Staphylococcus aureus α-hemolysin (Hla), a potent cytotoxin, plays an important role in the pathogenesis of staphylococcal diseases, including those caused by methicillin-resistant epidemic strains. Hla is secreted as a water-soluble monomer that undergoes a series of conformational changes to generate a heptameric, β-barrel structure in host membranes. Structural maturation of Hla depends on its interaction with a previously unknown proteinaceous receptor in the context of the cell membrane. It is reported here that a disintegrin and metalloprotease 10 (ADAM10) interacts with Hla and is required to initiate the sequence of events whereby the toxin is transformed into a cytolytic pore. Hla binding to the eukaryotic cell requires ADAM10 expression. Further, ADAM10 is required for Hlamediated cytotoxicity, most notably when the toxin is present at low concentrations. These data thus implicate ADAM10 as the probable high-affinity toxin receptor. Upon Hla binding, ADAM10 relocalizes to caveolin 1-enriched lipid rafts that serve as a platform for the clustering of signaling molecules. It is demonstrated that the Hla-ADAM10 complex initiates intracellular signaling events that culminate in the disruption of focal adhesions.pore-forming cytotoxin | cellular receptor T he Gram-positive extracellular pathogen Staphylococcus aureus is one of the leading causes of human bacterial infection. As a commensal of the skin, S. aureus is well positioned to cause infection of the skin and soft tissues, the bloodstream, and the lower respiratory tract, which are the principal sites of clinically relevant infection (1, 2). To facilitate entry and spread through the host tissue, S. aureus encodes a number of virulence factors that allow the organism to breach structural and immunological barriers to infection. One of the most prominent and well-characterized virulence factors produced by S. aureus is α-hemolysin (Hla), a pore-forming cytotoxin implicated in the pathogenesis of sepsis, pneumonia, and severe skin infection (3-6). Pore formation on susceptible host cell membranes triggers alterations in ion gradients, loss of membrane integrity, activation of stress-signaling pathways, and cell death (3, 7). Hla binds to most eukaryotic cells, often by a nonspecific adsorptive mechanism requiring micromolar concentrations of toxin (8). However, a high-affinity interaction of the toxin with a proteinaceous eukaryotic receptor has been suggested because rabbit erythrocytes are significantly more sensitive to Hla than human erythrocytes, correlating with the identification of 1,200-5,000 toxin-binding sites per rabbit cell (8, 9). Binding is saturable and time dependent, consistent with a ligand-receptor interaction (8,10). In addition to these data, membrane lipids seem to be central to the interaction of the toxin with the eukaryotic cell. Membrane cholesterol or sphingomyelin depletion abrogates toxin binding and cytotoxicity, and the addition of exogenous phosphocholine disrupts toxin binding and impairs rabbit red cell hemolysis (11)....