hemolytic uremic syndrome

Summary

Summary: A syndrome that is associated with microvascular diseases of the KIDNEY, such as RENAL CORTICAL NECROSIS. It is characterized by hemolytic anemia (ANEMIA, HEMOLYTIC); THROMBOCYTOPENIA; and ACUTE RENAL FAILURE.

Top Publications

  1. Friedrich A, Zhang W, Bielaszewska M, Mellmann A, Köck R, Fruth A, et al. Prevalence, virulence profiles, and clinical significance of Shiga toxin-negative variants of enterohemorrhagic Escherichia coli O157 infection in humans. Clin Infect Dis. 2007;45:39-45 pubmed
    ..Stx production by infecting organisms is considered to be a critical requirement for the development of hemolytic uremic syndrome (HUS), which occurs in approximately 15% of E. coli O157-infected patients...
  2. Kavanagh D, Goodship T, Richards A. Atypical haemolytic uraemic syndrome. Br Med Bull. 2006;77-78:5-22 pubmed
    ..Discovery of these mutations has revealed important genotype-phenotype correlations. MCP-HUS has a better prognosis and a better outcome after transplantation than either CFH-HUS or IF-HUS...
  3. Cho H, Lee B, Moon K, Ha I, Cheong H, Choi Y. Complete factor H deficiency-associated atypical hemolytic uremic syndrome in a neonate. Pediatr Nephrol. 2007;22:874-80 pubmed
    Recent advances have shown that atypical hemolytic uremic syndrome (aHUS) is a disease of complement dysregulation...
  4. Pollock K, Young D, Beattie T, Todd W. Clinical surveillance of thrombotic microangiopathies in Scotland, 2003-2005. Epidemiol Infect. 2008;136:115-21 pubmed
  5. Bielaszewska M, Köck R, Friedrich A, von Eiff C, Zimmerhackl L, Karch H, et al. Shiga toxin-mediated hemolytic uremic syndrome: time to change the diagnostic paradigm?. PLoS ONE. 2007;2:e1024 pubmed
    b>Hemolytic uremic syndrome (HUS) is caused by enterohemorrhagic Escherichia coli (EHEC) which possess genes encoding Shiga toxin (stx), the major virulence factor, and adhesin intimin (eae)...
  6. Loirat C, Fremeaux Bacchi V. Hemolytic uremic syndrome recurrence after renal transplantation. Pediatr Transplant. 2008;12:619-29 pubmed publisher
    ..Kidney or kidney + liver transplantation with concomitant plasmatherapy need to be evaluated by prospective trials in patients with hereditary complement abnormalities...
  7. Werber D, Beutin L, Pichner R, Stark K, Fruth A. Shiga toxin-producing Escherichia coli serogroups in food and patients, Germany. Emerg Infect Dis. 2008;14:1803-6 pubmed publisher
    ..Two thirds (41/61), representing 72% of food isolates, were also found in patients. Serogroups typically isolated from patients with hemolytic uremic syndrome were rarely found in food.
  8. Sauter K, Melton Celsa A, Larkin K, Troxell M, O Brien A, Magun B. Mouse model of hemolytic-uremic syndrome caused by endotoxin-free Shiga toxin 2 (Stx2) and protection from lethal outcome by anti-Stx2 antibody. Infect Immun. 2008;76:4469-78 pubmed publisher
    ..These results indicate that, when performed during progression of HUS, passive immunization of mice with anti-Stx2 antibody prevented the lethal effects of Stx2...
  9. Davin J, Strain L, Goodship T. Plasma therapy in atypical haemolytic uremic syndrome: lessons from a family with a factor H mutation. Pediatr Nephrol. 2008;23:1517-21 pubmed publisher

More Information

Publications62

  1. Boctor F. Tacrolimus (FK506) associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in lung transplant salvage with a plasmapheresis and cyclosporin. Egypt J Immunol. 2006;13:95-9 pubmed
    ..The combination of daily plasmapheresis with fresh frozen plasma as a source of ADAMTS-13 and cyclosporine may be used as a rescue therapy in patients with FK506-induced TTP/HUS...
