Streptococcal inhibitor of complement (Sic) is a secreted protein made predominantly by serotype M1 Group A Streptococcus (GAS), which contributes to persistence in the mammalian upper respiratory tract and epidemics of human disease. Unexpectedly, an isogenic sic-negative mutant adhered to human epithelial cells significantly better than the wild-type parental strain. Purified Sic inhibited the adherence of a sic negative serotype M1 mutant and of non-Sic-producing GAS strains to human epithelial cells. Sic was rapidly internalized by human epithelial cells, inducing cell flattening and loss of microvilli. Ezrin and moesin, human proteins that functionally link the cytoskeleton to the plasma membrane, were identified as Sic-binding proteins by affinity chromatography and matrix-assisted laser desorption͞ionization time-of-flight mass spectrometry analysis. Sic colocalized with ezrin inside epithelial cells and bound to the F-actin-binding site region located in the carboxyl terminus of ezrin and moesin. Synthetic peptides corresponding to two regions of Sic had GAS adherence-inhibitory activity equivalent to mature Sic and inhibited binding of Sic to ezrin. In addition, the sic mutant was phagocytosed and killed by human polymorphonuclear leukocytes significantly better than the wild-type strain, and Sic colocalized with ezrin in discrete regions of polymorphonuclear leukocytes. The data suggest that binding of Sic to ezrin alters cellular processes critical for efficient GAS contact, internalization, and killing. Sic enhances bacterial survival by enabling the pathogen to avoid the intracellular environment. This process contributes to the abundance of M1 GAS in human infections and their ability to cause epidemics. microbiology ͉ Serotype M1 ͉ epidemic waves ͉ ezrin F or most bacterial pathogens, there is relatively little understanding of why certain clonally related isolates cause abundant infections, whereas others do not. Molecular explanation of these phenomena is critical to development of rational methods to limit pathogen emergence, resurgence, and dissemination.Group A Streptococcus (GAS) is an important human pathogen that causes infections ranging from pharyngitis to necrotizing fasciitis and the postinfectious sequelae acute rheumatic fever and acute glomerulonephritis. GAS are genetically highly heterogeneous. For example, more than 150 distinct M-types have been identified on the basis of antigenic differences in the M protein, an antiphagocytic surface molecule that is an important virulence factor (1). However, GAS expressing relatively few M types cause the majority of human invasive infections. In particular, M1 strains are the most common serotype recovered from invasive disease episodes and also have a propensity to cause epidemics (2).Streptococcal inhibitor of complement (Sic) is a secreted protein produced by serotype M1 GAS that inhibits the formation of the membrane attack complex (MAC) of complement in vitro by binding to the C5b-C7 complex (3, 4). Sic production is necessary for per...