The B-subunits of cholera toxin (CTB) and Escherichia coli heat-labile enterotoxin (LTB) are structurally and functionally related. However, the carbohydrate binding specificities of the two proteins differ. While both CTB and LTB bind to the GM1 ganglioside, LTB also binds to N-acetyllactosamine-terminated glycoconjugates. The structural basis of the differences in carbohydrate recognition has been investigated by a systematic exchange of amino acids between LTB and CTB. Thereby, a CTB/LTB hybrid with a gain-of-function mutation resulting in recognition of blood group A and B determinants was obtained. Glycosphingolipid binding assays showed a specific binding of this hybrid Bsubunit, but not CTB or LTB, to slowly migrating nonacid glycosphingolipids of human and animal small intestinal epithelium. A binding-active glycosphingolipid isolated from cat intestinal epithelium was characterized by mass spectrometry and proton NMR as GalNAc␣3(Fuc␣2)Gal4(Fuc␣3)GlcNAc3Gal4Glc NAc3Gal4Glc1Cer. Comparison with reference glycosphingolipids showed that the minimum binding epitope recognized by the CTB/LTB hybrid was Gal␣3(Fuc␣2)Gal4(Fuc␣3)GlcNAc. The blood group A and B determinants bind to a novel carbohydrate binding site located at the top of the B-subunit interfaces, distinct from the GM1 binding site, as found by docking and molecular dynamics simulations.Enterotoxins produced by Vibrio cholerae and enterotoxigenic Escherichia coli are causative agents of diarrheal diseases leading to millions of deaths annually (1). Both cholera toxin (CT) 1 and E. coli type I heat-labile enterotoxin (LT) are oligomeric proteins with one A-subunit and five B-subunits (2). The A-subunits have ADP-ribosyltransferase activity, while the B-subunits mediate binding to receptors on the eukaryotic cell surface. LT type I B-subunits originating from porcine and human isolates of enterotoxigenic E. coli (pLTB and hLTB, respectively) share 96% sequence identity with each other, but only approximately 80% with CTB (3). Despite great similarity between the carbohydrate binding sites of the B-subunits, evidenced by recent crystal complexes (4 -6), the carbohydrate binding specificities of CTB and LTB differ. Both B-subunits bind with high affinity to GM1 (7), whereas only LTB interacts with N-acetyllactosamine-terminated glycoconjugates (8 -10). Binding of LTB, but not CTB, to gangliotetraosylceramide and the GD1b ganglioside has also been reported (8, 10, 11). The structural basis of the differences in carbohydrate binding between CTB and hLTB have been investigated by construction of a number of CTB/hLTB hybrids, having CTB amino acids substituted with heterologous amino acids of hLTB (12). By introducing hLTB residues in the 1-25 region and at positions 94 and 95 of CTB, a hybrid B-subunit (designated LCTBH) was created, with N-acetyllactosaminebinding properties almost indistinguishable from hLTB.These studies have now been extended by re-substitution of single amino acids of LCTBH back to the original CTB residues. By re-substituting...