This figure shows that exotoxins are secreted by bacterial cells, Clostridium botulinum for example, and are toxic to somatic cells. Somatic cells have antibodies on the cell surface to target exotoxins and bind to them, preventing the invasion into the somatic cells. The binding of the exotoxin and antibody forms an antigen-antibody interaction and the exotoxins are targeted for destruction by the immune system. If this interaction does not happen, the exotoxins bind to the exotoxin receptors that are on the cell surface and causes death of the host cell by inhibiting protein synthesis. This figure also shows that the application of heat or chemicals to exotoxins can result in the deactivation of exotoxins. The deactivated exotoxins are called toxoids and they are not harmful to somatic cells.

An exotoxin is a toxin secreted by bacteria.[1] An exotoxin can cause damage to the host by destroying cells or disrupting normal cellular metabolism. They are highly potent and can cause major damage to the host. Exotoxins may be secreted, or, similar to endotoxins, may be released during lysis of the cell. Gram negative pathogens may secrete outer membrane vesicles containing lipopolysaccharide endotoxin and some virulence proteins in the bounding membrane along with some other toxins as intra-vesicular contents, thus adding a previously unforeseen dimension to the well-known eukaryote process of membrane vesicle trafficking, which is quite active at the host-pathogen interface.

They may exert their effect locally or produce systemic effects. Well-known exotoxins include: botulinum toxin produced by Clostridium botulinum; Corynebacterium diphtheriae toxin, produced during life-threatening symptoms of diphtheria; tetanospasmin produced by Clostridium tetani. The toxic properties of most exotoxins can be inactivated by heat or chemical treatment to produce a toxoid. These retain their antigenic specificity and can be used to produce antitoxins and, in the case of diphtheria and tetanus toxoids, are used as vaccines.

Exotoxins are susceptible to antibodies produced by the immune system, but many exotoxins are so toxic that they may be fatal to the host before the immune system has a chance to mount defenses against them. For this reason antitoxin, anti-serum containing antibodies, is injected to provide passive immunity.


Many exotoxins have been categorized.[2][3] This classification, while fairly exhaustive, is not the only system used. Other systems for classifying or identifying toxins include:

The same exotoxin may have different names, depending of the field of research.

Type I: cell surface-active

Type I toxins bind to a receptor on the cell surface and stimulate intracellular signaling pathways. Two examples are described below.


Superantigens are produced by several bacteria. The best-characterized superantigens are those produced by the strains of Staphylococcus aureus and Streptococcus pyogenes that cause toxic shock syndrome. Superantigens bridge the MHC class II protein on antigen-presenting cells with the T cell receptor on the surface of T cells with a particular Vβ chain. As a consequence, up to 50% of all T cells are activated, leading to massive secretion of proinflammatory cytokines, which produce the symptoms of toxic shock.

Heat-stable enterotoxins

Some strains of E. coli produce heat-stable enterotoxins (ST), which are small peptides that are able to withstand heat treatment at 100 °C. Different STs recognize distinct receptors on the cell surface and thereby affect different intracellular signaling pathways. For example, STa enterotoxins bind and activate membrane-bound guanylate cyclase, which leads to the intracellular accumulation of cyclic GMP and downstream effects on several signaling pathways. These events lead to the loss of electrolytes and water from intestinal cells.

Type II: membrane damaging

Membrane-damaging toxins exhibit hemolysin or cytolysin activity in vitro. However, induction of cell lysis may not be the primary function of the toxins during infection. At low concentrations of toxin, more subtle effects such as modulation of host cell signal transduction may be observed in the absence of cell lysis. Membrane-damaging toxins can be divided into two categories, the channel-forming toxins and toxins that function as enzymes that act on the membrane.

Channel-forming toxins

Most channel-forming toxins, which form pores in the target cell membrane, can be classified into two families: the cholesterol-dependent toxins and the RTX toxins.

Formation of pores by cholesterol-dependent cytolysins (CDC) requires the presence of cholesterol in the target cell. The size of the pores formed by members of this family is extremely large: 25-30 nm in diameter. All CDCs are secreted by the type II secretion system;[4] the exception is pneumolysin, which is released from the cytoplasm of Streptococcus pneumoniae when the bacteria lyse.

The CDCs Streptococcus pneumoniae Pneumolysin, Clostridium perfringens perfringolysin O, and Listeria monocytogenes listeriolysin O cause specific modifications of histones in the host cell nucleus, resulting in down-regulation of several genes that encode proteins involved in the inflammatory response.[5] Histone modification does not involve the pore-forming activity of the CDCs.

RTX toxins can be identified by the presence of a specific tandemly repeated nine-amino acid residue sequence in the protein. The prototype member of the RTX toxin family is haemolysin A (HlyA) of E. coli. RTX is also found in Legionella pneumophila.[6]

Enzymatically active toxins

One example is the α toxin of C. perfringens, which causes gas gangrene; α toxin has phospholipase activity.

Type III: intracellular

Type III exotoxins can be classified by their mode of entry into the cell, or by their mechanism once inside.

By mode of entry

Intracellular toxins must be able to gain access to the cytoplasm of the target cell to exert their effects.

By mechanism

Once in the cell, many of the exotoxins act at the eukaryotic ribosomes (especially 60S), as protein synthesis inhibitors. (Ribosome structure is one of the most important differences between eukaryotes and prokaryotes, and, in a sense, these exotoxins are the bacterial equivalent of antibiotics such as clindamycin.)

Other intracellular toxins do not directly inhibit protein synthesis.

Extracellular matrix damage

These "toxins" allow the further spread of bacteria and, as a consequence, deeper tissue infections. Examples are hyaluronidase and collagenase. These molecules, however, are enzymes that are secreted by a variety of organisms and are not usually considered toxins. They are often referred to as virulence factors, since they allow the organisms to move deeper into the hosts tissues.[7]

See also


  1. Ray, editors, Kenneth J. Ryan, C. George (2010). Sherris medical microbiology (5th ed.). New York: McGraw Hill Medical. ISBN 978-0-07-160402-4.
  2. Desk Encyclopedia of Microbiology. Amsterdam: Elsevier Academic Press. 2004. p. 428. ISBN 0-12-621361-5.
  3. "Bacterial Pathogenesis: Bacterial Factors that Damage the Host - Producing Exotoxins". Retrieved 2008-12-13.
  4. Tweten RK (2005). "Cholesterol-Dependent Cytolysins, a Family of Versatile Pore-Forming Toxins". Infect. Immun. 73 (10): 6199–209. doi:10.1128/IAI.73.10.6199-6209.2005. PMC 1230961Freely accessible. PMID 16177291.
  5. Hamon MA, Batsché E, Régnault B, et al. (2007). "Histone modifications induced by a family of bacterial toxins". Proc. Natl. Acad. Sci. U.S.A. 104 (33): 13467–72. doi:10.1073/pnas.0702729104. PMC 1948930Freely accessible. PMID 17675409.
  6. D'Auria G, Jiménez N, Peris-Bondia F, Pelaz C, Latorre A, Moya A (2008). "Virulence factor rtx in Legionella pneumophila, evidence suggesting it is a modular multifunctional protein". BMC Genomics. 9: 14. doi:10.1186/1471-2164-9-14. PMC 2257941Freely accessible. PMID 18194518.
  7. Machunis-Masuoka E, Bauman RW, Tizard IR (2004). Microbiology. San Francisco: Pearson/Benjamin Cummings. ISBN 0-8053-7590-2.
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