This study investigated the effect of the biochemical and biophysical properties of the plasma membrane as well as membrane morphology on the susceptibility of human red blood cells to the cholesterol-dependent cytolysin pneumolysin, a key virulence factor of Streptococcus pneumoniae, using single cell studies. We show a correlation between the physical properties of the membrane (bending rigidity and surface and dipole electrostatic potentials) and the susceptibility of red blood cells to pneumolysin-induced hemolysis. We demonstrate that biochemical modifications of the membrane induced by oxidative stress, lipid scrambling, and artificial cell aging modulate the cell response to the toxin. We provide evidence that the diversity of response to pneumolysin in diabetic red blood cells correlates with levels of glycated hemoglobin and that the mechanical properties of the red blood cell plasma membrane are altered in diabetes. Finally, we show that diabetic red blood cells are more resistant to pneumolysin and the related toxin perfringolysin O relative to healthy red blood cells. Taken together, these studies indicate that the diversity of cell response to pneumolysin within a population of human red blood cells is influenced by the biophysical and biochemical status of the plasma membrane and the chemical and/or oxidative stress pre-history of the cell.The interaction of toxins with their target cells is generally characterized by a dose-response curve that is sigmoidal in shape (1). This shape is taken to reflect the differing susceptibilities of individual cells within the population. The fact that red blood cells (RBCs), with their less developed glycocalyx compared with other cell types (2), exhibit such a response is evidence that the initial interaction between the toxin and the plasma membrane is subject to, and probably the main determinant of, such variability. Therefore, it is important to understand the biochemical and biophysical factors affecting toxin-membrane interactions and the resulting variability of susceptibility within the same cell population.Individual RBCs within a population differ significantly (3) with respect to their shape, volume, and surface area. Some of these changes are related to cell age, due to the variety of mechanical and chemical stresses that an RBC undergoes in its life span of ϳ120 days (4, 5), and others can be associated with diseases, such as diabetes and with acute conditions, such as sepsis, among many others (6), and thus are likely to be present in the membranes of many other cell types.Previous work on bulk cell preparations revealed that in addition to its normal discocytic shape, the RBC at rest can assume a variety of other distinct shapes, such as echinocytes and acanthocytes, characterized by exterior projections, and stomatocytes with cup-shaped invaginations (7). Many of these unusual shapes appear in normal blood at a frequency of about 1%. However, during blood bank storage and in many inflammatory, degenerative, and microvascular disorders, the frequ...