Enterotoxigenic Bacteroides fragilis Toxin: Biological Properties and Pathogenesis

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (30 April 2026) | Viewed by 12693

Special Issue Editor


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Guest Editor
Biomedical Laboratory Science, Yonsei University Mirae Campus, Wonju 26493, Republic of Korea
Interests: bacteroides fragilis; enterotoxin; inflammatory bowel disease; mucosal immunity; intestinal microbiota; colitis-associated cancer

Special Issue Information

Dear Colleagues,

It is with great pleasure to invite you to contribute to a Special Issue of Toxins, entitled “Enterotoxigenic Bacteroides fragilis Toxin: Biological Properties and Pathogenesis”. The intestinal symbiont Bacteroides fragilis colonizes humans, providing a beneficial effect on host health. However, a subset of B. fragilis, called enterotoxigenic B. fragilis (ETBF), secretes the metalloprotease B. fragilis toxin (BFT, also called fragilysin), which induces the cleavage of E-cadherin, resulting in the disruption of epithelial integrity. In various animal models, ETBF infection causes proinflammatory diarrhea and colitis. In the past decade, accumulating experimental evidence suggests that ETBF-driven colitis promotes colorectal tumorigenesis, but the contribution of ETBF to human carcinogenesis still remains to be explored. A major limitation to understanding ETBF pathogenesis is the still-unidentified, elusive host cell receptor for BFT. Recent data have also raised the idea that enteric infections can also influence other clinical diseases. In this Special Issue, we welcome submissions that delve into the latest research as well as comprehensive reviews on this topic. Areas of particular interest include, but are not limited to, the following:

  • BFT biological activity in the areas of cell signaling, mechanisms of target protein cleavage, and cytokine secretion.
  • Investigating ETBF pathogenesis in the intestine as well as its contribution to other diseases.
  • Identification of the putative BFT receptor.
  • Developing approaches for the detection of ETBF and/or BFT in clinical samples, epidemiology, and outcome prediction.
  • Exploring other virulence factors in ETBF strains.

Dr. Ki-Jong Rhee
Guest Editor

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Keywords

  • toxin structure
  • metalloprotease
  • cell receptor
  • cell signaling
  • cell junction
  • epithelium
  • mucosal immunity
  • host–pathogen interaction
  • colitis-associated cancer
  • inflammatory bowel disease

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Published Papers (4 papers)

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Research

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25 pages, 6774 KB  
Article
Purification and Characterization of His-Tagged Recombinant Bacteroides fragilis Toxin-2 Variants In Vitro and In Vivo
by Woo-Seung Kim, Soohyun Lee, Ki-Ju Kwon, So-Min Kim and Ki-Jong Rhee
Toxins 2026, 18(4), 189; https://doi.org/10.3390/toxins18040189 - 16 Apr 2026
Viewed by 573
Abstract
Bacteroides fragilis is a major commensal bacterium of the human colon. However, enterotoxigenic B. fragilis (ETBF) secretes B. fragilis toxin (BFT), a zinc-dependent metalloprotease that cleaves E-cadherin and promotes chronic inflammation and colorectal tumorigenesis. Despite extensive research, the cellular receptor for BFT remains [...] Read more.
Bacteroides fragilis is a major commensal bacterium of the human colon. However, enterotoxigenic B. fragilis (ETBF) secretes B. fragilis toxin (BFT), a zinc-dependent metalloprotease that cleaves E-cadherin and promotes chronic inflammation and colorectal tumorigenesis. Despite extensive research, the cellular receptor for BFT remains unidentified. In this study, we developed His-tagged recombinant BFT variants including both catalytically active and inactive forms to facilitate biochemical and functional analyses. Functional assays confirmed that the active variant retained proteolytic activity and induced characteristic cellular responses, while the inactive variant served as an effective negative control. These results establish a robust experimental platform for BFT receptor identification and mechanistic studies of BFT-host interactions. The active and inactive BFT variants provide essential molecular tools for investigating ETBF pathogenicity and developing therapeutic interventions. Full article
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Review

