The natural diversity of the elt operons, encoding the heat-labile toxin LT-I (LT), carried by enterotoxigenic Escherichia coli (ETEC) strains isolated from humans was investigated. For many years, LT was supposed to be represented by a rather conserved toxin, and one derivative, produced by the reference H10407 strain, was intensively studied either as a virulence factor or as a vaccine adjuvant. Enterotoxigenic Escherichia coli (ETEC)-associated diarrhea represents a major cause of mortality and morbidity among children and travelers, respectively, in most developing countries in Latin America, Africa, and Asia (3, 33). ETEC secretory diarrhea involves a rather straightforward pathogenesis plan, requiring first colonization of small intestine epithelial cells by means of filamentous adhesins collectively known as colonization factors (CFs) and, at a second stage, production of at least one out of two enterotoxin types, the heat-stable toxin (ST) and/or the heat-labile toxin (LT) (28, 36). One of the most complex aspects of ETEC pathogenesis is the remarkable antigen heterogeneity. At least 150 O:H serotypes have been found among ETEC strains isolated from humans, although a more restricted number of serotype combinations is detected among strains isolated from patients requiring medical intervention, also characterized, in some cases, by a conserved set of virulence-associated factors and a common clonal origin (29,30,46). Moreover, the ETEC phenotypic heterogeneity is also well illustrated by the encoded virulence-associated factors, including more than 20 known CFs and production of LT, ST, or both enterotoxins (10,33,46). Two types of ST, STa and STb (also known as ST-I and ST-II), have been differentiated based on biological and chemical features (7,11). Similarly, LTs produced by ETEC strains are also a heterogeneous group of toxins. Two major LT families have been identified, LT-I and LT-II. LT-II is rarely found among human-derived ETEC strains, but two natural variants have been reported, LT-IIa and LT-IIb, based on differences in the subunit sequences (14, 16). LT-I shows a rather high similarity with cholera toxin (CT) (over 80% amino acid identity), and both have been intensively studied as virulence factors and modulators of immune responses in mammalian species, including humans (18,28).The known natural variability of LT-I toxins expressed by ETEC strains has been mainly restricted to the differences detected between LTs produced by human (LTh)-and pig (LTp)-derived strains. Initial evidence based on the antigenicities and electrophoretic mobilities of LTh and LTp indicated that the toxins differ in their primary amino acid sequences (19,42). Sequencing of the elt operons encoding LTh and LTp revealed differences in the primary sequences of the toxins, which share over 95% identity along the complete amino acid sequence (45). Altogether, six amino acid replacements were detected between the A subunits (K4R, K213E, and N238D) and the B subunits (S4T, A46E, and E102K) of LTh and LTp derived from th...