Bacterial Toxins Classification Dr.Faghri Meisam.Roozbahani
May 24, 2015
Bacterial
Toxins Classification
Dr.Faghri
Meisam.Roozbahani
Introduction
Toxins were the first bacterial virulence factors to be identified and were also the first link between bacteria and cell biology.
Introduction
Cellular microbiology was, in fact, naturally born a long time ago with the study of toxins, and only recently, thanks to the sophisticated new technologies, has it expanded to include the study of many other aspects of the interactions between bacteria and host cells.
Two Main Categories of Toxins
Specific Host Site Exotoxins
Neurotoxins Enterotoxins Cytotoxins
Nephrotoxin
Hepatotoxin
Cardiotoxin
Classification by Entrance Mechanism
Acting on intracellular
targets
Injected into eukaryotic cells
Unknown mechanism of
action
Acting on the cell surface
Immune system (Superantigens)
Clas
sTa
rget
Surface molecules
Cell membrane
Large pore- forming toxins
Small pore- forming toxins
Insecticidal toxins
Membrane-perturbing toxins
Other pore- forming toxins
RTX toxins
Protein synthesis Mediators of apoptosis
Signal transduction
Cytoskeleton structure
Intracellular trafficking
Inositol phosphate metabolism
Cytoskeleton
Signal transduction
Toxins acting on the cell surface: Immune system (Superantigens)
Superantigens are bacterial and viral proteins that share the ability to activate a large fraction of T-lymphocytes.
Toxins acting on the cell surface: Immune system (Superantigens)Toxin Organism Activity Consequence
SEA-SEI, TSST-1, SPEA, SPEC, SPEL, SPEM, SSA, and SMEZ
Staphylococcusaureus and Streptococcuspyogenes
Binding to MHC class II molecules and to Vβ or Vγ of T cell receptor
T cell activation and cytokines secretion
MAM Mycoplasmaarthritidis
Binding to MHC class II molecules and to Vβ or Vγ of T cell receptor
Chronic inflammation
YPMa Yersiniapseudotuberculosis
Binding to MHC class II molecules and to Vβ or Vγ of T cell receptor
Chronic Inflammation
SPEB S. pyogenes Cysteine proteaseAlteration in Immunoglobulin binding properties
ETA, ETB, and ETD S. aureus Trypsin-like serineproteases
T-cell proliferation,intraepidermal layer separation
Agr Regulatory System
Toxins acting on the cell surface: Surface molecules
BFT enterotoxin: The pathogenicity of ETBF is ascribed to a heat-labile ∼20-kDa toxin (B. fragilis toxin [BFT], also called fragilysin).
This toxin binds to a specific intestinal epithelial cell receptor and stimulates cell proliferation.
Zonula
BFT enterotoxin
Toxins acting on the cell surface: Surface moleculesToxin Organism Activity Consequence
BFT enterotoxin Bacteroides fragilis Metalloprotease, cleavage of E-cadherin
Alteration of epithelialpermeability
AhyB Aeromonashydrophyla
E l a s t a s e ,metalloprotease
Hydrolization of casein and elastine
Aminopeptidase Pseudomonasaeruginosa
E l a s t a s e ,metalloprotease
Corneal infection, inflammation and ulceration
ColH Clostridiumhistolyticum
Collagenase,metalloprotease
Collagenolytic activity
Nhe Bacillus cereus Metalloprotease andcollagenase
Collagenolytic activity
Toxins acting on the cell surface:Pore-Forming Protein toxins forming pores in biological membranes
occur frequently in Gram-positive and Gram-negative bacteria.
Pore-forming toxins, also known as "lytic factors". Some of them are also called "hemolysins“.
Toxins acting on the cell surface:Large Pore-Forming Toxins
Generally secreted by diverse species of Gram-positive bacteria.
Binding selectively to cholesterol on the eukaryotic cell membrane.
Toxins acting on the cell surface: Large pore forming toxinsToxin Organism Activity Consequence
PFO C. perfringensThiol-activated cytolysin, cholesterol Binding
Gas gangrene
SLO S. pyogenesThiol-activated cytolysin, cholesterol Binding
Transfer of other toxins, cell death
LLO Listeria monocytogenesInduction of Lymphocyte apoptosis Membrane damage
Pneumolysin S. pneumoniae Induction of Lymphocyte Apoptosis
Complement activation, cytokine production, apoptosis
Toxins acting on the cell surface: Small pore forming toxins
Creating very small pores 1-1.5 nm diameter. Selective permeabilization to solutes with a
molecular mass less than 2 kDa.
