Table 1

Summary of diverse biological effects of Stx, SPATEs, and polyphosphate that modulate activation of complement and coagulation during STEC-HUS

Summary of diverse biological effects of Stx, SPATEs, and polyphosphate
Stx  
 Direct effects that promote complement activation • Induces release and cell surface expression of P-selectin (receptor for C3b) 
• Induces release of VWF (site for AP convertase assembly) 
• Interferes with functions of FH 
• Induces release of C3- and C9-bearing microparticles from platelets and monocytes 
 Direct effects that induce endothelial damage and activation of coagulation • Activates endothelial cells, platelets, monocytes, and neutrophils 
• Induces release of reactive oxygen species from neutrophils 
• Induces expression of TF 
• Suppresses expression of TM and TF pathway inhibitor 
• Induces endothelial expression of leukocyte adhesion molecules (e.g., ICAM-1, VCAM-1) 
• Induces platelet-neutrophil interactions 
• Interferes with cleavage of ULVWF by ADAMTS13 and FH 
• Promotes release of TF-bearing microparticles 
• Induces proinflammatory cytokine (e.g., TNF, IL-8) release by endothelial cells and monocytes 
SPATEs  
 Pic • Proteolyses and inactivates C2, C3/C3b, C4/C4b 
• Des-arginates C3a 
 EspP • Proteolyses and inactivates C3/C3b, C5 
• Inactivates coagulation factor V and α2-antiplasmin 
 StcE • Cleaves C1-INH and increases its neutralization of C1s and MASP 
• Binds to host/pathogen surfaces and tethers C1-INH 
PolyP • Promotes coagulation activation at several steps in cascade 
• Destabilizes C5b,6 and interferes with MAC assembly on host and pathogen 
• Binds to C1-INH and increases its neutralization of C1s and MASP 
• Binds to FH (function unknown) 
Summary of diverse biological effects of Stx, SPATEs, and polyphosphate
Stx  
 Direct effects that promote complement activation • Induces release and cell surface expression of P-selectin (receptor for C3b) 
• Induces release of VWF (site for AP convertase assembly) 
• Interferes with functions of FH 
• Induces release of C3- and C9-bearing microparticles from platelets and monocytes 
 Direct effects that induce endothelial damage and activation of coagulation • Activates endothelial cells, platelets, monocytes, and neutrophils 
• Induces release of reactive oxygen species from neutrophils 
• Induces expression of TF 
• Suppresses expression of TM and TF pathway inhibitor 
• Induces endothelial expression of leukocyte adhesion molecules (e.g., ICAM-1, VCAM-1) 
• Induces platelet-neutrophil interactions 
• Interferes with cleavage of ULVWF by ADAMTS13 and FH 
• Promotes release of TF-bearing microparticles 
• Induces proinflammatory cytokine (e.g., TNF, IL-8) release by endothelial cells and monocytes 
SPATEs  
 Pic • Proteolyses and inactivates C2, C3/C3b, C4/C4b 
• Des-arginates C3a 
 EspP • Proteolyses and inactivates C3/C3b, C5 
• Inactivates coagulation factor V and α2-antiplasmin 
 StcE • Cleaves C1-INH and increases its neutralization of C1s and MASP 
• Binds to host/pathogen surfaces and tethers C1-INH 
PolyP • Promotes coagulation activation at several steps in cascade 
• Destabilizes C5b,6 and interferes with MAC assembly on host and pathogen 
• Binds to C1-INH and increases its neutralization of C1s and MASP 
• Binds to FH (function unknown) 

ICAM, intercellular adhesion molecule; IL, interleukin; TM, thrombomodulin; TNF, tumor necrosis factor; VCAM, vascular cell adhesion molecule.

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