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Gc survives in neutrophil-rich gonorrheal secretions, and recovered bacteria predominantly express phase-variable, surface-expressed opacity-associated (Opa) proteins (Opa+). However, expression of Opa proteins like OpaD decreases Gc survival when exposed to human neutrophils\n                    <jats:italic>ex vivo<\/jats:italic>\n                    . Here, we made the unexpected observation that incubation with normal human serum, which is found in inflamed mucosal secretions, enhances survival of Opa+ Gc from primary human neutrophils. We directly linked this phenomenon to a novel complement-independent function for C4b-binding protein (C4BP). When bound to the bacteria, C4BP was necessary and sufficient to suppress Gc-induced neutrophil reactive oxygen species production and prevent neutrophil phagocytosis of Opa+ Gc. This research identifies for the first time a complement-independent role for C4BP in enhancing the survival of a pathogenic bacterium from phagocytes, thereby revealing how Gc exploits inflammatory conditions to persist at human mucosal surfaces.\n                  <\/jats:p>","DOI":"10.1371\/journal.ppat.1011055","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T13:47:21Z","timestamp":1677764841000},"page":"e1011055","update-policy":"https:\/\/doi.org\/10.1371\/journal.ppat.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Neisseria gonorrhoeae co-opts C4b-binding protein to enhance complement-independent survival from neutrophils"],"prefix":"10.1371","volume":"19","author":[{"given":"Lacie M.","family":"Werner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Alcott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida","family":"Mohlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn C.","family":"Ray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meagan","family":"Belcher Dufrisne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asya","family":"Smirnov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Columbus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Blom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7738-3757","authenticated-orcid":true,"given":"Alison K.","family":"Criss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"issue":"8","key":"ppat.1011055.ref001","doi-asserted-by":"crossref","first-page":"548","DOI":"10.2471\/BLT.18.228486","article-title":"Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016","volume":"97","author":"J Rowley","year":"2019","journal-title":"Bull World Health Organ"},{"key":"ppat.1011055.ref002","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1071\/SH19061","article-title":"Epidemiology of Gonorrhea: A Global Perspective","volume":"16","author":"RD Kirkcaldy","year":"2019","journal-title":"Sex 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Novel functions of an old friend","volume":"169","author":"D Ermert","year":"2016","journal-title":"Immunol Lett"},{"issue":"Suppl 8","key":"ppat.1011055.ref026","doi-asserted-by":"crossref","first-page":"I49","DOI":"10.1016\/j.vaccine.2008.11.049","article-title":"Contribution of interactions between complement inhibitor C4b-binding protein and pathogens to their ability to establish infection with particular emphasis on Neisseria gonorrhoeae","volume":"26","author":"AM Blom","year":"2008","journal-title":"Vaccine"},{"key":"ppat.1011055.ref027","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1084\/jem.193.3.281","article-title":"Binding of C4b-binding protein to porin: a molecular mechanism of serum resistance of Neisseria gonorrhoeae","volume":"193","author":"S Ram","year":"2001","journal-title":"J Exp Med"},{"key":"ppat.1011055.ref028","doi-asserted-by":"crossref","DOI":"10.1172\/jci.insight.131886","article-title":"C4BP-IgM protein as a therapeutic approach to treat Neisseria gonorrhoeae infections","volume":"4","author":"S Bettoni","year":"2019","journal-title":"JCI Insight."},{"key":"ppat.1011055.ref029","doi-asserted-by":"crossref","first-page":"17142","DOI":"10.1073\/pnas.0506471102","article-title":"Human C4b-binding protein selectively interacts with Neisseria gonorrhoeae and results in species-specific infection","volume":"102","author":"J Ngampasutadol","year":"2005","journal-title":"Proc Natl Acad Sci U S A"},{"key":"ppat.1011055.ref030","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1002\/cyto.a.24037","article-title":"Imaging Flow Cytometry Analysis of CEACAM Binding to Opa-Expressing Neisseria gonorrhoeae","volume":"97","author":"LM Werner","year":"2020","journal-title":"Cytom Part J Int Soc Anal Cytol"},{"key":"ppat.1011055.ref031","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1055\/s-0038-1646373","article-title":"Protein S and C4b-binding protein: components involved in the regulation of the protein C anticoagulant system","volume":"66","author":"B. 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