“…Interestingly, an ACT mutant extending from amino acids 483 to 1706 (ACT-∆N482 hemolysin), which contains the entire ACT RTX hemolysin domain, induces by contrast a transient membrane permeabilization that is rapidly reverted in a time scale of minutes (≈30 min) by a repair pathway activated by extracellular Ca 2+ influx and that requires ATP [ 84 ] (Etxaniz et al, manuscript in revision). The increase of intracellular Ca 2+ induced by the sublytic doses of ACT was found to be very limited [ 84 ] (Etxaniz et al, manuscript in revision), and translocation of the adenylate cyclase domain into the cytosol of the macrophages consumes cellular ATP; both factors might contribute to the incapability of the ACT-treated cells to reseal the injured membrane [ 84 ] (Etxaniz et al, manuscript in revision). Furthermore, we have found that the repair pathway acting in the ACT-∆N482 hemolysin-treated cells involves consecutive steps of exocytosis and endocytosis, likely initiated by lysosomal fusion with the damaged cell membrane, subsequent secretion to the extracellular medium of acid sphingomyelinase, and concomitant local generation of ceramide, all of which culminates in the endocytosis of the pore-ridden membrane ( Figure 4 ) [ 84 ] (Etxaniz et al, manuscript in revision).…”