). Therefore, we hypothesized that the identification of a compound that inhibits the activity of the toxin would have a suppressive effect on the ETEC colonization capabilities. Using in vivo and in vitro approaches, we present evidence demonstrating that a fluorenone-based compound, DC5, which inhibits the accumulation of cAMP in intoxicated cultured cells, significantly decreases the colonization abilities of adenylyl cyclase toxin-producing bacteria, such as ETEC. These findings established that DC5 is a potent inhibitor both of toxin-induced cAMP accumulation and of ETEC adherence to epithelial cells. Thus, DC5 may be a promising compound for treatment of diarrhea caused by ETEC and other adenylyl cyclase toxinproducing bacteria.Diarrheal diseases caused by enteric pathogens such as enterotoxigenic Escherichia coli (ETEC) or Vibrio cholerae remain a major cause of morbidity and mortality worldwide (25,31,34). ETEC, a pathogen of increasing frequency in the United States, is a leading cause of traveler's diarrhea (36). Prevention of diarrhea caused by these toxigenic organisms, by virtue of improved hygiene and provision of sanitation and water treatment, often is impractical in most developing countries, where the morbidity and mortality rates are highest (37). ETEC and V. cholerae produce the heat-labile toxin (LT) and cholera toxin (CT), respectively, and both toxins display ADP ribosylation activity, which results in increased chloride and water efflux into the intestinal lumen, leading to significant volumes of watery diarrhea (25). Interestingly, recent studies have confirmed prior observations indicating that enterotoxins, such as LT and CT, enhance enteric bacterial colonization and pathogenicity (reviewed in reference 8). Anti-toxigenic compounds have been shown to decrease morbidity and mortality of diseases caused by other toxin-producing bacteria (18, 29). Therapy using anti-toxigenic compounds is therefore an area of great interest. Identification of a new class of drugs that afford selective anti-toxigenic activities would constitute a highly desired compound useful for future therapy; however, these drugs need to be experimentally validated by first testing efficacy, bioavailability, and the absence of toxicity in relevant animal models.We have previously shown that prostaglandin E 2 -histidine (PGE 2 -L-histidine) and prostaglandin E 2 -imidazole (PGE 2 -imidazole) adducts significantly reduced CT-induced fluid loss and cyclic AMP (cAMP) accumulation in the murine ligated small intestinal loop model (21). These and other derived adducts have been shown to act on ETEC LT and on the edema factor (EF) produced by Bacillus anthracis (15). Our recent progress has resulted in the development of structurally stable compounds that inhibit toxin-induced accumulation of cAMP in in vitro cell culture assays (3). Our studies have shown that although some of these compounds are extremely active in vitro and showed reduced fluid accumulation in the murine model of experimental cholera, they were also toxic...