  2. Venables J, Strain L, Routledge D, Bourn D, Powell H, Warwicker P, et al. Atypical haemolytic uraemic syndrome associated with a hybrid complement gene. PLoS Med. 2006;3:e431 pubmed
    ..In this study we tested the hypothesis that nonallelic homologous recombination between low-copy repeats in the RCA cluster could result in the formation of a hybrid CFH/CFHL1 gene that predisposes to the development of aHUS...
  3. Saunders R, Abarrategui Garrido C, Fremeaux Bacchi V, Goicoechea de Jorge E, Goodship T, Lopez Trascasa M, et al. The interactive Factor H-atypical hemolytic uremic syndrome mutation database and website: update and integration of membrane cofactor protein and Factor I mutations with structural models. Hum Mutat. 2007;28:222-34 pubmed
    Atypical hemolytic uremic syndrome (aHUS) is a disease of hemolytic anemia, thrombocytopenia, and renal failure associated with defective alternative pathway (AP) complement control. Previously, we presented a database (www.FH-HUS...
  4. Geelen J, van der Velden T, te Loo D, Boerman O, van den Heuvel L, Monnens L. Lack of specific binding of Shiga-like toxin (verocytotoxin) and non-specific interaction of Shiga-like toxin 2 antibody with human polymorphonuclear leucocytes. Nephrol Dial Transplant. 2007;22:749-55 pubmed
    ..Previous studies indicated that polymorphonuclear leucocytes (PMN) could serve as carriers for Stx in the systemic circulation. As at a later stage we could not confirm these data, we performed new studies...
  5. Heinen S, Jozsi M, Hartmann A, Noris M, Remuzzi G, Skerka C, et al. Hemolytic uremic syndrome: a factor H mutation (E1172Stop) causes defective complement control at the surface of endothelial cells. J Am Soc Nephrol. 2007;18:506-14 pubmed
    Defective complement regulation results in hemolytic uremic syndrome (HUS), a disease that is characterized by microangiopathy, thrombocytopenia, and acute renal failure and that causes endothelial cell damage...
  6. Franchini M. Thrombotic microangiopathies: an update. Hematology. 2006;11:139-46 pubmed
    ..the two most relevant conditions associated with TMA are thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), characterized by prominent brain or renal lesions, respectively...
  7. Persson S, Olsen K, Ethelberg S, Scheutz F. Subtyping method for Escherichia coli shiga toxin (verocytotoxin) 2 variants and correlations to clinical manifestations. J Clin Microbiol. 2007;45:2020-4 pubmed
    ..Of 255 strains from the Danish STEC cohort, all 20 cases of hemolytic-uremic syndrome were associated with subtype Stx2 (11 cases), subtype Stx2c (1 case), or the two combined (8 cases)...
  8. Bresin E, Daina E, Noris M, Castelletti F, Stefanov R, Hill P, et al. Outcome of renal transplantation in patients with non-Shiga toxin-associated hemolytic uremic syndrome: prognostic significance of genetic background. Clin J Am Soc Nephrol. 2006;1:88-99 pubmed
    More than 50% of patients with non-Shiga toxin-associated hemolytic uremic syndrome (non-Stx-HUS) progress to ESRD...
  9. Jokiranta T, Zipfel P, Fremeaux Bacchi V, Taylor C, Goodship T, Noris M. Where next with atypical hemolytic uremic syndrome?. Mol Immunol. 2007;44:3889-900 pubmed
    b>Hemolytic uremic syndrome (HUS) is a systemic disease characterized by damage to endothelial cells, erythrocytes and kidney glomeruli. A "typical" form of HUS follows gastrointestinal infection with enterohemorrhagic E. coli (e...
  10. Ståhl A, Vaziri Sani F, Heinen S, Kristoffersson A, Gydell K, Raafat R, et al. Factor H dysfunction in patients with atypical hemolytic uremic syndrome contributes to complement deposition on platelets and their activation. Blood. 2008;111:5307-15 pubmed publisher
    Atypical hemolytic uremic syndrome (aHUS) may be associated with mutations in the C-terminal of factor H (FH)...
