Engineered tumor-targeted anthrax lethal toxin proteins have been shown to strongly suppress growth of solid tumors in mice. These toxins work through the native toxin receptors tumor endothelium marker-8 and capillary morphogenesis protein-2 (CMG2), which, in other contexts, have been described as markers of tumor endothelium. We found that neither receptor is required for tumor growth. We further demonstrate that tumor cells, which are resistant to the toxin when grown in vitro, become highly sensitive when implanted in mice. Using a range of tissue-specific loss-of-function and gain-of-function genetic models, we determined that this in vivo toxin sensitivity requires CMG2 expression on host-derived tumor endothelial cells. Notably, engineered toxins were shown to suppress the proliferation of isolated tumor endothelial cells. Finally, we demonstrate that administering an immunosuppressive regimen allows animals to receive multiple toxin dosages and thereby produces a strong and durable antitumor effect. The ability to give repeated doses of toxins, coupled with the specific targeting of tumor endothelial cells, suggests that our strategy should be efficacious for a wide range of solid tumors.anthrax toxin | tumor targeting | angiogenesis | CMG2 | TEM8 R ecognition that aberrant activation of the RAS and PI3K pathways is often the mechanism of human tumorigenesis has inspired development of many small molecule inhibitors of these pathways and has led to improved treatments in certain cancers (1). However, these therapies are effective only in patients having defects in the specific targets of these drugs, and the therapies are rarely curative due to the development of resistance through acquisition of additional oncogenic mutations (2). Therefore, strategies are needed that are effective against a broad spectrum of cancers and that act through features that are not subject to development of resistance. This unmet need has fostered continued interest in strategies that target host-derived tumor vasculature.Anthrax toxin, a major virulence factor of Bacillus anthracis, consists of three individually nontoxic proteins: the cellular binding component, protective antigen (PA), and two enzymatic moieties, lethal factor (LF) and edema factor (EF) (3). PA binds to two host cell-surface integrin-like proteins: tumor endothelium marker-8 (TEM8) [also termed anthrax toxin receptor 1 (ANTXR1)] and capillary morphogenesis protein-2 (CMG2 or ANTXR2) (4, 5). Receptor-bound PA is processed by the ubiquitous cell-associated furin protease to a 63-kDa fragment (PA63), which then forms LFand EF-binding competent PA oligomers. Three or four molecules of LF or EF bind to the PA oligomers, and the complexes are then endocytosed (6-8). The acidic pH within the endosomes causes the PA oligomer to form a pore in the endosomal membrane, allowing translocation of LF or EF into the cytosol of cells to exert their cytotoxic actions (9). Thus, LF plus PA forms lethal toxin and EF plus PA forms edema toxin, with both toxins playing essenti...