b</year>). <article-title>Synergistic role of curli and cellulose in cell adherence and biofilm formation of attaching and effacing <italic>Escherichia coli</italic> and identification of Fis as a negative regulator of curli.</article-title> <source><italic>Environ. Microbiol.</italic></source> <volume>11</volume> <fpage>992</fpage>&#x2013;<lpage>1006</lpage>. <pub-id pub-id-type="doi">10.1111/j.1462-2920.2008.01824.x</pub-id> <pub-id pub-id-type="pmid">19187284</pub-id></citation></ref>
<ref id="B42"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Samadder</surname> <given-names>P.</given-names></name> <name><surname>Xicohtencatl-Cortes</surname> <given-names>J.</given-names></name> <name><surname>Salda&#x00F1;a</surname> <given-names>Z.</given-names></name> <name><surname>Jordan</surname> <given-names>D.</given-names></name> <name><surname>Tarr</surname> <given-names>P. I.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name><etal/></person-group> (<year>2009</year>). <article-title>The <italic>Escherichia coli</italic> ycbQRST operon encodes fimbriae with laminin-binding and epithelial cell adherence properties in Shiga-toxigenic <italic>E. coli</italic> O157:H7.</article-title> <source><italic>Environ. Microbiol.</italic></source> <volume>11</volume> <fpage>1815</fpage>&#x2013;<lpage>1826</lpage>. <pub-id pub-id-type="doi">10.1111/j.1462-2920.2009.01906.x</pub-id> <pub-id pub-id-type="pmid">19508558</pub-id></citation></ref>
<ref id="B43"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Scaletsky</surname> <given-names>I. C.</given-names></name> <name><surname>Aranda</surname> <given-names>K. R.</given-names></name> <name><surname>Souza</surname> <given-names>T. B.</given-names></name> <name><surname>Silva</surname> <given-names>N. P.</given-names></name></person-group> (<year>2010</year>). <article-title>Adherence factors in atypical enteropathogenic <italic>Escherichia coli</italic> strains expressing the localized adherence-like pattern in HEp-2 cells.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>48</volume> <fpage>302</fpage>&#x2013;<lpage>306</lpage>. <pub-id pub-id-type="doi">10.1128/JCM.01980-09</pub-id> <pub-id pub-id-type="pmid">19864474</pub-id></citation></ref>
<ref id="B44"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Scaletsky</surname> <given-names>I. C.</given-names></name> <name><surname>Aranda</surname> <given-names>K. R.</given-names></name> <name><surname>Souza</surname> <given-names>T. B.</given-names></name> <name><surname>Silva</surname> <given-names>N. P.</given-names></name> <name><surname>Morais</surname> <given-names>M. B.</given-names></name></person-group> (<year>2009</year>). <article-title>Evidence of pathogenic subgroups among atypical enteropathogenic <italic>Escherichia coli</italic> strains.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>47</volume> <fpage>3756</fpage>&#x2013;<lpage>3759</lpage>. <pub-id pub-id-type="doi">10.1128/JCM.01599-09</pub-id> <pub-id pub-id-type="pmid">19759223</pub-id></citation></ref>
<ref id="B45"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Scaletsky</surname> <given-names>I. C.</given-names></name> <name><surname>Pedroso</surname> <given-names>M. Z.</given-names></name> <name><surname>Oliva</surname> <given-names>C. A.</given-names></name> <name><surname>Carvalho</surname> <given-names>R. L.</given-names></name> <name><surname>Morais</surname> <given-names>M. B.</given-names></name> <name><surname>Fagundes-Neto</surname> <given-names>U.</given-names></name></person-group> (<year>1999</year>). <article-title>A localized adherence-like pattern as a second pattern of adherence of classic enteropathogenic <italic>Escherichia coli</italic> to HEp-2 cells that is associated with infantile diarrhea.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>67</volume> <fpage>3410</fpage>&#x2013;<lpage>3415</lpage>. <pub-id pub-id-type="pmid">10377120</pub-id></citation></ref>
