Diarrhea remains a worldwide scourge, and its prevalence and impact is also under-recognized and perhaps increasing even in developed countries. Studies from our laboratory, as well as many others, are beginning to reveal the spectrum of mechanisms that are exploited by invasive pathogens, which complements our understanding of enterotoxigenic diarrheal disease. We may also gain a greater understanding of the benefits of the diarrheal response, which has implications for the treatment of diarrhea in otherwise healthy individuals. Likewise, an improved understanding of epithelial transport physiology may lead to the development of more rational treatments, such as those that target signaling events related to growth factor receptors.
Conversely, it may lead to a greater knowledge of the rationale for old therapies, such as probiotics, that enjoy wide patient acceptance due to their ‘natural’ provenance and an apparently excellent safety profile. However, it is humbling to realize that improvements in public health and sanitation will have a far greater effect on the impact of diarrheal disease in the poorest countries of the world . Unsafe and inadequate water for basic hygiene place billions of children at risk and account for the vast majority of deaths from diarrheal disease .
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