Blood Group O–Dependent Cellular Responses to Cholera Toxin: Parallel Clinical and Epidemiological Links to Severe Cholera

F. Matthew Kuhlmann Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.

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Srikanth Santhanam Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.

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Pardeep Kumar Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.

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Qingwei Luo Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.

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Matthew A. Ciorba Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.
Molecular Microbiology and Microbial Pathogenesis Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, Saint Louis, Missouri.

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James M. Fleckenstein Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.
Molecular Microbiology and Microbial Pathogenesis Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, Saint Louis, Missouri.
Veterans Affairs Medical Center, Saint Louis, Missouri.

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Because O blood group has been associated with more severe cholera infections, it has been hypothesized that cholera toxin (CT) may bind non-O blood group antigens of the intestinal mucosae, thereby preventing efficient interaction with target GM1 gangliosides required for uptake of the toxin and activation of cyclic adenosine monophosphate (cAMP) signaling in target epithelia. Herein, we show that after exposure to CT, human enteroids expressing O blood group exhibited marked increase in cAMP relative to cells derived from blood group A individuals. Likewise, using CRISPR/Cas9 engineering, a functional group O line (HT-29-A−/−) was generated from a parent group A HT-29 line. CT stimulated robust cAMP responses in HT-29-A−/− cells relative to HT-29 cells. These findings provide a direct molecular link between blood group O expression and differential cellular responses to CT, recapitulating clinical and epidemiologic observations.

Author Notes

* Address correspondence to James M. Fleckenstein, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110. E-mail: jflecken@wustl.edu

Financial support: This work was supported by funding from the Department of Veterans Affairs(grant 5I01BX001469); grant R01AI89894 from the National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIAID); CTSA grant UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and the Digestive Diseases Research Core Center at Washington University School of Medicine; grant P30 DK52574 from the National Institute of Diabetes and Digestive and Kidney Diseases. Matthew A. Ciorba was supported by grants DK100737, DK089016, and DK109384 from the NIDDK, AI095776 from the NIAID, and a Crohn's and Colitis Foundation Senior Research Award.

Authors' addresses: F. Matthew Kuhlmann, Pardeep Kumar, and Qingwei Luo, Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, E-mails: fkuhlman@dom.wustl.edu, pradeepkumar.19@gmail.com, and qluo@dom.wustl.edu. Srikanth Santhanam, Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, E-mail: ssanthan@dom.wustl.edu. Matthew A. Ciorba, Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, and Molecular Microbiology and Microbial Pathogenesis Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, Saint Louis, MO, E-mail: mciorba@dom.wustl.edu. James M. Fleckenstein, Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, John Cochran Division, Veterans Affairs Medical Center, Saint Louis, MO, and Molecular Microbiology and Microbial Pathogenesis Program, Division of Biology and Biomedical Sciences, Washington University School of Medicine, Saint Louis, MO, E-mail: jflecken@dom.wustl.edu.

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