Enterohaemorhagic Escherichia coli (EHEC) are a group of bacteria responsible for numerous
foodborne outbreaks in humans which can lead to bloody diarrhea, haemorrhagic uremic
syndrome and in some cases in children even in death. E. coli O157:H7 is the most well known
serotype of this group. Ruminants are the most important reservoir of these microorganisms
and many outbreaks have been traced to ruminant’s origin. Ruminants typically continue to
shed bacteria in their feces for weeks to months. Carcasses of non-colonized animals have
regularly been found to be contaminated with E. coli O157:H7 in the abattoir, suggesting that
cross-contamination during meat processing can be a major source of the contamination of beef
products and subsequently of human’s infection. Therefore reducing E. coli O157:H7 shedding
by ruminants would be a way to control the infection of humans. Up till now, no efficient
treatment is available against E. coli O157:H7 infection and some traditional treatments,
including antibiotic therapy may even increase the chance of developing severe disease in
humans. Therefore, there is need for alternative ways to reduce the risk of E. coli O157:H7
infection of humans for instance by diminishing or preventing E. coli O157:H7 excretion at the
farm level.
The first part of this thesis reviews current literature. Chapter 1 of this thesis gives an
overview of the literatures on the pathogenesis of E. coli O157:H7 in human and ruminants. Also
the reported intervention strategies in ruminants were discussed. Chapter 2 reviews present
knowledge on lactoferrin as the main antibacterial immunomodulatory protein of milk. The
focus of this chapter is on the antimicrobial mechanism of lactoferrin and its peptides, in
particular the antimicrobial mechanism against gram-negative pathogens. In addition the role of
lactoferrin as immunomodulatory protein is briefly reviewed.
A second part of the thesis describes the aims. Following questions were addressed in this
thesis:
√ What is the pattern of antimicrobial susceptibility among E. coli isolates from dairy cows in Iran?
√ Can lactoferrin, a natural antimicrobial protein of milk, be used to prevent or reduce
colonisation of the ovine intestinal tract with E. coli O157:H7 and so reduce or prevent fecal
shedding?
√ Is systemic vaccination of sheep with type III secretion system proteins and intimin g a possible
strategy to reduce fecal shedding of E. coli O157:H7 as in cattle?
A third part, comprising Chapters 3 to 7, presents the experimental work of this thesis.
In Chapter 3 the antimicrobial susceptibility of E. coli isolates from milk and healthy cattle
feces in Iran has been investigated. The results identified ceftiofur ( 6%) and colistin as the most
effective antibiotics. However the incidence of colistin resistance (14%) among the isolates was
remarkably higher than in previous reports on antibiotic susceptibility of commensal bacteria.
The highest percentage of acquired resistance was detected for tetracycline (46%), followed by
ampicillin (43%). %). For the other tested antimicrobials (amoxicillin-clavulanic acid,
chloramphenicol, enrofloxacin, florfenicol, spectinomycin, sulfafurazole and trimethoprim)
resistance varied between 30 and 17%. Seventy-five percent of the isolates showed multiple
antimicrobial resistance. This means resistance to three or more antimicrobial agents. This
overall high antimicrobial resistance should alert veterinarians and authorities to take measures
for decreasing antimicrobial usage and should stimulate research towards alternative strategies
for treating cattle against bacterial infections.
Since traditional treatment including antibiotic therapy is not a suitable option in the control
and/or treatment of E. coli O157:H7, the use of lactoferrin, a natural antimicrobial protein of
milk has been investigated in the present thesis for reducing E. coli O157:H7 shedding in
ruminants feces. First the effect of lactoferrin on this bacterium was tested. In Chapter 4
lactoferrin from bovine and human milk were compared for their direct effect on E. coli
O157:H7 growth. Bovine lactoferrin (bLF) had a significantly stronger inhibitory effect than
human lactoferrin (hLF). The non iron-saturated form of bovine lactoferrin (apo-bLF) reduced E.
coli O157:H7 growth significantly stronger than the iron-saturated form. In addition, all
lactoferrins, apart of their origin or iron saturation level, reduced E. coli O157:H7 attachment to
Caco-2 cells at a dose that had no effect on bacterial growth. Therefore other factors rather than simply scavenging iron from the environment and/or reducing bacterial growth plays a role
in the anti-adhesive effect of lactoferrin. In Chapter 4 we showed that this effect is at least in
part due to a catalytic effect of lactoferrin on TTSS proteins of E. coli O157:H7; EspA and EspB
which are essential for E. coli O157:H7 colonisation were cleaved. This proteolytic activity of
lactoferrin has already been shown on the TTSS apparatus of EPEC, a similar pathogen. In
conclusion, the results reported in this chapter, support the idea that lactoferrin may reduce the
colonisation of E. coli O157:H7 in vivo.
