Recent research regarding the structure and function of B. anthracis lethal (LeTx) and edema (ETx) toxins provide growing insights into the pathophysiology and treatment of shock with this lethal bacteria. These are both binary type toxins comprised of protective antigen (PA) necessary for their cellular uptake and either lethal (LF) or edema factors (EF), the toxigenic moieties. The primary cellular receptors for PA have been identified and constructed and key steps in the extracellular processing and internalization of the completed toxins clarified. Consistent with LF's primary action as an intracellular endopeptidase targeting mitogen activated protein kinase kinases (1-4, 7 and 8) growing evidence indicates that shock with this toxin does not result from an excessive inflammatory response. In fact the potent immunosuppressive effects of LeTx may actually contribute to the establishment and persistence of infection. Instead, shock with LeTx may be related to the direct injurious effects of LF on endothelial cell function. Despite the importance of LeTx, very recent studies show that EF, a potent adenyl cyclase, has the ability to make a substantial contribution to shock caused by B. anthracis and works additively with the former. Furthermore, ETx may contribute to the immunosuppressive effects of LeTx. Therapies under development which target several different steps in the cellular uptake and function of these two toxins have been effective in both in vitro and in vivo systems. Understanding how best to apply these agents clinically and how they interact with conventional treatments should be goals for future research.