Toxins acting on the cell surface: Small pore forming toxinsToxin Organism Activity Consequence
Alveolysin B. alveis Induction of lymphocyte Apoptosis
Complement activation, cytokine production, apoptosis
ALO B. anthracis Induction of lymphocyte apoptosis
Complement activation, cytokine production, Apoptosis
α-Toxin S. aureus Binding of erythrocytes Release of cytokines, cell lysis, apoptosis
PVL leukocidin(LukS-LukF) S. aureus Cell membrane
permeabilizationNecrotic enteritis, rapid shock-like syndrome
γ-Hemolysins(HlgA- HlgB andHlgC- HlgB)
S. aureus Cell membrane permeabilization
Necrotic enteritis, rapid shock-like syndrome
β-Toxin C. perfringens Cell membrane permeabilization Necrotic enteritis, neurologic effects
Toxins acting on the cell surface: RTX toxins
The RTX toxin family is a group of cytotoxins produced by Gram-negative bacteria.
There are over 1000 known members with a variety of functions.
Toxins acting on the cell surface: RTX toxins The RTX family is defined by two common features:
characteristic repeats in the toxin protein sequences, and extracellular secretion by the type I secretion system (T1SS).
The name RTX (repeats in toxin) refers to the glycine and aspartate-rich repeats located at the C-terminus of the toxin proteins.
Genomic Structure
The toxin is encoded by four genes, one of which, hlyA, encodes the 110-kDa hemolysin. The other genes are required for its posttranslational modification (hlyC) and secretion (hlyB and hlyD).
Toxins acting on the cell surface: RTX toxins
Toxin Organism Activity Consequence
Hemolysin II
B. cereus Cell membrane permeabilization Hemolytic activity
CytK B. cereus Cell membrane Permeabilization Necrotic enteritis
HlyA E. coli Calcium-dependent formation of transmembrane Pores
Cell permeabilization and lysis
Toxins acting on the cell surface: Membrane perturbing toxins
Soap like structure. The toxin binds nonspecifically parallel to the
surface of any membrane without forming transmembrane channels.
Cells first become permeable to small solutes and eventually swell and lyse, releasing cell intracellular content.
Toxins acting on the cell surface: Membrane perturbing toxinsToxin Organism Activity Consequence
ApxI, ApxII, and ApxIII A.pleuropneumoniae Calcium-dependent formation
of transmembrane PoresLysis of erythrocytes and other nucleated Cells
LtxA A.actinomycetemcomitans
Calcium-dependent formation of transmembrane Pores Apoptosis
LtxA P.Haemolytica Calcium-dependent formation of transmembrane Pores
Activity specific versus ruminant leukocytes
Toxins acting on the cell surface: Other pore forming toxins Like other functionally related toxins, aerolysin
changes its topology in a multi-step process from a completely water-soluble form to a membrane-soluble heptameric transmembrane channel that destroys sensitive cells by breaking their permeability barriers.
Toxins acting on the cell surface: Other pore forming toxinsToxin Organism Activity Consequence
δ-Hemolysin S. aureus Perturbation of the lipid
bilayer Cell permeabilization and lysis
Aerolysin A. hydrophila Perturbation of the lipid bilayer Cell permeabilization and lysis
AT C. septicum Perturbation of the lipid bilayer Cellpermeabilization and lysis
Toxins acting on the cell surface: Insecticidal toxins
The class of insecticidal proteins, also known as
δ-endotoxins, includes a number of toxins produced by species of Bacillus thuringiensis. These exert their toxic activity by making pores in
the epithelial cell membrane of the insect midgut.
Toxins acting on the cell surface: Insecticidal toxins
δ-Endotoxins form two multigenic families, cry and cyt; members of the cry family are toxic to insects of
Lepidoptera, Diptera and Coleoptera orders (Hofmann et al., 1988),
whereas members of the cyt family are lethal specifically to the larvae of Dipteran insects (Koni and Ellar, 1994).
Lepidoptera is a large order of insects that includes moths and butterflies.True flies are insects of the order Diptera.Coleoptera is an order of insects commonly called beetles.
