Abstract. In vitro and in vivo studies were conducted to assess the response of cholera toxin (CT) production to increasing iron concentrations in an aquatic environment. Production of CT by seven of eight Vibrio cholerae strains tested, including the Bengal strain (O139), was significantly enhanced in the presence of iron concentrations of 1.0 and 10 g/L. The exception (El Tor Ogawa) had a significant CT response only in the presence of 10 g of iron/L. Enhancement of CT production also occurred at iron concentrations less than 1.0 g/L, but not to a statistically significant degree. The high iron concentrations, which in this study were found to stimulate CT production, have been described by others in association with sediments, water plants, and chitinous fauna. Other investigators have shown a predilection by V. cholerae to attach to these sites in the aquatic environment. The importance of excess in vivo iron with respect to the pathogenicity of several gram-negative bacilli is well recognized. However, the possible impact of environmental iron on the in vitro toxigenicity of a microorganism, in this case V. cholerae in its aquatic environment, is to the best of our knowledge a new finding with important epidemiologic implications. These findings, coupled with the fact that iron concentration is considerably enhanced in industrially polluted waters and sediments, may reflect a causal link between the concurrent global upsurge of industrialization and pandemic occurrence of cholera during the latter half of the 20th century. Enhanced toxigenicity may also cause clinical disease following ingestion of lower than usual infective doses of cholera vibrios, thereby increasing the incidence of symptomatic cases and, possibly, of severe cases.Iron is an essential component of many enzymes and other proteins and is required for growth of virtually all bacteria. 1 The environment as well as animal hosts have limited amounts of free iron available for microbial growth since the metal forms insoluble complexes at neutral or alkaline pH and is sequestered in hosts by iron-binding proteins. One specific iron acquisition system found in some pathogens, including Vibrio cholerae, consists of a microbially produced iron-binding compound, or siderophore, and proteins associated with the transport and use of chelated iron. Environmental strains of V. cholerae produce more siderophore than clinical isolates. 2 The iron transport system is related to increased virulence of some invasive pathogens. Low or unavailable iron may trigger virulence factors such as the shiga toxin of Shigella dysenteriae, 3 diphtheria toxin of Corynebacterium diphtheriae, 4 shiga-like toxin I of enterohemorrhagic Escherichia coli, 5 and exotoxin A of Pseudomonas aeruginosa. 6,7 A previous study showed that V. cholerae survival time in water significantly increased with increasing iron levels up to optimum values of 0.1-1.0 g/L (pH 7) and 0.01-0.1 g/L (pH 9-11), above which survival decreased. 8 Vibrio cholerae is a noninvasive bacillus that exerts its ...