To obtain more insights in the effect of lactoferrin on the interaction of E. coli O157:H7 with
the sheep intestinal mucosa, a sheep intestinal explant model was developed. In Chapter 5 we
examined using this sheep specific in vitro model 1) the tropism of E. coli O157:H7 for ileal or
large intestinal mucosa, 2) the intestinal mucosal cytokine response induced by the mucosal E.
coli O157:H7 colonisation and 3) the effect of lactoferrin on colonisation and cytokine response.
The data presented in this chapter show that E. coli O157:H7 preferentially binds to ileal follicleassociated
epithelium, but can also bind to the normal absorptive ileal mucosa and colonic
mucosa, although to a lesser extent. We also demonstrated that this bacterial attachment could
enhance IL-8 and TNF-α mRNA expression with the increase in expression being correlated with
the number of bacteria attaching to the sheep intestinal explant. Furthermore results presented
in this chapter clearly showed that lactoferrin inhibits E. coli O157:H7 attachment to the
explants with lower IL-8 and TNF-α mRNA expression as a consequence.
In Chapter 6, we examined if lactoferrin, administered via the oral route, could reduce E. coli
O157:H7 excretion of sheep. It is not evident that the administration via this route would be
effective since the protein perhaps could become degraded in the rumen. Therefore, lactoferrin
was solublized in a bicarbonate buffer which can close the esophageal groove allowing
lactoferrin to pass rumen, reticulum and omasum so reaching the abomasum. Oral lactoferrin
was given every 12 hours for 30 days in two different doses (1.5 or 0.15 g) and the inoculation
with E. coli O157:H7 occurred 24 hours after the first lactoferrin administration. Both dosages
reduced the number of E. coli O157:H7 in sheep feces as well as the duration of fecal excretion.
Furthermore, sheep, which received the high dose of lactoferrin (1.5 g, every 12 hours) showed
a significantly higher serum antibody response against EspA and EspB in comparison with the control group. Since the peak of this antibody response was seen when the excretion of E. coli
O157:H7 had completely ceased, it could be that this immune response plays a role in reducing
the bacterial excretion in sheep orally treated with lactoferrin. Results of this study show that
lactoferrin can become a new tool in controlling E. coli O157:H7 but also other EHEC infections
by decreasing their excretion by reservoir animals.
In the last chapter of the experimental part of the present thesis, the potential of systemic
vaccination against E. coli O157:H7 in sheep was examined. Vaccination studies have previously
been performed in cattle. Some of these studies in which cattle were systemically vaccinated
with an antigen mixture containing several type III secretion system (TTSS) proteins could
significantly reduce shedding. In this chapter we wanted to know if similar result could be
obtained in sheep. This could allow us to study in a next step the mechanism of this protection
and to further optimize vaccination in sheep. Sheep were intramuscularly vaccinated with a
mixture of the TTSS proteins EspA and EspB and the surface antigen intimin g in incomplete
Freund’s adjuvant or received only the adjuvant. The data obtained in Chapter 7 showed that
the vaccination significantly reduced the fecal excretion of the bacteria. These results are
consistent with the previous studies in cattle. Although the vaccination strongly increased the
level of serum IgG against intimin, EspA and EspB, the mechanism for the observed E. coli
O157:H7 reduction in the feces still needs to be determined. Results suggest that besides oral
lactoferrin treatment also vaccination could become an important tool to reduce E. coli
O157:H7 excretion by sheep.
The fourth part of the thesis consists of the general discussion and future perspectives.
Although important steps were set towards new strategies in the control of E. coli O157:H7
infections, many questions still remain to be resolved such as: 1) Is there a tropism for the rectal
mucosa in sheep and can lactoferrin via the oral route reach the rectal mucosa and clear the
colonizing bacteria?; 2) What is the mechanism for the enhanced antibody response following
lactoferrin treatment?; 3) Is this antibody response also present in the mucosa?; 4) Can we
develop an administration form that is feasible in practice?; 5) What is the mechanism of the
reduction in excretion following vaccination?; 6) Can we still improve this clearance using more or different antigens and different adjuvants?; 7) What is the duration of this immune
mechanism in the mucosa?
Future research has to direct these questions. For some of these questions the first steps to
resolve them have already been taken.