Toxins acting on the cell surface: Insecticidal toxinsToxin Organism Activity Consequence
PA B. anthracis Perturbation of the lipid bilayer Cell permeabilization and lysis
HlyE E. coli Perturbation of the lipid bilayer Osmotic lysis of cells lining the Midgut
CryIA, CryIIA,CryIIIA, etc
Bacillus thuringiensis
Destruction of the transmembranePotential
Osmotic lysis of cells lining the Midgut
CytA, CytB B. thuringiensisDestruction of the transmembranePotential
Osmotic lysis of cells lining the Midgut
BT toxin B. thuringiensisDestruction of the transmembranePotential
Cytocidal activity on human cells
Toxins Acting on Intracellular Targets
The group of toxins with an intracellular target (A/B toxins) contains many toxins with different structures that have only one general feature in common: they are composed of two domains generally identified as "A" and "B.“
Acting on intracellular
targets
Injected into eukaryotic cells
Unknown mechanism of
action
Acting on the cell surface
Immune system (Superantigens)
Clas
sTa
rget
Surface molecules
Cell membrane
Large pore- forming toxins
Small pore- forming toxins
Insecticidal toxins
Membrane-perturbing toxins
Other pore- forming toxins
RTX toxins
Protein synthesis Mediators of apoptosis
Signal transduction
Cytoskeleton structure
Intracellular trafficking
Inositol phosphate metabolism
Cytoskeleton
Signal transduction
Toxins Acting on Intracellular Targets
The A domain is the active portion of the toxin; it usually has enzymatic activity and can recognize and modify a target molecule within the cytosol of eukaryotic cells.
The B domain is usually the carrier for the A subunit; it bind the receptor on the cell surface and facilitates the translocation of A across the cytoplasmic membrane.
Toxins acting on intracellular targets: Protein synthesis
These toxins are able to cause rapid cell death at extremely low concentrations.
This reaction leads to the formation of a completely inactive EF2-ADP-ribose complex.
Toxins acting on intracellular targets: Protein synthesis
A very important step in the elucidation of the mechanism of enzymatic activity has been the determination of the crystal structure for the complex of diphtheria toxin with NAD.
Upon the addition of NAD to nucleotide-free DT crystals, a significant structural change.
This change lead to recognition and binding of the acceptor substrate EF-2.
This would explain why DT recognizes EF-2 only after NAD has bound.
Toxins acting on intracellular targets: Protein synthesis
Toxins acting on intracellular targets: Protein synthesisToxin Organism Activity Consequence
DT Corynebacterium diphtheriae ADP-ribosylation of EF-2 Cell death
PAETA P. aeruginosa ADP-ribosylation of EF-2 Cell death
SHT S. dysenteriae N-glycosidase activity on 28S RNA Cell death, apoptosis
Toxins acting on intracellular targets: Signal transduction
Two types of transduction mechanism: Tyrosine phosphorylation
Modification of a receptor-coupled GTP-binding protein cyclic AMP
inositol triphosphate
diacylglycerol
Pertussis toxin
PT Subunits
A
B
Cholera toxin (CT) and E. coli heat-labile enterotoxins (LT-I and LT-II)
Cholera toxin (CT) and E. coli heat-labile enterotoxins (LT-I and LT-II) share an identical mechanism of action and homologous primary and 3D structures.
While V. cholerae exports the CT toxin into the culture medium, LT remains associated to the outer membrane bound to lipopolysaccharide.
The corresponding genes of CT and LT are organized in a bicistronic operon and are located on a filamentous bacteriophage and on a plasmid, respectively.
Clostridium difficile Toxins
Enterotoxin A (TcdA) and cytotoxin B (TcdB) of Clostridium difficile are the two virulence factors responsible for the induction of antibiotic-associated diarrhea.
The toxin genes tcdA and tcdB together with three accessory genes (tcdC-E) constitute the pathogenicity locus (PaLoc) of C. difficile.
Toxins acting on intracellular targets: Signal transduction 1Toxin Organism Activity Consequence
PT Bordetella pertussis
ADP-ribosylation of Gi cAMP increase
CT Vibrio cholerae ADP-ribosylation of Gi cAMP increase
LT E. coli ADP-ribosylation of Gi cAMP increase
α-Toxin (PLC) C. perfringens Zinc-phospholipase C, hydrolase Gas gangrene
Toxins A and B (TcdA and TcdB) C. difficile Monoglucosylation of Rho, Rac,
Cdc42Breakdown of cellular actin stress fibers
Adenylate cyclase (CyaA) B. pertussis Binding to calmodulin
ATP→cAMP conversion cAMP increase
Anthrax Edema and Lethal Factors
The EF and LF genes are located on a large plasmids.
