51 st International Congress of Meat Science and Technology

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1 Use of Comparative Genomics as a Tool to Assess the Clinical and Public Health Significance of Emerging Shiga toxin Producing Escherichia coli Serotypes 51 st International Congress of Meat Science and Technology Baltimore, MD, August 9 th, 2005 Mohamed A. Karmali, MB ChB, FRCP(C) Public Health Agency of Canada

2 Bloody Stools from a Patient with STEC O157:H7 associated Hemorrhagic Colitis

3 Clinical Features of Infection by Shiga toxin producing E. Coli (STEC) O157:H7 Abdominal pain Low grade or absent fever Diarrhea Hemorrhagic colitis Hemolytic uremic syndrome (HUS)

4 Advanced Hemorrhagic/necrotic Colitis in a Fatal Case of STEC associated HUS

5 Renal Histopathology in a Fatal Case of STECassociated HUS. Evidence of Glomerulus Microangiopathy

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7 Public Health Impact of the Hemolytic Uremic Syndrome (HUS) Leading cause of acute renal failure in children Mortality rate 0.5 3% (higher in the elderly) Up to 40% of survivors develop chronic renal disease or hypertension Occasionally long term involvement of other organ systems, e.g., pancreas, GI tract, CNS

8 Epidemiology of Escherichia coli O157:H7 Outbreaks, United States, JM Rangel et al., Emerg. Infect. Dis. 11:603 9, to 2002 (350 outbreaks 49 States) Cases 8,598 Hospitalizations 1,493 (17%) HUS 354 (4%) Deaths 40 (0.5%)

9 Epidemiology of Escherichia coli O157:H7 Outbreaks, United States, JM Rangel et al., Emerg. Infect. Dis. 11:603 9, 2005 Transmission Routes (350 Outbreaks) 14% 21% 9% 3% 53% Foodborne Unknown Person to person Waterborne Animal contact

10 Epidemiology of Escherichia coli O157:H7 Outbreaks, United States, JM Rangel et al., Emerg. Infect. Dis. 11:603 9, 2005 Roast beef (5) Steak (2) Sirloin tip (1) Salami (1) 21% 6% 5% 4% Food vehicle (183 outbreaks) 23% 41% Ground Beef Unknown Produce Other beef Other food vehicle Dairy product

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12 STEC Virulence Factors Shiga toxins Stx1, Stx2, Stx2 variants Attaching and effacing lesion (LEE PAI) TSSS, Intimin, Tir, effector molecules p O157 plasmid mediated factors hlycabd, katp, espp, etpc etpo, Product with homology to clostridial toxins Miscellaneous factors efa1, iha, chua, and many others

13 EVOLUTION OF BACTERIAL VARIANTS BY ACQUISITION AND LOSS OF GENETIC INFORMATION U. Dobrindt et al., Nature Reviews (Microbiology) 2: , 2004 Common bacterial ancestor Genome reduction by deletion events Gene acquisition by HGT Mutations, Rearrangements GEI Plasmid

14 HORIZONTAL GENE TRANSFER Plasmids Bacteriophages Transposons Integrons Genomic Islands Ecological islands Symbiosis islands Saprophytic islands Pathogenicity islands

15 Pathogenicity Islands (PAIs) Large blocks of apparently foreign genes, found uniquely in (more) pathogenic members of a genus or species Hacker J and Kaper J (2001) The Concept of Pathogenicity Islands. In JB Kaper and J Hacker (Eds.). Pathogenicity islands and other mobile virulence elements (pp 1 11). ASM Press, Washington DC.

16 Examples of PAIs UPEC kb, hemolysins, P fimbriae, and CNF EPEC/EHEC LEE (35 43 kb) Salmonella SPIs 1 5 (17 40 kb) Shigella flexneri SHI I and SHI II (~ 50 kb) Yersinia spp. HPI (~ 40 kb) Vibrio cholerae VPI (40 kb Tcp adhesin) H. pylori cag (40 kb) S. aureus SaPI 1 (15 kb; TSST 1)

17 The Locus of Enterocyte Effacement JB Kaper, Centre for Vaccine Development, U of Maryland School of Medicine

18 TYPE III SECRETION NEEDLE COMPLEX A. Blocker et al. Mol. Microbiol 39: , 2001 A. Blocker et al., Mol. Microbiol. 39: , 2001

