Non-toxigenic Vibrio Cholerae O1 Research Articles

Epidemiological Situation on Cholera in the Russian Federation in 2023 and Forecast for 2024

The paper presents an analysis and assessment of risks of complication of epidemiological situation regarding cholera in the Russian Federation and a forecast for 2024. It briefly characterizes the dynamics of the epidemic process around the world during the last decade (2013–2022). The forecast of cholera importation into the Russian Federation, due to activity of the epidemic process in endemic countries, has been confirmed. In 2023, two cases of cholera importation from India were reported. It was established that the toxigenic strains isolated from patients belonged to the currently dominant in the world “post-Haitian” group, including in India and Bangladesh, with the genotype ctxB7 tcpACIRS rtxA4a VSP-IIΔ0495-0512. Furthermore, non-toxigenic Vibrio cholerae O1 strains were isolated from samples of biological material from persons arriving from India, containing preCTX prophage and distinct from the strain (ctxAB– tcpAEТ–) isolated from a patient with acute intestinal infection (Zaporozhye Region, Melitopol). Nontoxigenic NAG vibrios were isolated from 13 patients with acute intestinal infections, which is 1.9 times more than in 2022. Regardless of importations, a strain of V. cholerae O1 (ctxB1+tcpAEТ) of the “pre-Haitian” group was isolated from a water sample of a surface reservoir. 52 non-toxigenic V. сholerae O1 strains were found on the territory of 11 constituent entities of the Russian Federation, which is 18.9 % more than in 2022. In 2024, epidemiological risks of cholera importation from endemic countries to any administrative territory of the Russian Federation remain. The risks of epidemic manifestations of cholera are especially high in the territories of the constituent entities of the Russian Federation which are under ongoing emergency, due to migration processes, and the impact of other risk-forming factors that contribute to an increase in the degree of contact of the population with water bodies contaminated with cholera vibrios. If epidemic foci of cholera are to emerge in a neighboring country, there will be a high probability of spread of this infection in the stated constituent entities of the Russian Federation and in other territories of southern Russia. In the absence of epidemic manifestations of cholera, the possibility of occasional detection of toxigenic O1 serogroup strains in water samples due to unidentified introductions from cholera-affected areas cannot be ruled out.

Comparative Analysis of Molecular-Genetic Properties in Non-Toxigenic Vibrio cholerae O1 Strains Biovar El Tor, Isolated in Russia and on Cholera Endemic Territories

Objective of the study was to perform a comparative analysis of molecular-genetic properties in non-toxigenic Vibrio cholerae O1 strains biovar El Tor, isolated in the Republic of Kalmykia and on cholera endemic territories and to reveal their phylogenetic relations to toxigenic isolates.Materials and methods. We have carried out bio-information analysis of whole genome sequences of 60 cholera vibrio strains from endemic as regards cholera regions and from Kalmykia. The presence of pathogenicity and endemicity islands in their genomes has been determined. Specifed have been the sequence-types of the examined strains and whole genome SNP-analysis conducted.Results and discussion. Non-toxigenic El Tor vibrios circulating in Kalmykia are clustered into two major genotypes: ctxA–tcpA+VPI-2+VSP– and ctxA–tcpA–VPI-2Δ+VSP–, where VPI-2 Δ+ signifes the presence of deletions of varying length in the genome of this pathogenicity island. Only the latter one is found in regions endemic for cholera. In addition, ctxA– tcpA+VPI-2+VSP+ populations circulate in cholera endemic foci, not found in Kalmykia. 17 sequence-types were identifed among the studied strains (by seven housekeeping gene loci). Phylogenetic analysis performed using SNP-typing demonstrated the absence of close genetic relation between the ctxA–tcpA+VPI-2+VSP– vibrios from Kalmykia and both toxigenic and non-toxigenic vibrios with different composition of pathogenicity and pandemicity islands in the genome. At the same time, genetic proximity of ctxA–tcpA–VPI-2Δ+VSP– cholera vibrios from endemic cholera foci with those isolated in Kalmykia was detected, which may indicate the possibility of their recurrent importation into the territory of Russia. Non-toxigenic V. cholerae strains found in the territory of Kalmykia are characterized by a high genetic diversity. Circulation of the strains with unique sequence-types suggests their potential for long-term persistence on this territory. At the same time, phylogenetic closeness and identity of certain strains with strains from endemic territories can be an evidence of repeated importation.