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13 pages, 1471 KB  
Review
The “Direct Structural Disruption” Hypothesis: Bacteroides fragilis Toxin as a Potentiating Cofactor in MASH Pathogenesis
by Ju-Eun Hong and Soonjae Hwang
Toxins 2026, 18(5), 200; https://doi.org/10.3390/toxins18050200 - 24 Apr 2026
Viewed by 250
Abstract
Metabolic dysfunction-associated steatohepatitis (MASH) is a complex, multifactorial disease heavily influenced by the gut–liver axis. While enterotoxigenic Bacteroides fragilis (ETBF) and its principal virulence factor, B. fragilis toxin (BFT)—a zinc-dependent metalloprotease—are well-known for disrupting intestinal barriers, their potential systemic impact on distant organs [...] Read more.
Metabolic dysfunction-associated steatohepatitis (MASH) is a complex, multifactorial disease heavily influenced by the gut–liver axis. While enterotoxigenic Bacteroides fragilis (ETBF) and its principal virulence factor, B. fragilis toxin (BFT)—a zinc-dependent metalloprotease—are well-known for disrupting intestinal barriers, their potential systemic impact on distant organs remains an emerging area of interest. Although various gut-derived factors contribute to hepatic inflammation, the precise molecular triggers that exacerbate the transition from simple steatosis to progressive fibrosis remain incompletely understood. This review proposes the “Direct Structural Disruption” hypothesis, examining the biological activity of BFT and its proposed role in MASH pathogenesis. We postulate that under permissive conditions, systemic BFT may target hepatic structural proteins (e.g., cadherins). This hypothesized architectural impairment amplifies canonical fibrogenic signaling and hepatic stellate cell (HSC) activation. In addition, we discuss current challenges in the detection and characterization of systemic BFT, particularly the technical limitations in clinical diagnostics stemming from its profound structural homology with host metalloproteinases. Future research integrating advanced diagnostic methodologies and liver-specific in vivo models is essential to elucidate these pathophysiological mechanisms and evaluate the ETBF-BFT axis as a complementary target in progressive MASH. Full article
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29 pages, 982 KB  
Review
The Ambivalent Nature of Bacteroides fragilis and the Interaction with Clostridioides difficile: Benefits and Disadvantages for the Human Host
by Patrizia Spigaglia
Toxins 2025, 17(10), 513; https://doi.org/10.3390/toxins17100513 - 19 Oct 2025
Cited by 1 | Viewed by 3874
Abstract
Bacteroides fragilis is a usually beneficial colonizer of the human gut that can also act as an opportunistic pathogen, causing infection and contributing to the development and progression of important diseases. The production and secretion of the B. fragilis toxin (BFT), the main [...] Read more.
Bacteroides fragilis is a usually beneficial colonizer of the human gut that can also act as an opportunistic pathogen, causing infection and contributing to the development and progression of important diseases. The production and secretion of the B. fragilis toxin (BFT), the main virulence factor of this bacterium, distinguishes enterotoxigenic (ETBF) from non-toxigenic (NTBF) strains. Although NTBF does not produce the BFT, certain strains can exhibit unexpected pathogenic characteristics. The complex interactions between B. fragilis and the other intestinal bacteria, such as Clostridioides difficile, the leading cause of antibiotic-associated diarrhea in healthcare settings, highlights its ambivalent role of benefactor and pathogen. In fact, although B. fragilis plays a part in preventing colonization and infection due to C. difficile (CDI), both these anaerobic bacteria can contribute to the development and progression of colorectal cancer (CRC), one of the most prevalent malignant tumors of the digestive tract. This review provides an overview of the dual nature of B. fragilis, focusing on the peculiarities of ETBF and NTBF, delving into B. fragilis interaction with C. difficile and impacts on the host. Full article
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14 pages, 832 KB  
Review
Biological Mechanisms of Enterotoxigenic Bacteroides fragilis Toxin: Linking Inflammation, Colorectal Cancer, and Clinical Implications
by Seyedesomaye Jasemi, Paola Molicotti, Milena Fais, Ilaria Cossu, Elena Rita Simula and Leonardo A. Sechi
Toxins 2025, 17(6), 305; https://doi.org/10.3390/toxins17060305 - 16 Jun 2025
Cited by 19 | Viewed by 7093
Abstract
Enterotoxigenic Bacteroides fragilis (ETBF) has emerged as a gut microbiome pathogen that can promote intestinal inflammation and contribute to colorectal cancer (CRC). Its principal virulence factor, the Bacteroides fragilis toxin (BFT), is a zinc-dependent metalloprotease that disrupts epithelial barrier integrity, initiates inflammatory signaling [...] Read more.
Enterotoxigenic Bacteroides fragilis (ETBF) has emerged as a gut microbiome pathogen that can promote intestinal inflammation and contribute to colorectal cancer (CRC). Its principal virulence factor, the Bacteroides fragilis toxin (BFT), is a zinc-dependent metalloprotease that disrupts epithelial barrier integrity, initiates inflammatory signaling pathways, and enhances epithelial proliferation. Although growing evidence supports a link between ETBF and CRC, some inconsistencies across studies highlight the need for further investigation into the molecular mechanisms underpinning BFT-mediated pathogenesis. This review examines the biological structure and activity of BFT, with a focus on its role in epithelial injury, inflammatory responses, and tumorigenesis. In addition, we discuss current challenges in the detection and characterization of ETBF and BFT, including technical limitations in clinical diagnostics and methodological variability across studies. Recent advances in multi-omics technologies, molecular diagnostics, nanobody-based detection platforms, and probiotic intervention are also highlighted as promising avenues for improving ETBF identification and therapeutic targeting. Future research integrating systematic molecular profiling with clinical data is essential to enhance diagnostic accuracy, elucidate pathophysiological mechanisms, and develop effective interventions against ETBF-associated diseases. Full article
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