19 Characteristic Attaching &Effacing Colonization of Epithelial Cells by LEE +ve EPEC S. Knutton, U of Birmingham

20 Classification of VTEC Serotypes Into Seropathotypes Seropathotype A Relative Incidence Outbreaks Severe Disease Serotypes LEE B Moderate Uncommon Yes O26:H11; O103:H2 O111:NM O111:H8 O145:NM C D E O91:H21 Low Rare Yes O104:H21 /+ O113:H21 others Low Rare No Multiple /+ High Common Yes O157:H7 O157:H Nonhuman N/A N/A Multiple /+ + +

21 Genome Sequence of Enterohaemorrhagic Escherichia coli O157:H7 Perna T, Et Al: Nature 2001, 409: EDL 933 genome (5.5 Mb) has 1 million more base pairs and 1387 more genes than the commensal E. coli K 12 strain MG1655 The extra genes are organized mostly in gene clusters known as O islands

22 Comparative Genomics Approaches to Investigate Non O157 VTEC Targeted survey of EDL 933 O islands Subtractive hybridization DNA Microarrays Genome walking Multi locus sequence typing (MLST)

23 O Island #122 in the genome of EDL 933 (O157:H7) 23,029 bp (26 ORFs) 0 5 kb 10 kb Z4316 Z4318 Z4323 phev trna Int pagc Z4322 Z4325 sen Z4313 Z4314 Z4315 Z4317 Z4321 Z4324 Z4326 ISA (ISEc8) Z4320 ISA (p. transposase) Z kb Z kb Z4331 efa1 efa1 Z4336 Z4338 Z4328 Z4329 Z4330 Z4332 Z4333 Z4334 Z4337 Z4340 ISA (p. transposase) IS629 ISA ISEc8

24 Study Strains (N=70) Karmali et al, J. Clin. Microbiol. 41: , 2003 SEROPATHO TYPE NUMBER STRAINS A 13 O157:H7 (10 strains) O157:NM (3 strains) B 15 SEROTYPES O26:H11 (3); O103:H2 (3); O111:NM (3); O121:H19 (3); O145:NM (3) C 14 D 14 E 14 O5:NM (2); O91:H21 (4); O104:H21 (1); O113:H21 (4); O121:NM (2); O165:H25 (1) O7:H4 (1), O69:H11 (1); O103:H25 (2); O113:H4 (1), O117:H7 (2);O119:H25 (1); O132:NM (1); O146:H21 (1), O171:H2 (1), O172:NM (1), O174:H8 (1), OR:H2 (1) O6:H34 (1); O8:H19 (1); O39:H49 (1): O46:H38 (1); O76:H7 (1); O84:NM (1); O88:H25 (1); O98:H25 (1); O113:NM (1) O136:NM (1); O136:H12 (1); O153:H31 (1) O156:NM (1); O163:NM (1)

25 Distribution of OI#122 genes in representative strains in different seropathotypes (A to E) and controls. Karmali et al, J. Clin. Microbiol. 41: , 2003 Control (A) Control (A) Control ( ) (B) EDL933 Sakai K12 CL1 L L L L (C) (D) (E) (D) CL3 EC2 267 EC3 377 N02 L L L L Kb 600bp Lanes: L, 100bp ladder; 1, pagc (Z4321); 2, sen (Z4326); 3, efa1 (Z4332); 4, efa1 (Z4333)

26 Frequency of Complete, Incomplete, and Absent OI 122 in 70 VTEC Strains Karmali et al, J. Clin. Microbiol. 41: , % Positive "Complete" "Incomplete" "Absent"

27 Seropathotype Distribution of Complete, Incomplete, and Absent OI 122 in 70 (N=70) Karmali et al, J. Clin. Microbiol. 41: , 2003 % +ve A B C D E Complete Incomplete Absent Seropathotype

28 Differences in Distribution of COI#122 in VTEC Seropathotypes Karmali et al, J. Clin. Microbiol. 41: , 2003 Seropathotype (% Strains +ve for COI#122) A, B (78.6) Associated with epidemic disease A, B, C (62.0) Associated with serious disease (HUS) Seropathotype (% Strains +ve for COI#122) C, D, E (14.3) Not associated with epidemic disease D, E (7.1) Not associated with serious disease (HUS) SIGNIFICANCE P< OR =22 95% CI P< OR = % CI

29 Relationship Between the Presence of Intact OI#122 and LEE Karmali et al, J. Clin. Microbiol. 41: , 2003 % +ve A B C D E Intact OI#122 LEE Seropathotype

30 Seropathotype Distribution of Stx1, Stx2, & HlyA Karmali et al, J. Clin. Microbiol. 41: , 2003 % +VE A B C D E Stx1 Stx2 hlya SEROPATHOTYPE

