TcdB is one of the key virulence factors of Clostridium difficile that is responsible for causing serious and potentially fatal colitis. The toxin contains at least two enzymatic domains: an effector glucosyltransferase domain for inactivating host Rho GTPases and a cysteine protease domain for the delivery of the effector domain into host cytosol. Here, we describe a novel intrabody approach to examine the role of these enzymes of TcdB in cellular intoxication. By screening a single-domain heavy chain (V H H) library raised against TcdB, we identified two V H H antibodies, 7F and E3, that specifically inhibit TcdB cysteine protease and glucosyltransferase activities, respectively. Cytoplasmic expression of 7F intrabody in Vero cells inhibited TcdB autoprocessing and delayed cellular intoxication, whereas E3 intrabody completely blocked the cytopathic effects of TcdB holotoxin. These data also demonstrate for the first time that toxin autoprocessing occurs after cysteine protease and glucosyltransferase domains translocate into the cytosol of target cells. We further determined the role of the enzymatic activities of TcdB in in vivo toxicity using a sensitive systemic challenge model in mice. Consistent with these in vitro results, a cysteine protease noncleavable mutant, TcdB-L543A, delayed toxicity in mice, whereas glycosyltransferase-deficient TcdB demonstrated no toxicity up to 500-fold of the 50% lethal dose (LD 50 ) when it was injected systemically. Thus, glucosyltransferase but not cysteine protease activity is critical for TcdB-mediated cytopathic effects and TcdB systemic toxicity, highlighting the importance of targeting toxin glucosyltransferase activity for future therapy. C lostridium difficile is an anaerobic Gram-positive bacterial species that can induce serious and potentially fatal inflammatory disease of the colon and is the most prevalent cause of antibioticassociated diarrhea and pseudomembranous colitis in nosocomial settings (1, 2). Disease in patients with C. difficile infection is strongly associated with the two exotoxins, TcdA and TcdB (3). Both toxins are large, homologous single-chain proteins that contain at least four distinct domains (4-6): the N terminus glucosyltransferase domain (GTD), a cysteine protease domain (CPD), a translocation domain (TD), and a C terminus receptor binding domain (RBD; also known as combined repetitive oligopeptides, or CROPs). A recent study suggests that there might also be an additional receptor binding region besides the N-terminal CROP region (7) although the specific region has yet to be identified. Both toxins exert cytopathic effects that include cell rounding after disruption of the actin cytoskeleton and tight junctions in human colonocytes (8, 9). Toxin exposure may also trigger potent cytotoxic and inflammatory effects leading to mucosal cell death, diarrhea, and colitis associated with C. difficile infections (10, 11). TcdB appears to be more clinically relevant for C. difficile virulence as it is invariably associated with clinically isol...