The cytolethal distending toxin (Cdt) is produced from a number of bacteria capable of causing infection and inflammatory disease. Our previous studies with Actinobacillus actinomycetemcomitans Cdt demonstrate not only that the active toxin subunit functions as a phosphatidylinositol-3,4,5-triphosphate (PIP3) phosphatase but also that macrophages exposed to the toxin were stimulated to produce proinflammatory cytokines. We now demonstrate that the Cdt-induced proinflammatory response involves the activation of the NLRP3 inflammasome. Specific inhibitors and short hairpin RNA (shRNA) were employed to demonstrate requirements for NLRP3 and ASC as well as caspase-1. Furthermore, Cdt-mediated inflammasome activation is dependent upon upstream signals, including reactive oxygen species (ROS) generation and Cdt-induced increases in extracellular ATP levels. Increases in extracellular ATP levels contribute to the activation of the P2X 7 purinergic receptor, leading to K ؉ efflux. The relationship between the abilities of the active toxin subunit CdtB to function as a lipid phosphatase, activate the NLRP3 inflammasome, and induce a proinflammatory cytokine response is discussed. These studies provide new insight into the virulence potential of Cdt in mediating the pathogenesis of disease caused by Cdt-producing organisms such as Aggregatibacter actinomycetemcomitans.T he cytolethal distending toxins (Cdts) are a family of heatlabile protein cytotoxins produced by several bacterial species, including Campylobacter jejuni, Shigella species, Haemophilus ducreyi, Aggregatibacter actinomycetemcomitans, and diarrheal disease-causing enteropathogens such as some Escherichia coli isolates (1-7). There is clear evidence that Cdts are encoded by three genes, designated cdtA, cdtB, and cdtC, which are arranged as an apparent operon (7-12). These three genes specify three polypeptides, designated CdtA, CdtB, and CdtC, with apparent molecular masses of 28, 32, and 20 kDa, respectively, that form a heterotrimeric holotoxin. Several cell lines and cell types have been shown to be sensitive to Cdt-induced cell cycle arrest and cell death via apoptosis; these include human lymphoid cells, fibroblasts, human embryonic intestinal epithelial cells, a human colon carcinoma cell line, and human keratinocytes, among others (7,11,12). There is considerable agreement that the heterotrimeric holotoxin functions as an AB 2 toxin, where CdtB is the active (A) unit and the complex of CdtA and CdtC comprises the binding (B) unit (13)(14)(15). In this regard, we have shown that CdtA and CdtC are required for the toxin to associate with lipid microdomains within lymphocyte membranes and that Cdt-mediated toxicity is dependent upon the integrity of these lipid domains (16). Furthermore, we have demonstrated that the CdtC subunit contains a cholesterol recognition sequence that is required for interactions with membrane cholesterol (16,17).The active Cdt subunit CdtB exhibits enzymatic activity, enabling it to degrade the signaling lipid phosphatidylino...