Clostridium perfringens enterotoxin (CPE) causes the symptoms of a very common food poisoning. To assess whether CPE-induced cytotoxicity is necessary for enterotoxicity, a rabbit ileal loop model was used to compare the in vivo effects of native CPE or recombinant CPE (rCPE), both of which are cytotoxic, with those of the noncytotoxic rCPE variants rCPE D48A and rCPE . Both CPE and rCPE elicited significant fluid accumulation in rabbit ileal loops, along with severe mucosal damage that starts at villus tips and then progressively affects the entire villus, including necrosis of epithelium and lamina propria, villus blunting and fusion, and transmural edema and hemorrhage. Similar treatment of ileal loops with either of the noncytotoxic rCPE variants produced no visible histologic damage or fluid transport changes. Immunohistochemistry revealed strong CPE or rCPE 168-319 binding to villus tips, which correlated with the abundant presence of claudin-4, a known CPE receptor, in this villus region. These results support (i) cytotoxicity being necessary for CPE-induced enterotoxicity, (ii) the CPE sensitivity of villus tips being at least partially attributable to the abundant presence of receptors in this villus region, and (iii) claudin-4 being an important intestinal receptor for CPE. Finally, rCPE 168-319 was able to partially inhibit CPEinduced histologic damage, suggesting that noncytotoxic rCPE variants might be useful for protecting against some intestinal effects of CPE.Clostridium perfringens enterotoxin (CPE) is produced by ϳ1 to 5% of all isolates of the gram-positive spore-forming anaerobic pathogen C. perfringens (25). CPE, a single 35-kDa polypeptide of 319 amino acids (6), is responsible for the gastrointestinal symptoms of C. perfringens type A food poisoning (25,39), which is the second most common food-borne illness in the United States and the United Kingdom (36). In addition, CPE-producing C. perfringens isolates are increasingly recognized as a cause of antibiotic-associated or sporadic diarrhea (2,3,27).Studies of CPE effects in experimental animals identified the ileum as the most sensitive region of the small intestine (31, 41). CPE treatment inhibits ileal fluid and electrolyte absorption (30, 31). However, with time, CPE-treated ileum develops gross fluid/electrolyte secretion and histologic damage that includes desquamation of the ileal epithelium, prominent villus blunting, and enterocyte plasma membrane blebbing (32,33,41). Recently, similar histopathologic changes were observed following ex vivo CPE treatment of human ileal tissues, along with increased transepithelial resistance and water permeability (9).In vitro cell culture models have provided considerable information about the cellular and molecular actions of CPE (12,13,24,26,28,34,43). This enterotoxin first binds to certain members of the claudin family of tight junction proteins (19,20,29), which results in formation of an sodium dodecyl sulfate (SDS)-sensitive "small" complex of ϳ90 kDa (48) that contains CPE and one or mor...