31 Frequency of Complete, Incomplete, and Absent OI 122 in 70 VTEC Strains Karmali et al, J. Clin. Microbiol. 41: , % Positive "Complete" "Incomplete" "Absent"

32 Analysis of Incomplete OI pagc +VE sen, efa1, efa1 VE No. Strains sen, efa1, efa1+ve pagc VE A B C D E Seropathotype 3 Genes 2 Genes 1 Gene

33 Genetic Organization of EPEC, EHEC, and RDEC 1 LEE C. Zhu et al. Infect. Immun. 69: , 2001 M. Tauschek et al. Mol. Microbiol. 44: , 2002 LEE EPEC (E2348/69) IS600 selc LEE EHEC (EDL 933) Prophage 933L selc int LEE RDEC 1 (63/39) efa1/ lifa sena pheu trna The LEE Core Region

34 Analysis of Incomplete OI pagc +VE sen, efa1, efa1 VE No. Strains sen, efa1, efa1+ve pagc VE A B C D E Seropathotype 3 Genes 2 Genes 1 Gene

35 Genetic and Physical Map of the Sequenced Region of the Genomic Island of E. coli O113:H21 Strain CL3 Shen et al. Infect. Immun. 72: , kb BsiWI EcoRI BsiWI EcoRI EcoRI BsiWI Probe E2 B1 Probe E1 Z1635 Z1637 S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 Z Z1643 Z1644 Yp Yp Y. Pestis ad/ha t t X H Z4321 Z1636 Z Z H8dr 1 H8dr 2 Z DR12 I I DR12 OI#122 OI#48 GS I GS II OI#

36 Why do strains of Seropathotype A cause HUS and Epidemic Disease More Often than Seropathotype B Strains? SUBTRACTIVE HYBRIDIZATION between EDL 933 (O157:H7) Seropathotype A and CLI (O26:H11) Seropathotype B

37 Four Fimbria Encoding Genomic Islands that are Highly Specific for STEC O157 Strains Shen et al. J. Clin. Microbiol. 43: , 2005 OI 1 5M 0 OI 154 ORI OI 141 E. Coli O157:H7 EDL 933 1M OI 47 3M

38 Distribution of OI #s 1, 47, 141,& 154 in EDL 933 (O157:H7) and CL1 (O26:H11) bp A B M bp M OI 1 OI 141 OI Ctrl OI Ctrl EDL933 CL1 EDL933 CL1 Figure 1. Ethidium bromide stained agarose gel showing the results of PCR investigation of the existence of OIs 1, 47, 141 and 154 in E. coli strain CL1 (serotype O26:H11). EDL933 were used as positive control. ORFs are designaed as following: Panel A, OI 1: 1, Z ; 2, Z0022; 3, Z0023; 4, Z0024; 5, Z0025. OI 141: 6, Z4965; 7, Z4966; 8, Z4968m; 9, Z4969; 10, Z4971. OI 154: 11, Z5220; 12, Z5221; 13, Z5222; 14, Z , 15, Z5225. Panel B, ORFs in OI 47: 1, Z1528; 2, Z1530; 3, Z1531; 4, Z1533; 5, Z1534; 6, Z1535; 7, Z1536; 8, Z1537; 9, Z1538; 10, Z1539; 11, Z ; 12, Z1542; 13, Z1543; 14, Z1544; 15, Z1545; 16, Z1546; 17, Z1547; 18, Z1548; 19, Z1549; 20, Z1550; 21, Z1551; 22, Z1552; 23, Z1553; 24, Z1554; 25, Z1555; 26, Z1556. M, DNA size marker; Ctrl, 23S rrna gene.

39 Seropathotype distribution of OIs # 1, 47, 141, and SPT A SPT B SPT C SPT D SPT E OI 1 OI 47 OI 141 OI 154

40 Public Health Applications of Comparative Genomics Diagnosis & Epidemiology Molecular Risk Assessment Detection / surveillance of emerging pathogens Detection of engineered BT pathogens Treatment Elimination from reservoirs Microbiology as a predictive discipline

41 Acknowledgements LFZ M Karmali M Mascarenhas S Shen K Ziebell S Johnson R. Reid Smith K. Rahn S. Ralston Robyn Morgan Shirley Yung NML C Clark CPHLN J Isaac Renton U Maryland J Kaper CIHR LFZ M Karmali, V Gannon U of Guelph C. Whitfield, C. Gyles U of British Columbia B. Finlay, U of Toronto P Sherman VIDO A Potter

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