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Anthrax lethal factor is the active component of the protein exotoxin, the lethal toxin, secreted by toxigenic strains of B. anthracis. Lethal toxin is an A-B type toxin consisting of two non-covalently bound factors, the lethal factor and the protective antigen. The protective antigen binds to a ubiquitous receptor on the plasma membrane and is processed proteolytically by membrane peptidases, including furin, to a 63kDa form that is able to oligomerize and bind the lethal factor. Upon endocytic uptake, the protective antigen undergoes an acid-triggered conformational rearrangement that mediates the transfer of the lethal factor from the lumen of a late endocytic compartment to the cytoplasm. Anthrax lethal toxin has specific cytopathic effects on macrophages after the production of reactive oxygen intermediates, which induce cellular lysis.
While the exact mechanism of action of lethal factor is unknown, death is apparently due to oxygen depletion, secondary shock, increased vascular permeability, respiratory failure and cardiac failure. Death from Anthrax in humans or animals frequently occurs suddenly and unexpectedly. The level of the lethal toxin in the circulation increases rapidly quite late in the disease, and it closely parallels the concentration of organisms in the blood. It has been observed, however, that high levels of the toxin are cytolytic to macrophages, whereas low levels stimulate these cells to produce cytokines such as interleukin-1 beta (IL-1 -
•) and tumor necrosis factor-alpha (TNF-á), which induce systemic shock and death.
Production of the Anthrax toxin is mediated by a temperature-sensitive plasmid, pX01, of 110 megadaltons. The toxin complex is then transported to the cytosol where edema toxin acts by converting adenosine triphosphate to cyclic adenosine monophosphate. Cellular cyclic adenosine monophosphate levels are increased, leading to the edema characteristic of disease.