Undesired complement activation is a major cause of tissue injury in various pathological conditions and contributes to several immune complex diseases. Compstatin, a 13-residue peptide, is an effective inhibitor of the activation of complement component C3 and thus blocks a central and crucial step in the complement cascade. The precise binding site on C3, the structure in the bound form, and the exact mode of action of compstatin are unknown. Here we present the crystal structure of compstatin in complex with C3c, a major proteolytic fragment of C3. The structure reveals that the compstatin-binding site is formed by the macroglobulin (MG) domains 4 and 5. This binding site is part of the structurally stable MG-ring formed by domains MG 1-6 and is far away from any other known binding site on C3. Compstatin does not alter the conformation of C3c, whereas compstatin itself undergoes a large conformational change upon binding. We propose a model in which compstatin sterically hinders the access of the substrate C3 to the convertase complexes, thus blocking complement activation and amplification. These insights are instrumental for further development of compstatin as a potential therapeutic.The complement system is a key part of the innate and adaptive immune system and plays a major role in homeostasis by clearing altered host cells and invading pathogens (1, 2). Inappropriate activation of the complement system leads to tissue injury, causing or aggravating various pathological conditions, such as autoimmune diseases, burn injuries, Alzheimer disease, stroke, and heart attack (reviewed in Ref.3). Several complement inhibitors are under development, targeting various steps in the complement activation pathways. None of these compounds have been approved for clinical use yet (3-5). We studied a 13-residue cyclic peptide, called compstatin, which inhibits complement response by preventing the proteolytic activation of C3 3 (6). Activation of C3 by the C3 convertases is a central amplification step in complement activation. All three recognition and initiation pathways, the classical, lectin, and alternative pathways, converge in the activation of C3. Proteolytic activation of C3 yields C3b, which covalently binds to pathogenic or self surfaces, providing a strong signal for clearance of the tagged particles. Because compstatin blocks this critical step of complement activation and because it is a small non-immunogenic peptide, compstatin has the potential to be developed into a therapeutic agent.Compstatin (ICVVQDWGHHRCT-NH 2 , circularized by disulfide bond Cys-2-Cys-12) was discovered by a phage-display, random peptide library search (6). Compstatin has been shown to be an effective inhibitor of complement activation in several clinically relevant models (reviewed in Ref. 5). For example, compstatin was shown to prolong the survival of kidneys in an ex vivo xenograft model (7), inhibited complement activation during the contact of whole blood with biomaterial in a model of extracorporeal circulation (8), and in...