  11. Pickering M, de Jorge E, Martinez Barricarte R, Recalde S, Garcia Layana A, Rose K, et al. Spontaneous hemolytic uremic syndrome triggered by complement factor H lacking surface recognition domains. J Exp Med. 2007;204:1249-56 pubmed
    ..Age-related macular degeneration (AMD), atypical hemolytic uremic syndrome (aHUS), and membranoproliferative glomerulonephritis type II (MPGN2) are associated with polymorphisms ..
  12. Moake J. Thrombotic thrombocytopenia purpura (TTP) and other thrombotic microangiopathies. Best Pract Res Clin Haematol. 2009;22:567-76 pubmed publisher
  13. Nangaku M, Nishi H, Fujita T. Pathogenesis and prognosis of thrombotic microangiopathy. Clin Exp Nephrol. 2007;11:107-114 pubmed publisher
    ..Included in the broad category of TMA are the hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP)...
  14. Sellier Leclerc A, Fremeaux Bacchi V, Dragon Durey M, Macher M, Niaudet P, Guest G, et al. Differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol. 2007;18:2392-400 pubmed
    ..I (IF), and membrane cofactor protein (MCP) genes have been described as risk factors for atypical hemolytic uremic syndrome (aHUS). This study analyzed the impact of complement mutations on the outcome of 46 children with aHUS...
  15. Goicoechea de Jorge E, Harris C, Esparza Gordillo J, Carreras L, Arranz E, Garrido C, et al. Gain-of-function mutations in complement factor B are associated with atypical hemolytic uremic syndrome. Proc Natl Acad Sci U S A. 2007;104:240-5 pubmed
    b>Hemolytic uremic syndrome (HUS) is an important cause of acute renal failure in children...
  16. Fang C, Fremeaux Bacchi V, Liszewski M, Pianetti G, Noris M, Goodship T, et al. Membrane cofactor protein mutations in atypical hemolytic uremic syndrome (aHUS), fatal Stx-HUS, C3 glomerulonephritis, and the HELLP syndrome. Blood. 2008;111:624-32 pubmed
    The hemolytic uremic syndrome (HUS) is a triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment...
  17. Johnson K, Thorpe C, Sears C. The emerging clinical importance of non-O157 Shiga toxin-producing Escherichia coli. Clin Infect Dis. 2006;43:1587-95 pubmed
    ..This commentary provides a perspective on the non-O157 STEC as human pathogens, how and when the clinician should approach the diagnosis of these organisms, and the challenges ahead...
  18. Geelen J, van den Dries K, Roos A, van de Kar N, de Kat Angelino C, Klasen I, et al. A missense mutation in factor I (IF) predisposes to atypical haemolytic uraemic syndrome. Pediatr Nephrol. 2007;22:371-5 pubmed
    ..One additional transplant was lost due to arterial thrombosis of the renal artery. This report confirms the gloomy outcome of renal transplants in patients with an IF deficiency. New therapies should be evaluated in these patients...
  19. Mellmann A, Bielaszewska M, Köck R, Friedrich A, Fruth A, Middendorf B, et al. Analysis of collection of hemolytic uremic syndrome-associated enterohemorrhagic Escherichia coli. Emerg Infect Dis. 2008;14:1287-90 pubmed publisher
    ..sequence typing of 169 non-O157 enterohemorrhagic Escherichia coli (EHEC) isolated from patients with hemolytic uremic syndrome (HUS) demonstrated 29 different sequence types (STs); 78.1% of these strains clustered in 5 STs...
  20. Jalanko H, Peltonen S, Koskinen A, Puntila J, Isoniemi H, Holmberg C, et al. Successful liver-kidney transplantation in two children with aHUS caused by a mutation in complement factor H. Am J Transplant. 2008;8:216-21 pubmed
    ..boy and his 16-year-old aunt became acutely ill 6 months apart and were diagnosed to have atypical hemolytic uremic syndrome (aHUS)...
  21. Zimmerhackl L, Scheiring J, Prüfer F, Taylor C, Loirat C. Renal transplantation in HUS patients with disorders of complement regulation. Pediatr Nephrol. 2007;22:10-6 pubmed
    ..espn.ucwm.ac.uk . On no account should live related donation take place unless the risks of graft loss are understood. International collaboration to identify safer ways of transplanting these challenging patients is urgently needed...