<ref id="B46"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Scaletsky</surname> <given-names>I. C.</given-names></name> <name><surname>Silva</surname> <given-names>M. L.</given-names></name> <name><surname>Trabulsi</surname> <given-names>L. R.</given-names></name></person-group> (<year>1984</year>). <article-title>Distinctive patterns of adherence of enteropathogenic <italic>Escherichia coli</italic> to HeLa cells.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>45</volume> <fpage>534</fpage>&#x2013;<lpage>536</lpage>. <pub-id pub-id-type="pmid">6146569</pub-id></citation></ref>
<ref id="B47"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Stacy</surname> <given-names>A. K.</given-names></name> <name><surname>Mitchell</surname> <given-names>N. M.</given-names></name> <name><surname>Maddux</surname> <given-names>J. T.</given-names></name> <name><surname>De la Cruz</surname> <given-names>M. A.</given-names></name> <name><surname>Dur&#x00E1;n</surname> <given-names>L.</given-names></name> <name><surname>Gir&#x00F3;n</surname> <given-names>J. A.</given-names></name><etal/></person-group> (<year>2014</year>). <article-title>Evaluation of the prevalence and production of <italic>Escherichia coli</italic> common pilus among avian pathogenic <italic>E. coli</italic> and its role in virulence.</article-title> <source><italic>PLoS One</italic></source> <volume>9</volume>:<issue>e86565</issue>. <pub-id pub-id-type="doi">10.1371/journal.pone.0086565</pub-id> <pub-id pub-id-type="pmid">24466152</pub-id></citation></ref>
<ref id="B48"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Tennant</surname> <given-names>S. M.</given-names></name> <name><surname>Tauschek</surname> <given-names>M.</given-names></name> <name><surname>Azzopardi</surname> <given-names>K.</given-names></name> <name><surname>Bigham</surname> <given-names>A.</given-names></name> <name><surname>Bennett-Wood</surname> <given-names>V.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name><etal/></person-group> (<year>2009</year>). <article-title>Characterisation of atypical enteropathogenic <italic>E. coli</italic> strains of clinical origin.</article-title> <source><italic>BMC Microbiol.</italic></source> <volume>9</volume>:<issue>117</issue>. <pub-id pub-id-type="doi">10.1186/1471-2180-9-117</pub-id> <pub-id pub-id-type="pmid">19490652</pub-id></citation></ref>
<ref id="B49"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Tobe</surname> <given-names>T.</given-names></name> <name><surname>Sasakawa</surname> <given-names>C.</given-names></name></person-group> (<year>2001</year>). <article-title>Role of bundle-forming pilus of enteropathogenic <italic>Escherichia coli</italic> in host cell adherence and in microcolony development.</article-title> <source><italic>Cell. Microbiol.</italic></source> <volume>3</volume> <fpage>579</fpage>&#x2013;<lpage>585</lpage>. <pub-id pub-id-type="doi">10.1046/j.1462-5822.2001.00136.x</pub-id> <pub-id pub-id-type="pmid">11553010</pub-id></citation></ref>
<ref id="B50"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Torres</surname> <given-names>A. G.</given-names></name> <name><surname>Gir&#x00F3;n</surname> <given-names>J. A.</given-names></name> <name><surname>Perna</surname> <given-names>N. T.</given-names></name> <name><surname>Burland</surname> <given-names>V.</given-names></name> <name><surname>Blattner</surname> <given-names>F. R.</given-names></name> <name><surname>Avelino-Flores</surname> <given-names>F.</given-names></name><etal/></person-group> (<year>2002</year>). <article-title>Identification and characterization of lpfABCC&#x2019;DE, a fimbrial operon of enterohemorrhagic <italic>Escherichia coli</italic> O157:H7.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>70</volume> <fpage>5416</fpage>&#x2013;<lpage>5427</lpage>. <pub-id pub-id-type="doi">10.1128/IAI.70.10.5416-5427.2002</pub-id></citation></ref>
