IntroductionIngestion of food contaminated with Shiga toxin (Stx)-producing Escherichia coli, such as strain O157:H7, can cause bloody diarrhea that develops into diarrhea-associated hemolytic uremic syndrome (D ϩ HUS) that is characterized by acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. D ϩ HUS is the most common cause of acute renal failure in children and is fatal in ϳ 3%-5% of cases. 1 Several mechanisms seem to influence the course of tissue injury by Stx. Stx-producing E coli make 2 major types of Stx, each of which is composed of 1 catalytically active A subunit (ϳ 33 kDa) and 5 B subunits (ϳ 7.7 kDa) that form a homopentameric ring. Stx1 is identical to the major toxin produced by Shigella dysenteriae serotype 1. Stx2 is ϳ 50%-60% identical in sequence to Stx1 and occurs in several variants. Stx1 binds to globotriaosylceramide (Gb3) more tightly than Stx2, but Stx2 is more toxic in animal models and is more often associated with D ϩ HUS in humans than Stx1. [2][3][4] The Stx B subunits bind to Gb3 on cell surfaces and facilitate internalization of the Stx holotoxin that undergoes retrograde transport to the endoplasmic reticulum. The Stx A subunit is then translocated into the cytoplasm where it cleaves the adenine base at position 4324 of 28S ribosomal RNA, thereby blocking protein synthesis and initiating a series of responses that culminate in cell death. 5 In addition, treatment of human umbilical vein endothelial cells (HUVECs) or glomerular microvascular endothelial cells (HGMECs) with nanomolar concentrations of Stx1 or Stx2 induces rapid VWF secretion and the formation of long cellassociated VWF strings. 6 Administration of Stx2 to Adamts13 Ϫ/Ϫ mice also causes fatal microvascular thrombosis that resembles thrombotic thrombocytopenic purpura, and Adamts13 Ϫ/Ϫ mice are protected from the lethal effects of Stx if they also lack VWF. 7 We recently found that the B subunits from Stx1 or Stx2, in the absence of the A subunits, are sufficient to stimulate VWF secretion by HUVECs or HGMECs and that Stx2B subunits can induce thrombotic microangiopathy in Adamts13 Ϫ/Ϫ mice. 8 These responses indicate the existence of Stx B-induced signaling pathways that may be responsible for some of the biologic effects attributed previously to the cytotoxic Stx A subunit.At least 3 signaling pathways can contribute to agonist-induced secretion of VWF. Histamine and thrombin activate phospholipase C (PLC)- that generates inositol 1,4,5-triphosphate (IP 3 ) and diacylglycerol. IP 3 increases the level of intracellular Ca 2ϩ that is required for VWF secretion induced by these agonists. In contrast, epinephrine and vasopressin induce VWF secretion by increasing intracellular cAMP and activating protein kinase A (PKA). 9 Alternatively, vascular endothelial growth factor (VEGF) stimulates VWF secretion through a pathway that depends on protein kinase C (PKC)-␦ but not on Ca 2ϩ or cAMP. 10 Whether any of these pathways contribute to Stx B-induced VWF secretion has not been determined previous...