Conversion of a recA-Mediated Non-toxigenic Vibrio cholerae O1 Strain to a Toxigenic Strain Using Chitin-Induced Transformation.

Toxigenic Vibrio cholerae strains, including strains in serogroups O1 and O139 associated with the clinical disease cholera, are ubiquitous in aquatic reservoirs, including fresh, estuarine, and marine environments. Humans acquire cholera by consuming water and/or food contaminated with the microorganism. The genome of toxigenic V. cholerae harbors a cholera-toxin producing prophage (CT-prophage) encoding genes that promote expression of cholera toxin. The CT-prophage in V. cholerae is flanked by two satellite prophages, RS1 and TLC. Using cell surface appendages (TCP and/or MSHA pili), V. cholerae can sequentially acquire TLC, RS1, and CTX phages by transduction; the genome of each of these phages ultimately integrates into V. cholerae’s genome in a site-specific manner. Here, we showed that a non-toxigenic V. cholerae O1 biotype El Tor strain, lacking the entire RS1-CTX-TLC prophage complex (designated as RCT: R for RS1, C for CTX and T for TLC prophage, respectively), was able to acquire RCT from donor genomic DNA (gDNA) of a wild-type V. cholerae strain (E7946) via chitin-induced transformation. Moreover, we demonstrated that a chitin-induced transformant (designated as AAS111) harboring RCT was capable of producing cholera toxin. We also showed that recA, rather than xerC and xerD recombinases, promoted the acquisition of RCT from donor gDNA by the recipient non-toxigenic V. cholerae strain. Our data document the existence of an alternative pathway by which a non-toxigenic V. cholerae O1 strain can transform to a toxigenic strain by using chitin induction. As chitin is an abundant natural carbon source in aquatic reservoirs where V. cholerae is present, chitin-induced transformation may be an important driver in the emergence of new toxigenic V. cholerae strains.

Genomic Diversity of Nontoxigenic Vibrio cholerae O1 Strains Isolated in the Territory of Russia and Neighboring States

Apart from strains of Vibrio cholerae biovar El Tor imported from cholera-endemic regions, causing outbreaks or sporadic cases of cholera, a significant number of different variants of nontoxigenic strains that can induce acute enteric infections are annually isolated from surface water bodies and human beings in the Russian Federation. We have carried out analysis of whole genomes that we sequenced (29) and obtained from the GenBank database (11), of 40 toxigenic and nontoxigenic strains isolated in cholera nonendemic (Russia, Ukraine, Turkmenistan, Georgia) and endemic (India, Bangladesh, Vietnam, and others) territories. It is established that they fall into three main groups which differ in the composition of mobile elements with pathogenicity and epidemicity genes, both from toxigenic isolates and among themselves. Nontoxigenic strains of the first group are deprived of all intact virulence prophages (CTXφ, RS1φ, TLCφ), pathogenicity (VPI-1, VPI-2) and pandemicity (VSP-I, VSP-II) islands, which testifies to their epidemic safety. The strains of the second group differ from the first one by the presence of the TLCφ prophage and two pathogenicity islands. It is demonstrated that this population of nontoxigenic strains, which is detected only in the Russian Federation and other cholera nonendemic regions, does not pose a potential epidemic hazard as was assumed earlier, despite the availability of tcpA–F genes in VPI-1. The lack of not only the CTXφ prophage but also VSP-I and VSP-II, which we revealed in these strains, eliminates the possibility of their reversion to epidemically hazardous ones. The strains of the third group have opulent similarity to toxigenic strains, being different in the absence of the CTXφ prophage only. It is this group of nontoxigenic strains, isolated only in cholera-endemic territories and capable of acquiring CTXφ through phage conversion, that is potentially epidemically hazardous. The results of whole genome SNP analysis of 58 different strains confirmed these data. We have also shown with the help of model animals (7- to 8-day-old rabbits) that nontoxigenic strains, irrespective of the structure of their genome, cannot cause typical cholera infection. The results provide insight into genomic diversity of nontoxigenic strains, as well as draw us nearer to an understanding of the mechanisms of reversion of their different variants into epidemically hazardous isolates.