<ref id="B51"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Torres</surname> <given-names>A. G.</given-names></name> <name><surname>Kanack</surname> <given-names>K. J.</given-names></name> <name><surname>Tutt</surname> <given-names>C. B.</given-names></name> <name><surname>Popov</surname> <given-names>V.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name></person-group> (<year>2004</year>). <article-title>Characterization of the second long polar (LP) fimbriae of <italic>Escherichia coli</italic> O157:H7 and distribution of LP fimbriae in other pathogenic <italic>E. coli</italic> strains.</article-title> <source><italic>FEMS Microbiol. Lett.</italic></source> <volume>238</volume> <fpage>333</fpage>&#x2013;<lpage>344</lpage>. <pub-id pub-id-type="pmid">15358418</pub-id></citation></ref>
<ref id="B52"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Vieira</surname> <given-names>M. A.</given-names></name> <name><surname>Andrade</surname> <given-names>J. R.</given-names></name> <name><surname>Trabulsi</surname> <given-names>L. R.</given-names></name> <name><surname>Rosa</surname> <given-names>A. C.</given-names></name> <name><surname>Dias</surname> <given-names>A. M.</given-names></name> <name><surname>Ramos</surname> <given-names>S. R.</given-names></name><etal/></person-group> (<year>2001</year>). <article-title>Phenotypic and genotypic characteristics of <italic>Escherichia coli</italic> strains of non-enteropathogenic <italic>E. coli</italic> (EPEC) serogroups that carry EAE and lack the EPEC adherence factor and Shiga toxin DNA probe sequences.</article-title> <source><italic>J. Infect. Dis.</italic></source> <volume>183</volume> <fpage>762</fpage>&#x2013;<lpage>772</lpage>. <pub-id pub-id-type="doi">10.1086/318821</pub-id> <pub-id pub-id-type="pmid">11181153</pub-id></citation></ref>
<ref id="B53"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Waters</surname> <given-names>L. S.</given-names></name> <name><surname>Storz</surname> <given-names>G.</given-names></name></person-group> (<year>2009</year>). <article-title>Regulatory RNAs in bacteria.</article-title> <source><italic>Cell</italic></source> <volume>136</volume> <fpage>615</fpage>&#x2013;<lpage>628</lpage>. <pub-id pub-id-type="doi">10.1016/j.cell.2009.01.043</pub-id> <pub-id pub-id-type="pmid">19239884</pub-id></citation></ref>
<ref id="B54"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Xicohtencatl-Cortes</surname> <given-names>J.</given-names></name> <name><surname>Monteiro-Neto</surname> <given-names>V.</given-names></name> <name><surname>Ledesma</surname> <given-names>M. A.</given-names></name> <name><surname>Jordan</surname> <given-names>D. M.</given-names></name> <name><surname>Francetic</surname> <given-names>O.</given-names></name> <name><surname>Kaper</surname> <given-names>J. B.</given-names></name><etal/></person-group> (<year>2007</year>). <article-title>Intestinal adherence associated with type IV pili of enterohemorrhagic <italic>Escherichia coli</italic> O157:H7.</article-title> <source><italic>J. Clin. Invest.</italic></source> <volume>117</volume> <fpage>3519</fpage>&#x2013;<lpage>3529</lpage>. <pub-id pub-id-type="doi">10.1172/JCI30727</pub-id> <pub-id pub-id-type="pmid">17948128</pub-id></citation></ref>
<ref id="B55"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Yamamoto</surname> <given-names>D.</given-names></name> <name><surname>Hernandes</surname> <given-names>R. T.</given-names></name> <name><surname>Liberatore</surname> <given-names>A. M.</given-names></name> <name><surname>Abe</surname> <given-names>C. M.</given-names></name> <name><surname>Souza</surname> <given-names>R. B.</given-names></name> <name><surname>Rom&#x00E3;o</surname> <given-names>F. T.</given-names></name><etal/></person-group> (<year>2017</year>). <article-title><italic>Escherichia albertii</italic>, a novel human enteropathogen, colonizes rat enterocytes and translocates to extra-intestinal sites.</article-title> <source><italic>PLoS One</italic></source> <volume>12</volume>:<issue>e0171385</issue>. <pub-id pub-id-type="doi">10.1371/journal.pone.0171385</pub-id> <pub-id pub-id-type="pmid">28178312</pub-id></citation></ref>
</ref-list>
</back>
</article>