Pertussis (whooping cough), caused by Bordetella pertussis, is resurging in the United States and worldwide. Adenylate cyclase toxin (ACT) is a critical factor in establishing infection with B. pertussis and acts by specifically inhibiting the response of myeloid leukocytes to the pathogen. We report here that serum components, as discovered during growth in fetal bovine serum (FBS), elicit a robust increase in the amount of ACT, and Ն90% of this ACT is localized to the supernatant, unlike growth without FBS, in which Ն90% is associated with the bacterium. We have found that albumin, in the presence of physiological concentrations of calcium, acts specifically to enhance the amount of ACT and its localization to the supernatant. Respiratory secretions, which contain albumin, promote an increase in amount and localization of active ACT that is comparable to that elicited by serum and albumin. The response to albumin is not mediated through regulation of ACT at the transcriptional level or activation of the Bvg two-component system. As further illustration of the specificity of this phenomenon, serum collected from mice that lack albumin does not stimulate an increase in ACT. These data, demonstrating that albumin and calcium act synergistically in the host environment to increase production and release of ACT, strongly suggest that this phenomenon reflects a novel hostpathogen interaction that is central to infection with B. pertussis and other Bordetella species.KEYWORDS Bordetella pertussis, RTX toxins, adenylate cyclase toxin, albumin, calcium P ertussis (whooping cough) is a respiratory illness caused by Bordetella pertussis that can be life-threatening, especially in infants. In 2012, the number of cases of whooping cough in the United States was the highest since 1960 despite high vaccine coverage (1). Limited duration of protection by acellular pertussis vaccines is a major factor in the resurgence of pertussis (2), and one approach to this problem is reformulation of the acellular vaccines to include additional B. pertussis antigens (3). Adenylate cyclase toxin (ACT) is a critical factor in establishing infection with B. pertussis and a documented protective antigen (4-6). In light of these features, this toxin is a leading candidate for inclusion in new acellular pertussis vaccines (7,8).ACT is a single polypeptide of 1,706 amino acid residues that constitute a protein of ϳ200 kDa (9-12). ACT belongs to the RTX (repeats-in-toxin) family of proteins and has two activities (13). The toxin function involves insertion of the adenylate cyclase (AC) catalytic domain into the cytoplasm of host cells, activation by the host protein calmodulin, and conversion of intracellular ATP into cyclic AMP (cAMP), resulting in dysregulation of signaling processes and depletion of ATP in the intoxicated cell (14, 15). At higher concentrations, ACT undergoes oligomerization to form pores in the