Many bacterial pathogens encode the cytolethal distending toxin (CDT), which causes host cells to arrest during their cell cycle by inflicting DNA damage. CDT is composed of three proteins, CdtA, CdtB, and CdtC. CdtB is the enzymatically active or A subunit, which possesses DNase I-like activity, whereas CdtA and CdtC function as heteromeric B subunits that mediate the delivery of CdtB into host cells. We show here that Salmonella enterica serovar Typhi encodes CDT activity, which depends on the function of a CdtB homologous protein. Remarkably, S. enterica serovar Typhi does not encode apparent homologs of CdtA or CdtC. Instead, we found that toxicity, as well as cdtB expression, requires bacterial internalization into host cells. We propose a pathway of toxin delivery in which bacterial internalization relieves the requirement for the functional equivalent of the B subunit of the CDT toxin.cell cycle progression ͉ bacterial pathogenesis ͉ host-pathogen interactions ͉ typhoid fever T he cytolethal distending toxin (CDT) was first described as an activity in culture supernatants of Campylobacter spp. and certain enteropathogenic strains of Escherichia coli that caused eukaryotic cells to slowly distend over a period of 2-5 days, eventually leading to their death (1, 2). The cellular enlargement involved not only the cytoplasm but also the nucleus, which appeared as twice the normal size. Since then, this toxin has been identified in many other bacterial pathogens, including other strains of E. coli (3), Shigella dysenteriae (4), Haemophilus ducreyi (5), Actinobacillus actinomycetemcomitans (6), and Helicobacter hepaticus (7). The CDT is composed of three subunits, CdtA, CdtB, and CdtC, which form a tripartite complex (8). CdtA and CdtC form a heterologous B subunit that is necessary for the delivery of CdtB, the active or A subunit (9). The mechanism of action of this toxin is reasonably well understood. On delivery into host cells by CdtA and CdtC, the active subunit CdtB is transported to the nucleus where it causes DNA damage (10, 11). Indeed, CdtB exhibits limited amino acid sequence similarity with the DNase I family of proteins, and purified CdtB exhibits very low but measurable DNase activity. The cellular responses to DNA damage lead to the characteristic G 2 ͞M cell cycle arrest, cellular distention, and nuclear enlargement observed in intoxicated cells (3).Although cytotoxicity by exogenously administered toxin requires all three CDT subunits, CdtB alone can recapitulate all of the CDT effects, provided that it is administered in very small quantities directly into the cytosol of target cells by either microinjection or transient expression (10). The mechanism by which CDT enters cells is not completely understood. However, results of experiments using a number of pharmacological inhibitors have suggested that the toxin enters cells by means of receptor-mediated endocytosis, traveling deep into the endocytic pathway (12) before CdtB is delivered first into the cytosol and then into the nucleus of the t...