Cells resist death induced by the complement membrane attack complex (MAC, C5b-9) by removal of the MAC from their surface by an outward and/or inward vesiculation. To gain an insight into the route of MAC removal, human C9 was tagged with Alexa Fluor 488 and traced within live cells. Tagged C9-AF488 was active in lysis of erythrocytes and K562 cells. Upon treatment of K562 cells with antibody and human serum containing C9-AF488, C9-AF488 containing MAC bound to the cells. Within 5-10 min, the cells started shedding C5b-9-loaded vesicles (0.05-1 m) by outward vesiculation. Concomitantly, C9-AF488 entered the cells and accumulated in a perinuclear, late recycling compartment, co-localized with endocytosed transferrin-Texas Red. Similar results were obtained with fixed cells in which the MAC was labeled with antibodies directed to a C5b-9 neoepitope. Inhibition of protein kinase C reduced endocytosis of C5b-9. Kinetic analysis demonstrated that peripheral, trypsin-sensitive C5b-9 was cleared from cells at a slower rate relative to fully inserted, trypsin-resistant C5b-9. MAC formation is controlled by CD59, a ubiquitously expressed membrane complement regulator. Analysis at a cell population level showed that the amount of C5b-9-AF488 bound to K562 cells after complement activation was highly heterogeneous and inversely correlated with the CD59 level of expression. Efficient C9-AF488 vesiculation was observed in cells expressing low CD59 levels, suggesting that the protective impact of MAC elimination by vesiculation increases as the level of expression of CD59 decreases.The complement system is a major component of the innate immune system. It efficiently protects the host from pathogenic microorganisms, is involved in immune complex regulation, and serves an important link between innate and adaptive immune responses. Complement comprises a group of more than 30 proteins; most of them participate in the cascade-like activation process, whereas others serve as control proteins or act as cellular receptors (1, 2). Initiation of the complement activation cascade may occur through the classical, alternative, or lectin pathways. The three initiation pathways lead to activation of the terminal complement pathway and to assembly of the membrane attack complexes (MACs) 2 that are composed of the complement components C5b, C6, C7, C8, and C9 (also known as the C5b-9 complexes). Upon formation of C5b-7, C5b-8, and finally C5b-9 complexes, they adhere and then insert into the target cell membrane (3). The C5b-9 complexes may contain 1-18 C9 molecules attached to a C5b-8 complex. When the number of C9 molecules per C5b-8 exceeds 12, they self-polymerize and form a cylinder-shaped transmembrane structure (4). Upon its assembly, the MAC expresses neoantigens that can be detected by specific monoclonal antibodies (5). Although red blood cells require only one effective MAC to lyse, nucleated cells are killed by complement only after a combined action of several MACs (6). Although larger C5b-9 channels containing several C9 a...