Cleavage of the N-terminal signal peptides yields mature EF and LF proteins.
LF, is able to cause apoptosis in human endothelial cells.
E. coli Cytotoxin Necrotizing Factors and Bordetella Dermonecrotic Toxin
CNF1 & CNF2: produced by a number of uropathogenic and neonatal meningitis-causing pathogenic E. coli strains.
cnf1 is chromosomally encoded, cnf2 is carried on a large transmissible F-like plasmid called "Vir“.
DNT is a transglutaminase, which causes alteration of cell morphology, reorganization of stress fibers, and focal adhesions on a variety of animal models.
Cytolethal Distending Toxins
HdCDT is a complex of three proteins (CdtA, CdtB and CdtC) encoded by three genes that are part of an operon.
Members of this family have been identified in E. coli, Shigella, Salmonella, Campylobacter, Actinobacillus and Helicobacter hepaticus.
Toxins acting on intracellular targets: Signal transduction 2Toxin Organism Activity Consequence
Anthrax edema factor (EF) B. anthracis Binding to calmodulin
ATP→cAMP conversion cAMP increase
Anthrax lethal factor (LF) B. anthracis Cleavage of MAPKK1 and
MAPKK2 Cell death, apoptosis
Cytotoxin necrotizing factors 1 and 2 (CNF1, 2)
E. coli Deamidation of Rho, Rac and Cdc42
Ruffling, stress fiber formation.
DNT Bordetella species
Transglutaminase, deamidation or polyamination of Rho GTPase
Ruffling, stress fiber formation
CDT Several speciesDNA damage, formation of actin stress fibers via activation of RhoA
Cell-cycle arrest, cytotoxicity, apoptosis
Toxins acting on intracellular targets: Cytoskeleton structure
The cytoskeleton is a cellular structure that consists of a fiber network composed of microfilaments, microtubules, and the intermediate filaments.
It controls a number of essential functions in the eukaryotic cell: exo- and endocytosis
vesicle transport
cell-cell contact
and mitosis
Toxins acting on intracellular targets: Cytoskeleton structure
Most of them do it by modifying the regulatory, small G proteins, such as Ras, Rho, and Cdc42, which control cell shape.
Lymphostatin
Lymphostatin is a very recently identified protein in enteropathogenic strains of E. coli
Lymphostatin selectively block the production of interleukin-2, IL-4, IL-5 and γ interferon by human cells and inhibit proliferation of these cells, thus interfering with the cellular immune response.
Toxins acting on intracellular targets: Cytoskeleton structureToxin Organism Activity Consequence
Toxin C2 and related proteins C. botulinum ADP-ribosylation of monomeric G
actin Failure in actin polymerization
Lymphostatin E. coli Block of interleukin production Chronic diarrhea
Iota toxin and related proteins C. perfringens Block of interleukin production Chronic diarrhea
Toxins acting on intracellular targets: Intracellular trafficking
Vesicle structures are essential in: receptor-mediated endocytosis and exocytosis
One example of exocytic pathway is that involving the release of neurotransmitters
Mechanism of action of clostridial neurotoxins (CNT)
Synaptosomal-associated protein 25 (SNAP-25)
Helicobacter pylori Vacuolating Cytotoxin Vac A
This toxin is responsible for massive growth of vacuoles within epithelial cells.
VacA can insert into membranes forming hexameric, anion-selective pores.
Toxins acting on intracellular targets: Intracellular traffickingToxin Organism Activity Consequence
TeNT C. tetanii Cleavage of VAMP/ synaptobrevin Spastic paralysis
BoNT-B, D, G and F neurotoxins C. botulinum Cleavage of VAMP/ synaptobrevin Flaccid paralysis
BoNT-A, E neurotoxins C. botulinum Cleavage of SNAP-25 Flaccid paralysis
BoNT-C neurotoxin C. botulinum Cleavage of syntaxin, SNAP-25 Flaccid paralysis
Vacuolating cytotoxin VacA H. pylori Alteration in the endocytic pathway Vacuole formation,
apoptosis
NAD glycohydrolase S. pyogenes Keratinocyte apoptosis Enhancement of GAS proliferation
Toxins injected into eukaryotic cells
These bacteria intoxicate individual eukaryotic cells by using a contact-dependent secretion system to inject or deliver toxic proteins into the cytoplasm of eukaryotic cells.