  22. Noris M, Remuzzi G. Genetic abnormalities of complement regulators in hemolytic uremic syndrome: how do they affect patient management?. Nat Clin Pract Nephrol. 2005;1:2-3 pubmed
  23. Zhang W, Mellmann A, Sonntag A, Wieler L, Bielaszewska M, Tsch pe H, et al. Structural and functional differences between disease-associated genes of enterohaemorrhagic Escherichia coli O111. Int J Med Microbiol. 2007;297:17-26 pubmed publisher
    ..The divergence within EHEC O111 makes it possible to subtype these emerging pathogens in the laboratory thereby providing a basis for further investigations into their ecological niches and survival capabilities...
  24. Aldick T, Bielaszewska M, Zhang W, Brockmeyer J, Schmidt H, Friedrich A, et al. Hemolysin from Shiga toxin-negative Escherichia coli O26 strains injures microvascular endothelium. Microbes Infect. 2007;9:282-90 pubmed
    ..The toxicity of EHEC-Hly to microvascular endothelial cells plausibly contributes to the virulence of the stx-negative E. coli O26 strains and to the pathogenesis of HUS...
  25. Rivas M, Miliwebsky E, Chinen I, Deza N, Leotta G. [The epidemiology of hemolytic uremic syndrome in Argentina. Diagnosis of the etiologic agent, reservoirs and routes of transmission]. Medicina (B Aires). 2006;66 Suppl 3:27-32 pubmed
    ..Escherichia coli (STEC) cause sporadic cases and outbreaks of nonbloody and bloody diarrhea, and hemolytic uremic syndrome (HUS). E. coil O157:H7 is the most prevalent STEC serotype...
  26. Sonntag A, Prager R, Bielaszewska M, Zhang W, Fruth A, Tschäpe H, et al. Phenotypic and genotypic analyses of enterohemorrhagic Escherichia coli O145 strains from patients in Germany. J Clin Microbiol. 2004;42:954-62 pubmed
    ..The heterogeneity of EHEC O145 strains at the chromosomal and plasmid level, in particular the high diversity in PFGE patterns, provides a basis for molecular subtyping of these pathogens...
  27. Rodriguez de Cordoba S, Esparza Gordillo J, Goicoechea de Jorge E, Lopez Trascasa M, Sanchez Corral P. The human complement factor H: functional roles, genetic variations and disease associations. Mol Immunol. 2004;41:355-67 pubmed
    ..This review summarises our current knowledge of the role of factor H in health and disease...
  28. George J. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med. 2006;354:1927-35 pubmed
  29. Tarr P, Gordon C, Chandler W. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005;365:1073-86 pubmed
    ..The vascular injury leading to HUS is likely to be well under way by the time infected patients seek medical attention for diarrhoea. The best way to prevent HUS is to prevent primary infection with Shiga-toxin-producing bacteria...
  30. Karch H, Tarr P, Bielaszewska M. Enterohaemorrhagic Escherichia coli in human medicine. Int J Med Microbiol. 2005;295:405-18 pubmed
    ..This review will focus on the microbiology, epidemiology, and pathophysiology of EHEC-associated diseases, and illustrate future challenges and opportunities for their control...
  31. Zipfel P, Skerka C. Complement dysfunction in hemolytic uremic syndrome. Curr Opin Rheumatol. 2006;18:548-55 pubmed
    b>Hemolytic uremic syndrome is a rare disease of microangiopathic hemolytic anemia, low platelet count and is associated with renal impairment...
  32. Cheong H, Lee B, Kang H, Hahn H, Suh K, Ha I, et al. Attempted treatment of factor H deficiency by liver transplantation. Pediatr Nephrol. 2004;19:454-8 pubmed
    Complement factor H (FH) deficiency is one of the causes of atypical hemolytic uremic syndrome (HUS). Most patients with FH deficiency associated HUS progress to end-stage renal disease despite plasma therapy...
