Enteropathogenic Escherichia coli (EPEC) induces a characteristic histopathology on enterocytes known as the attaching-and-effacing (A/E) lesion, which is triggered by proteins encoded by the locus of enterocyte effacement (LEE). EPEC is currently classified as typical EPEC (tEPEC) and atypical EPEC (aEPEC), based on the presence or absence of the EPEC adherence factor plasmid, respectively. Here we analyzed the LEE regions of three aEPEC strains displaying the localized adherence-like (LAL), aggregative adherence (AA), and diffuse adherence (DA) patterns on HEp-2 cells as well as one nonadherent (NA) strain. The adherence characteristics and the ability to induce A/E lesions were investigated with HeLa, Caco-2, T84, and HT29 cells. The adherence patterns and fluorescent actin staining (FAS) assay results were reproducible with all cell lines. The LEE region was structurally intact and functional in all strains regardless of their inability to cause A/E lesions. An EspF U -expressing plasmid (pKC471) was introduced into all strains, demonstrating no influence of this protein on either the adherence patterns or the capacity to cause A/E of the adherent strains. However, the NA strain harboring pKC471 expressed the LAL pattern and was able to induce A/E lesions on HeLa cells. Our data indicate that FAS-negative aEPEC strains are potentially able to induce A/E in vivo, emphasizing the concern about this test for the determination of aEPEC virulence. Also, the presence of EspF U was sufficient to provide an adherent phenotype for a nonadherent aEPEC strain via the direct or indirect activation of the LEE4 and LEE5 operons.Diarrheal diseases are responsible for about 2 million deaths of children all over the world per year, mainly in developing countries (7). Enteropathogenic Escherichia coli (EPEC) is among the leading agents of acute infantile diarrhea (25,28,57). EPEC has been classified into two subgroups, named typical EPEC (tEPEC) and atypical EPEC (aEPEC), based on the presence or absence of the EPEC adherence factor plasmid (pEAF), respectively (27).The hallmark of EPEC pathogenesis is the ability to cause the attaching-and-effacing (A/E) lesion, which results from intimate bacterial adhesion to the intestinal epithelium, the effacement of local microvilli, and the accumulation of polymerized actin and other cytoskeleton elements at the site of bacterial attachment, forming pedestal-like structures (42). The capacity to cause A/E in vitro can be verified by the fluorescent actin staining (FAS) test, which detects polymerized actin aggregation at the site of bacterial attachment (33).A/E lesion-related genes are located in a pathogenicity island named the locus of enterocyte effacement (LEE) (28, 38).The LEE is organized into 5 operons (LEE1 to LEE5), where LEE1 to LEE3 encode type III secretion system (T3SS) proteins and the LEE-encoded regulator (Ler) (18,40), LEE4 encodes the secreted proteins that form the external part of the T3SS used to translocate effector proteins to the host cell, and LEE5 encodes th...