Nontypeable Haemophilus influenzae (NTHi) is a common cause of localized respiratory tract disease and initiates infection by colonizing the nasopharynx. Approximately 75 to 80% of NTHi clinical isolates produce proteins that belong to the HMW family of adhesins, which are believed to facilitate colonization. The prototype HMW adhesins are designated HMW1 and HMW2 and were identified in NTHi strain 12. HMW1 and HMW2 are 71% identical and 80% similar overall, yet display differing cellular binding specificities. In the present study we set out to define more clearly the relationships between HMW1 and HMW2 and other members of the HMW family of adhesins. PCR analysis of 49 epidemiologically distinct isolates revealed that all strains possessing hmw genes as determined by Southern analysis contain two hmw loci in conserved, unlinked physical locations on the chromosome. Functional analysis of the HMW adhesins produced by three unrelated strains demonstrated that each isolate possesses one protein with HMW1-like adherence properties and another with HMW2-like adherence properties. These findings suggest that the hmw1 and hmw2 loci may have arisen via a gene duplication event in an ancestral strain. In addition, they support the hypothesis that the distinct binding specificities of HMW1 and HMW2 emerged early and have persisted over time, suggesting an ongoing selective advantage.Nontypeable Haemophilus influenzae (NTHi) strains are commensal organisms in the nasopharynx and are also a frequent cause of localized respiratory tract disease, including otitis media, conjunctivitis, sinusitis, pneumonia, and exacerbations of chronic bronchitis (13,29,38). The pathogenesis of NTHi disease begins with colonization of the nasopharynx, followed by contiguous spread within the respiratory tract. Successful colonization requires that the organism overcome the mucociliary escalator, a task accomplished in part by adherence to respiratory epithelium (29,38). NTHi adherence is mediated by both pilus and nonpilus adhesins. In experiments with cultured human epithelial cells, the major nonpilus adhesins were found to be HMW1/HMW2 and Hia (20,22,33,35). Based on examination of several collections of epidemiologically distinct NTHi strains, approximately 75 to 80% of isolates produce HMW1/HMW2-like proteins, while most of the remaining isolates produce Hia (7, 20, 36). Of note, isolates produce either HMW1/HMW2-like proteins or Hia, but not both (7,20,36).The HMW adhesins were first identified as major targets of the human serum antibody response during acute otitis media (4). The prototype proteins are designated HMW1 and HMW2 and are produced by NTHi strain 12, the strain from which they were originally cloned and sequenced (5). HMW1 and HMW2 are encoded by separate chromosomal loci, with each locus consisting of three genes, designated hmwA, hmwB, and hmwC. The hmwA genes encode the surface-exposed adhesins (HMW1 and HMW2), and the hmwB and hmwC genes encode accessory proteins required for processing and secretion of the adhesins ...