This is done by using specialized secretion systems that in Gram-negative bacteria are called "type III" or "type IV,“.
Toxins injected into eukaryotic cells: Mediators of apoptosis: IpaB in Shigella
Shigella invasion plasmid antigen (Ipa) proteins: IpaA, IpaB, IpaC, IpaD.
Only IpaB is required to initiate cell death.
Acting on intracellular
targets
Injected into eukaryotic cells
Unknown mechanism of
action
Acting on the cell surface
Immune system (Superantigens)
Clas
sTa
rget
Surface molecules
Cell membrane
Large pore- forming toxins
Small pore- forming toxins
Insecticidal toxins
Membrane-perturbing toxins
Other pore- forming toxins
RTX toxins
Protein synthesis Mediators of apoptosis
Signal transduction
Cytoskeleton structure
Intracellular trafficking
Inositol phosphate metabolism
Cytoskeleton
Signal transduction
Toxins injected into eukaryotic cells: Mediators of apoptosis: SipB in Salmonella
An analog of Shigella invasin IpaB. In contrast to Shigella, Salmonella does not escape
from the phagosome, but it survives and multiplies within the macrophages.
Salmonella virulence genes are encoded by a chromosomal operon named sip containing five genes (sipEBCDA).
Toxins injected into eukaryotic cells: Mediators of apoptosisToxin Organism Activity Consequence
IpaB Shigella Binding to ICE Apoptosis
SipB Salmonella Cysteine proteases Apoptosis
YopP/YopJ
Yersinia species
Cysteine protease, blocks MAPK and NFkappaB pathways Apoptosis
Toxins injected into eukaryotic cells: Inositol phosphate metabolism
SopB: in Salmonella is homologous to the Shigella flexneri lpgD virulence factor.
Both proteins contain two regions of sequence similarities with human inositol polyphosphatases types I and II.
Toxins injected into eukaryotic cells: Inositol phosphate metabolismToxin Organism Activity Consequence
SopB Salmonella species
Inositol phosphate phosphatase, cytoskeleton rearrangements
Increased chloride secretion (diarrhea)
IpgD S. flexneri Inositol phosphate phosphatase, cytoskeleton rearrangements
Increased chloride secretion (diarrhea)
Toxins injected into eukaryotic cells: Signal transductionToxin Organism Activity Consequence
ExoS P. aeruginosa ADP-ribosylation of Ras, Rho GTPase Collapse of cytoskeleton
C3 exotoxin C. botulinum ADP-ribosylation of Rho Breakdown of cellular actin stress
fibers
EDIN-A, B and C S. aureus ADP-ribosylation of Rho Modification of actin cytoskeleton
SopES. typhimurium
Rac and Cdc42 activationMembrane ruffling, cytoskeletal reorganization, proinflammatory cytokines production
SipAS. typhimurium
Rac and Cdc42 activationMembrane ruffling, cytoskeletal reorganization, proinflammatory cytokines production
IpaA Shigella species Vinculin binding Depolymerization of actin
filaments
YopE Yersinia species
GAP activity towards RhoA, Rac1 or Cdc42
Cytotoxicity, actin depolymerization
YopT Yersinia species
Cysteine protease, cleaves RhoA, Rac, and Cdc42 releasing them from the membrane
Disruption of actin cytoskeleton
VirA Shigella flexneri Inhibition of tubulin polymerization Microtubule destabilization
and membrane ruffling
Toxins injected into eukaryotic cells: Signal transductionToxin Organism Activity Consequence
YpkA Yersinia species Protein serine/threonine kinase Inhibition of phagocytosis
YopH Yersinia species Tyrosine phosphatase Inhibition of phagocytosis
Tir E. coli EPEC Receptor for intimin Actin nucleation and pedestalformation
CagA H. pylori Tyrosine phosphorylated Cortactin dephosphorylation
YopM Yersinia species
