The adherence of uropathogenic Escherichia coli to the urothelial surface, a critical first step in the pathogenesis of urinary tract infection (UTI), is controlled by three key elements: E. coli adhesins, host receptors, and host defense mechanisms. Although much has been learned about E. coli adhesins and their urothelial receptors, little is known about the role of host defense in the adherence process. Here we show that Tamm-Horsfall protein (THP) is the principal urinary protein that binds specifically to type 1 fimbriated E. coli, the main cause of UTI. The binding was highly specific and saturable and could be inhibited by D-mannose and abolished by endoglycosidase H treatment of THP, suggesting that the binding is mediated by the high-mannose moieties of THP. It is species-conserved, occurring in both human and mouse THPs. In addition, the binding to THP was much greater with an E. coli strain bearing a phenotypic variant of the type 1 fimbrial FimH adhesin characteristic of those prevalent in UTI isolates compared with the one prevalent in isolates from the large intestine of healthy individuals. Finally, a physiological concentration of THP completely abolished the binding of type 1 fimbriated E. coli to uroplakins Ia and Ib, two putative urothelial receptors for type 1 fimbriae. These results establish, on a functional level, that THP contains conserved high-mannose moieties capable of specific interaction with type 1 fimbriae and strongly suggest that this major urinary glycoprotein is a key urinary anti-adherence factor serving to prevent type 1 fimbriated E. coli from binding to the urothelial receptors.The adhesion of Escherichia coli, the most common cause of urinary tract infection (UTI), 1 to urothelial cells is a crucially important first step in UTI pathogenesis (1-5). This adhesion process frequently requires filamentous surface appendages of uropathogenic E. coli that are called fimbriae, or pili. Epidemiological studies have shown that Ͼ90% of all E. coli isolates from UTI patients elaborate type 1 fimbriae (also named mannose-sensitive fimbriae) (4, 6, 7). Although controversies existed for several years, recent investigations have unequivocally documented the importance of type 1 fimbriae as a major urovirulence factor. For instance, of the nine most common E. coli virulence factors, the genes for type 1 fimbriae emerged as the only trait common in all 203 UTI isolates examined (8). In addition, 26% of the 203 strains were positive only for type 1 fimbrial genes and were negative for the eight other urovirulence factors tested, including P, S, and Dr fimbriae. In experimental mouse models, type 1 fimbriae were shown to be indispensable for bladder colonization and infection (9). Conversely, systemic immunization of mice with the FimH tip adhesin of type 1 fimbriae reduced bladder colonization of E. coli by 99% even in neutropenic mice, suggesting that blocking type 1 fimbriae could completely abolish E. coli adhesion (10). Further evidence supporting an important role of type 1 fimbriae ...