Genomic diversity of non-toxigenic Vibrio cholerae O1 strains, isolated in the territory of Russia and neighboring states

Genomic diversity of non-toxigenic Vibrio cholerae O1 strains, isolated in the territory of Russia and neighboring states

РАСПРОСТРАНЕННОСТЬ ICE ЭЛЕМЕНТОВ РАЗЛИЧНЫХ ТИПОВ У V. CHOLERAE

With the help of a virtual PCR in silico analysis of the local database 395 genome-nucleotide sequences of Vibrio cholerae in the presence of ICE element. The results showed widespread ICE member from toxigenic strains and nontoxigenic Vibrio cholerae O1 serotype. Thus all elements of ICE successfully typed three basic types – «Indian», «Mozambique», or «the SXT». In this case up to 40 % nontoxigenic strains O1 serovar and nonO1/nonO139 carried ICE element. When analyzed by PCR in vitro collection of 222 strains of Vibrio cholerae O1 serotype shows the presence of ICE element and determine its type in toxigenic strains isolated in recent years in the Russian Federation. All nontoxigenic O1, O139 and nonO1/nonO139 strains isolated in Russia, deprived of ICE element that differs from strains circulating in endemic cholera areas. This observation allows us to consider the presence of ICE element as a new epidemic marker «of invasive strains of» nontoxigenic Vibrio cholerae.

Analysis of the Results of Cholera Vibrios Monitoring in Environmental Objects in the Administrative Territories of the Russian Federation Using GIS “CHOLERA 1989–2014”

Objective of the work was to compare the results of monitoring of Vibrio cholerae strains isolated in the territories of federal districts, their constituent entities and from certain water bodies between 2006–2016. Based on the methodology, using updated geoinformation system “Cholera 1989–2014”, a comparative study of the dynamics of isolation and biological properties of 586 Vibrio cholerae O1, O139 strains and R-variants, collected from the surface water bodies in the administrative territories of Russia, was carried out. Eventually it is established that Vibrio cholerae strains of various serogroups are found in the territory of all federal districts, but not in all the entities included in them. It is shown that the greatest number of isolated strains was registered in the Southern Federal District. The overwhelming number of Vibrio cholerae strains, isolated in the country, were non-toxigenic. It was noted that against the background of epidemiological welfare, the detection of single epidemiologically significant strains continued (Rostov Region). ctxA–tcpA+ strains were found in the Southern, Far Eastern and North-Western Federal Districts. It is established that until 2013 in five constituent entities strains of Vibrio cholerae O1 and O139 in water bodies were not detected. Non-toxigenic strains of Vibrio cholerae O1 El Tor Ogawa serovar prevailed in the territories of the Southern and Ural, and Inaba serovar – in the remaining Federal Districts. The most frequently isolated were non-toxigenic Vibrio cholerae O1 strains with phagotype 15, while isolates with phagotypes 4, 5, 10, 14 and 17 were traced only in the Southern Federal District. The data obtained formed the basis of the approach that contributes to a comprehensive assessment of the epidemiological situation on cholera in the territory of Russia and highlighted the prospects for using GIS to improve the effectiveness of cholera vibrio monitoring in surface water bodies.

Safety and immunogenicity of a live oral recombinant cholera vaccine VA1.4: a randomized, placebo controlled trial in healthy adults in a cholera endemic area in Kolkata, India.