Interaction with PRK2 and RSK1 kinases Cytotoxicity
SptP S. typhimurium
Inhibition of the MAP kinase pathway
Enhancement of Salmonella capacity to induce TNF-alpha secretion
ExoU P. aeruginosa Lysophospholipase A activity Lung injury
Toxins with unknown mechanism of actionToxin Organism Activity Consequence
Zot V. cholerae ? Modification of intestinal tight junction permeability
Hemolysin BL (HBL) B. cereus Hemolytic, dermonecrotic and
vascular permeability activitiesFood poisoning, fluid accumulation and diarrhea
BSH L. monocytogenes ? Increased bacterial survival and
intestinal colonization
Abbreviations
SEA-SEI, staphylococcal enterotoxins SHT, Shiga toxin;
TSST, toxic shock syndrome toxin PT, pertussis toxin;
SPE, streptococcal exotoxin CT, cholera toxin;
SSA, streptococcal superantigen LT, heat-labile enterotoxin;
SMEZ, streptococcal mitogenic exotoxin z DNT, dermonecrotic toxin;
MAM, Mycoplasma arthritidis mitogen CDT, cytolethal distending toxin;
YPMa, Y. pseudotuberculosis-derived mitogen TeNT, tetanus neurotoxin;
ETA and ETB, exfoliative toxins RTX, repeats in the structural toxin;
ColH, collagenase Hly, hemolysin;
Nhe, nonhemolytic entertoxin Cry, crystal;
PFO, perfringolysin O; BoNT, botulinum neurotoxin;
SLO, streptolysin O; Ipa, invasion plasmid antigen;
Abbreviations
LLO, listeriolysin O; Sip, Salmonella invasion protein;
ALO, anthrolisin O; EDIN, epidermal cell differentiation inhibitor;
AT, α-toxin; Sop, Salmonella outer protein;
PA, protective antigen; Ipg, invasion plasmid gene;
DT, diphtheria toxin; Yop, Yersinia outer protein;
PAETA, Pseudomonas aeruginosa exotoxin A; GAP, GTPase-activating protein;
GAS, group A Streptococcus; Vir, virulence protein;
YpkA, Yersinia protein kinase A; Tir, translocated intimin receptor;
EPEC, enteropathogenic E. coli; CagA, cytotoxin-associated gene A;
SptP, Salmonella protein tyrosine phosphatase; VAMP, vesicle-associated membrane protein;
ICE, interleukin-1β-converting enzyme; SNAP, synaptosome-associated protein;
MAPKK, mitogen-activated protein kinase ; Zot, zonula. occludens toxin; and BSH, bile salt hydrolase.
Enzymatic activities
Glucosyl-transferases
Deamidases
ADP-ribosyltransferases
N-Glycosidases
Metalloproteases
DT Elongation factor EF-2 Cell death
PAETA Elongation factor EF-2 Cell death
PT Gi, Go and transducin
CTGs, Gt and Golf
cAMP increase
E. coli LT
Clostridium botulinum C2 Actin Failure in actin
P. aeruginosa ExoS Ras Collapse of cytoskeleton
Clostridium botulinum C3 Rho Breakdown of cellular actin stress fibers
ADP-
ribos
yltr
ansf
eras
esToxin Substrate Effect
Clostridium difficile toxins A and B Rho/Ras GTPases Breakdown of cytoskeletal structure
Toxin Substrate Effect
Glucosyl-transferases
DeamidasesE. coli CNF1 Rho, Rac and CdC42
Bordetella DNT Rho, Stress fiber formation
Shiga toxin Ribosomal RNA
Disruption of normal homoeostatic functions
N-Glycosidases
Metalloproteases
Bacillus anthracis LF Macrophages
Clostridium tetanii TeNT VAMP/synaptobrevin Spastic paralysis
Flaccid paralysisC. botulinum BoNTs VAMP/synaptobrevin, SNAP-25
Stop of protein synthesis
Abbreviations
SNAP-25, synaptosome-associated protein of 25 kDa.
CNF1, cytotoxin necrotizing factor 1;
DNT, dermonecrotic factor; DT, diphtheria toxin;
PAETA, Pseudomonas aeruginosa exotoxin A; PT, pertussis toxin;
CT, cholera toxin; LT, heat-labile enterotoxin;
ExoS, exoenzyme S; LF, lethal factor;
TeNT, tetanus neurotoxin; BoNT, botulinum neurotoxin;
VAMP, vesicle associated membrane protein;
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