The VSP-II variant found in V. cholerae O1 El Tor CIRS101 has a significant deletion compared with the other two variants presumably circulating among V. cholerae O1 El Tor Target Selective Inhibitor high throughput screening strains: the seventh pandemic and the Peruvian VSP-II. Although its function remains to be elucidated, the CIRS101 VSP-II presence is clearly dominant in recent V. cholerae O1 isolates from two cholera-endemic sites of Bangladesh, but not in V. cholerae O139 isolated from those sites, the latter possessing the prototypical seventh pandemic VSP-II. These data are surprising, given that

in the endemic areas under study, V. cholerae O1 and O139 share the same environment and host population, but appear not to have exchanged this genomic island. In Bangladesh, by tracking VSP-II variants, we were able to detect a shift between ‘old’ and ‘new’ pandemic clones of V. cholerae O1 El Tor, based on the fact that a 1994 strain (V. cholerae O1 MJ1236) carries the prototypical seventh pandemic VSP-II, while those isolated during 2004–2007 carry the new CIRS101 variant. It is of paramount importance to know whether the same shift occurred in clinical V. cholerae isolates from Africa or South America to be able to determine whether this event is region specific. Absence in nonepidemic isolates of V. cholerae non-O1/O139 suggests that the CIRS101

VSP-II confers a selective advantage when in the human host, but not when in the aquatic environment. In this regard, it is noteworthy that V. cholerae O1 El Tor AZD4547 manufacturer CIRS101 carries a variant of the CTX cluster found in a group of newly emerged seventh pandemic clones, referred to as El Tor/Classical ‘hybrid’ or ‘altered’ strains (Nair et al., 2006). Therefore,

the new V. cholerae CIRS101 VSP-II may have arisen in a genomic background Dolutegravir nmr positively selected in the human host (hybrid strains appear to produce more cholera toxins), likely becoming dominant among epidemic clones. A link between the evolutionary success of the two clusters (CTX and VSP-II) is not indicated, based on the presence of a canonical seventh pandemic VSP-II in two other hybrid strains: V. cholerae O1 MJ1236 (Bangladesh, 1994) and B33 (Mozambique, 2004). The VSP-II circulating among V. cholerae non-O1/non-O139 and V. mimicus is the RC385 VSP-II. Despite different serotypes and significant genetic diversities among the strains, this variant appears to be stable in isolates obtained at different times and geographical locations, while TMA21 and MZO-3 VSP-II show only a limited distribution. The presence of the new VSP-II variants was not correlated with the presence of a new VSP-I, indicating that the two gene clusters derive from a different history of genetic exchange among V. cholerae non-O1/non-O139 and V. mimicus.