The C1 inhibitor (C1INH), a plasma complement regulatory protein, prevents endotoxin shock, at least partially via the direct interaction of its amino-terminal heavily glycosylated nonserpin region with gramnegative bacterial lipopolysaccharide (LPS). To further characterize the potential LPS-binding site(s) within the amino-terminal domain, mutations were introduced into C1INH at the three N-linked glycosylation sites and at the four positively charged amino acid residues. A mutant in which Asn 3 was replaced with Ala was markedly less effective in its binding to LPS, while substitution of Asn 47 or Asn 59 had little effect on binding. The mutation of C1INH at all four positively charged amino acid residues (Arg 18 , Lys 22 , Lys 30 , and Lys 55 ) resulted in near-complete failure to interact with LPS. The C1INH mutants that did not bind to LPS also did not suppress LPS binding or LPS-induced up-regulation of tumor necrosis factor alpha mRNA expression in RAW 264.7 macrophages. In addition, the binding of C1INH mutants to diphosphoryl lipid A was decreased in comparison with that of recombinant wild-type C1INH. Therefore, the interaction of C1INH with gramnegative bacterial LPS is dependent both on the N-linked carbohydrate at Asn 3 and on the positively charged residues within the amino-terminal domain.Lipopolysaccharide (LPS) is a component of the outer membrane of gram-negative bacteria. It activates mononuclear phagocytes to produce and release inflammatory mediators, among which tumor necrosis factor alpha (TNF-␣) appears to be most important for the development of endotoxin shock (17). LPS binds to LPS-binding protein (LBP) and the complex binds to CD14 (14,24,38,46). The formation of LPS-CD14 complexes initiates intracellular signaling by binding to Tolllike receptors (TLRs) expressed on mononuclear phagocytes and other cells (1). LPS interacts with a number of glycoproteins, including the three components of the cell membrane LPS receptor, CD14, MD-2, and TLR4 (9,23,50,51,58,59). MD-2 has two N-glycosylation sites at Asn 26 and Asn 114 , while TLR4 has nine N-linked sites within its amino-terminal extracellular domain (9). Binding of LPS to the LPS receptor requires N-linked glycosylation of both MD-2 and TLR4 (9) but not of CD14 (50). However, the binding sites for LPS (or lipid A) on many LPS-binding proteins, including bactericidal/permeability increasing protein (19), LBP (25), and MD-2 (31, 40, 60), contain positively charged amino acids, frequently in a similar structural motif (4, 15).The C1 inhibitor (C1INH) is the only inhibitor of the classical complement pathway proteases C1r and C1s (48) and is the major inhibitor of factor XII and prekallikrein of the contact system (11, 44). The complement system has been implicated in both the pathogenesis of, and protection from, endotoxin shock (6). The contact system also appears to play a role in the mediation of septic shock (7). Levels of proteolytically inactivated C1INH are increased in fatal septic shock, which suggests an increased turnover and ...