  33. Fremeaux Bacchi V, Dragon Durey M, Blouin J, Vigneau C, Kuypers D, Boudailliez B, et al. Complement factor I: a susceptibility gene for atypical haemolytic uraemic syndrome. J Med Genet. 2004;41:e84 pubmed
  34. Blackall D, Marques M. Hemolytic uremic syndrome revisited: Shiga toxin, factor H, and fibrin generation. Am J Clin Pathol. 2004;121 Suppl:S81-8 pubmed
    The hemolytic uremic syndrome (HUS) is a disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure...
  35. Esparza Gordillo J, Goicoechea de Jorge E, Buil A, Carreras Berges L, Lopez Trascasa M, Sanchez Corral P, et al. Predisposition to atypical hemolytic uremic syndrome involves the concurrence of different susceptibility alleles in the regulators of complement activation gene cluster in 1q32. Hum Mol Genet. 2005;14:703-12 pubmed
    ..analyses have shown that this critical control of complement activation may be impaired in atypical hemolytic uremic syndrome (aHUS) patients...
  36. Noris M, Remuzzi G. Hemolytic uremic syndrome. J Am Soc Nephrol. 2005;16:1035-50 pubmed
  37. Saland J, Emre S, Shneider B, Benchimol C, Ames S, Bromberg J, et al. Favorable long-term outcome after liver-kidney transplant for recurrent hemolytic uremic syndrome associated with a factor H mutation. Am J Transplant. 2006;6:1948-52 pubmed
    A male child initially presented with atypical hemolytic uremic syndrome (HUS) at the age of 4 months and progressed within weeks to end stage renal disease (ESRD)...
  38. Gomez D, Miliwebsky E, Silva A, Deza N, Zotta C, Cotella O, et al. [Isolation of Shiga-toxin-producing Escherichia coli strains during a gastrointestinal outbreak at a day care center in Mar del Plata City]. Rev Argent Microbiol. 2005;37:176-83 pubmed
    ..6 +/- 13.9 months, and the mother of one of them had diarrhea. One case developed hemolytic uremic syndrome. No conclusive evidence of the origin of the outbreak was found, but the epidemic curve suggested person-..
  39. Caprioli J, Noris M, Brioschi S, Pianetti G, Castelletti F, Bettinaglio P, et al. Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood. 2006;108:1267-79 pubmed
    b>Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy with manifestations of hemolytic anemia, thrombocytopenia, and renal impairment...
  40. Jokiranta T, Jaakola V, Lehtinen M, Pärepalo M, Meri S, Goldman A. Structure of complement factor H carboxyl-terminus reveals molecular basis of atypical haemolytic uremic syndrome. EMBO J. 2006;25:1784-94 pubmed
    ..Therefore, the majority of the aHUS-associated mutations on the surface of FH19-20 interfere with the interaction between FH and C3b. This obviously leads to impaired control of complement attack on plasma-exposed cell surfaces in aHUS...
  41. Richards A, Kathryn Liszewski M, Kavanagh D, Fang C, Moulton E, Fremeaux Bacchi V, et al. Implications of the initial mutations in membrane cofactor protein (MCP; CD46) leading to atypical hemolytic uremic syndrome. Mol Immunol. 2007;44:111-22 pubmed
    The hemolytic uremic syndrome is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. There are two general types. One occurs in epidemic form and is diarrheal associated (D+HUS)...
  42. Sanchez Corral P, González Rubio C, Rodriguez De Cordoba S, Lopez Trascasa M. Functional analysis in serum from atypical Hemolytic Uremic Syndrome patients reveals impaired protection of host cells associated with mutations in factor H. Mol Immunol. 2004;41:81-4 pubmed
    A subgroup of patients with the most severe form of the Hemolytic Uremic Syndrome (HUS) presents mutations in the complement regulatory protein factor H...
  43. Tsai H. The molecular biology of thrombotic microangiopathy. Kidney Int. 2006;70:16-23 pubmed
    ..microangiopathy, which includes thrombotic thrombocytopenic purpura (TTP), shiga-toxin-associated hemolytic uremic syndrome (Stx-HUS) and atypical HUS, is characterized by the development of hyaline thrombi in the ..
