Aggregatibacter actinomycetemcomitans is a human pathogen that produces the RTX toxin (repeats in toxin), leukotoxin (LtxA). Based on other RTX toxin systems, the product of ltxC, the first gene of the ltx operon, is predicted to be involved in fatty acid modification of LtxA. To determine the function of ltxC in A. actinomycetemcomitans, we generated an ltxC mutation in the highly leukotoxic strain JP2N using random mutagenesis. The toxin from the ltxC mutant (LtxA(ltxC)) was expressed and secreted into the cell culture supernatant but could not lyse human leukocytes or erythrocytes. Mass spectrometric analysis of LtxA(ltxC) and LtxA from strain JP2N (LtxA(wt)) revealed two peptides that differed and this data suggests that two internal lysine residues of LtxA from the wild-type strain are modified. In blocking experiments, pre-treatment of cells with LtxA(ltxC) was unable to prevent LtxA(wt) from killing cells. Furthermore, in contrast to LtxA(wt), LtxA(ltxC) did not cause an increase in intracellular calcium levels in human leukocytes. Taken together, our data show that ltxC is required for full activity and modification of LtxA in A. actinomycetemcomitans and that modification is important for initial binding of toxin to host cells, as defined by an increase in intracellular calcium levels.