BackgroundA live oral cholera vaccine VA 1.4 developed from a non-toxigenic Vibrio cholerae O1 El Tor strain using ctxB gene insertion was further developed into a clinical product following cGMP and was evaluated in a double-blind randomized placebo controlled parallel group two arm trial with allocation ratio of 1∶1 for safety and immunogenicity in men and women aged 18–60 years from Kolkata, India.MethodA lyophilized dose of 1.9×109 CFU (n = 44) or a placebo (n = 43) reconstituted with a diluent was administered within 5 minutes of drinking 100 ml of a buffer solution made of sodium bicarbonate and ascorbic acid and a second dose on day 14.ResultThe vaccine did not elicit any diarrhea related adverse events. Other adverse events were rare, mild and similar in two groups. One subject in the vaccine group excreted the vaccine strain on the second day after first dose. The proportion of participants who seroconverted (i.e. had 4-folds or higher rise in reciprocal titre) in the vaccine group were 65.9% (95% CI: 50.1%–79.5%) at both 7 days (i.e. after 1st dose) and 21 days (i.e. after 2nd dose). None of the placebo recipients seroconverted. Anti-cholera toxin antibody was detected in very few recipients of the vaccine.ConclusionThis study demonstrates that VA 1.4 at a single dose of 1.9×109 is safe and immunogenic in adults from a cholera endemic region. No additional benefit after two doses was seen.Trial RegistrationClinical Trials Registry-India, National Institute of Medical Statistics (Indian Council of Medical Research) CTRI/2012/04/002582

Randomized placebo controlled human volunteer trial of a live oral cholera vaccine VA1.3 for safety and immune response

A live oral cholera vaccine developed from a non-toxigenic Vibrio cholerae O1 El Tor strain VA1.3 was tested in a double-blind randomized placebo controlled study for safety and immunogenicity in 304 men aged between 16 and 50 years from Kolkata, India. A dose of 5×109CFU (n=186) or a placebo (n=116) containing the diluent buffer was administered. The vaccine did not elicit adverse events except in two vaccine recipients with mild diarrhoea and vomiting. None excreted the vaccine strain. Vibriocidal antibody response developed in 105/186 (57%) and 5/116 (4%) in vaccine and placebo recipients, respectively. In a subgroup, anti-CT antibody rose (≥2-folds) in 23/30 (77%) and 6/19 (32%) in vaccine and placebo recipients, respectively. These studies demonstrate that VA1.3 at a dose of 5×109 is safe and immunogenic in adults from a cholera endemic region.

Determination of relationships among non-toxigenic Vibrio cholerae O1 biotype El Tor strains from housekeeping gene sequences and ribotype patterns

Sequencing of three housekeeping genes, mdh, dnaE and recA, and ribotyping for seven non-toxigenic Vibrio cholerae O1 strains isolated from different geographic sources indicate a phylogenetic relationship among the strains. Results of MLST and ribotyping indicate a clear difference between three toxigenic strains (N16961, O395, and 569B) and three non-toxigenic strains from India (GS1, GS2, and GW87) and one Guam strain (X392), the latter of which were similar in both MLST and ribotyping, while two other non-toxigenic strains from the USA and India (2740-80 and OR69) appeared to be more closely related to toxigenic strains than to non-toxigenic strains, although this was not supported by ribotyping. These results provide clues to the emergence of toxigenic strains from a non-toxigenic progenitor by acquisition of virulence gene clusters. Results of split decomposition analysis suggest that widespread recombination occurs among the three housekeeping genes and that recombination plays an important role in the emergence of toxigenic strains of V. cholerae O1.

Characterization of non-membrane-damaging cytotoxin of non-toxigenic Vibrio cholerae O1 and its relevance to disease