  44. Rivas M, Miliwebsky E, Chinen I, Roldán C, Balbi L, Garcia B, et al. Characterization and epidemiologic subtyping of Shiga toxin-producing Escherichia coli strains isolated from hemolytic uremic syndrome and diarrhea cases in Argentina. Foodborne Pathog Dis. 2006;3:88-96 pubmed
    Argentina has a high incidence of hemolytic uremic syndrome (HUS); 12.2 cases per 100,000 children younger than 5 years old were reported in 2002...
  45. Olie K, Florquin S, Groothoff J, Verlaak R, Strain L, Goodship T, et al. Atypical relapse of hemolytic uremic syndrome after transplantation. Pediatr Nephrol. 2004;19:1173-6 pubmed
    Atypical hemolytic uremic syndrome (HUS) frequently leads to end-stage renal failure and can relapse after transplantation...
  46. Tazzari P, Ricci F, Carnicelli D, Caprioli A, Tozzi A, Rizzoni G, et al. Flow cytometry detection of Shiga toxins in the blood from children with hemolytic uremic syndrome. Cytometry B Clin Cytom. 2004;61:40-4 pubmed
    b>Hemolytic uremic syndrome (HUS) is the main cause of acute renal failure in early childhood. Most cases are due to intestinal infections from Escherichia coli strains (STEC) which produce by Shiga toxin (Stxs)...
  47. Saunders R, Goodship T, Zipfel P, Perkins S. An interactive web database of factor H-associated hemolytic uremic syndrome mutations: insights into the structural consequences of disease-associated mutations. Hum Mutat. 2006;27:21-30 pubmed
    ..Nucleotide changes within this gene (CFH) have been observed in patients with hemolytic uremic syndrome (HUS), and also membranoproliferative glomerulonephritis and age-related macular degeneration...
  48. Olie K, Goodship T, Verlaak R, Florquin S, Groothoff J, Strain L, et al. Posttransplantation cytomegalovirus-induced recurrence of atypical hemolytic uremic syndrome associated with a factor H mutation: successful treatment with intensive plasma exchanges and ganciclovir. Am J Kidney Dis. 2005;45:e12-5 pubmed
    Atypical hemolytic uremic syndrome (HUS) can recur after renal transplantation and often leads to graft loss. In some series of familial HUS, the risk of early graft loss due to recurrence of HUS approaches 100% despite any therapy...
  49. Bielaszewska M, Prager R, Zhang W, Friedrich A, Mellmann A, Tsch pe H, et al. Chromosomal dynamism in progeny of outbreak-related sorbitol-fermenting enterohemorrhagic Escherichia coli O157:NM. Appl Environ Microbiol. 2006;72:1900-9 pubmed publisher
    ..The variability of PFGE patterns for the progeny of a single colony must be considered when interpreting PFGE patterns in SF EHEC O157-associated outbreaks...
  50. Rangel J, Sparling P, Crowe C, Griffin P, Swerdlow D. Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982-2002. Emerg Infect Dis. 2005;11:603-9 pubmed
    ..49 states reported 350 outbreaks, representing 8,598 cases, 1,493 (17%) hospitalizations, 354 (4%) hemolytic uremic syndrome cases, and 40 (0.5%) deaths...
  51. Mayer S, Aledort L. Thrombotic microangiopathy: differential diagnosis, pathophysiology and therapeutic strategies. Mt Sinai J Med. 2005;72:166-75 pubmed
    ..as thrombotic microangiopathies (TMA), most prominently thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS)...
  52. Fernandez G, Ramos M, Gomez S, Dran G, Exeni R, Alduncin M, et al. Differential expression of function-related antigens on blood monocytes in children with hemolytic uremic syndrome. J Leukoc Biol. 2005;78:853-61 pubmed
    ..Here, we investigate the phenotype and function of peripheral Mo from children with hemolytic uremic syndrome (HUS)...
  53. Bielaszewska M, Karch H. Consequences of enterohaemorrhagic Escherichia coli infection for the vascular endothelium. Thromb Haemost. 2005;94:312-8 pubmed
    ..Based on current data, cytolethal distending toxin, EHEC haemolysin, and subtilase cytotoxin might be such candidates...