The non-membrane-damaging cytotoxin which causes dramatic cell rounding of cultured HeLa cells was purified to homogeneity from a clinical strain (WO5) of non-toxigenic Vibrio cholerae O1 Inaba belonging to the El Tor biotype. The purified protein has a denatured molecular weight of 35 kDa and a native molecular weight of approximately 37 kDa indicating the monomeric nature of the protein. The 15 N-terminal amino acid sequence of non-membrane-damaging cytotoxin showed complete homology to the hemagglutinin protease previously purified and characterized from V. cholerae O1. Purified non-membrane-damaging cytotoxin from V. cholerae O1 was immunologically and biochemically identical to that previously purified from V. cholerae O26. Non-membrane-damaging cytotoxin was found to be enterotoxic in rabbit ileal loop assay inducing accumulation of non-hemorrhagic fluid at 100 μg and elicited a concentration dependent increase in short circuit current and tissue conductance of rabbit ileal mucosa mounted on Ussing chambers. A significant serum immunoglobulin G response against non-membrane-damaging cytotoxin was elicited by patients infected with V. cholerae O139 but not with V. cholerae O1. These properties make non-membrane-damaging cytotoxin a potential virulence factor of V. cholerae which should be taken into consideration while making live, attenuated recombinant vaccine strains against cholera.

Nontoxigenic Vibrio cholerae 01 Intestinal Pathology in Adult Mice

The intestinal pathology caused by nontoxigenic Vibrio cholerae O1 was examined in the sealed adult mouse (SAM) model. Histologic examination demonstrated that a nontoxigenic V. cholerae O1 strain that elicited maximum fluid accumulation (FA) in the small intestine of adult mice caused damages to the villi and necrosis of lymphoid elements within solitary submucosal lymphoid nodules in the Peyer's patches. Challenge of mice with a strain that did not elicit intestinal FA produced none of the above tissue responses. Increased FA activity, intestinal alterations, and tissue pathology caused by the nontoxigenic V. cholerae O1 indicate its pathogenic potential.

Molecular subtyping of Vibrio cholerae O1 strains recently isolated from patient, food and environmental samples in Spain.

Nineteen Vibrio cholerae O1 strains isolated in Spain from patient, food and environmental samples in the period 1990-1992 were characterized by detection of cholera toxin by enzyme immunoassay, detection of cholera toxin gene by polymerase chain reaction, and by biotyping, ribotyping and pulsed-field gel electrophoresis. Ten isolates were toxigenic and were further characterized by multilocus enzyme electrophoresis. Molecular subtyping methods allowed precise differentiation between isolates, indicating their geographic origin. Isolates associated with the ongoing seventh pandemic were distinguishable from those associated with the present Latin American epidemic. All isolates from the environment and seafood were nontoxigenic, and were genetically different and more diverse than toxigenic isolates. The data suggest that a focus of endemic cholera does not exist in Spain, and that the analyzed nontoxigenic Vibrio cholerae O1 isolates from imported seafood were not a threat to public health.

Vibriophage VcA-3 as an epidemic strain marker for the U.S. Gulf Coast Vibrio cholerae O1 clone.

Toxigenic and nontoxigenic Vibrio cholerae O1, El Tor biotype strains, which are endemic to the U.S. Gulf Coast, can be lysogenic for bacteriophage VcA-3. To evaluate the presence of VcA-3 as an indicator of toxigenicity and as an epidemic strain marker, phage production and the presence of phage and cholera toxin genes were assayed in 98 strains of V. cholerae O1 (35 U.S. and 63 foreign strains). By using a HindIII chromosomal digest for Southern blot analysis, 39 of the study strains hybridized with the VcA-3 probe in 10 banding patterns. The 15 toxigenic and 6 of the 20 nontoxigenic U.S. isolates gave four VcA-3-related patterns. Among the foreign isolates, 12 of 12 toxigenic classical biotype strains, 1 of 43 toxigenic El Tor biotype strains, and 3 of 8 nontoxigenic atypical strains gave six patterns that were clearly distinct from that of VcA-3. Compared with Southern blot analysis, the phage production assay had a sensitivity of 1.0 and a specificity of 0.48, while the colony hybridization assay had a sensitivity of 1.0 and a specificity of 0.77 for identification of VcA-3. Neither assay reliably identified the toxigenic Gulf Coast clone. The presence of VcA-3, as defined by Southern blot analysis, always separated toxigenic U.S. from foreign isolates and often from nontoxigenic U.S. isolates of V. cholerae O1.