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domains of VWF have been recently studied intensively because of their critical role in the function of this protein. The A3 domain binds to the exposed subendothelium when a vessel injury has occurred, anchoring the VWF multimer. Then, the high shear generated by rapidly flowing blood activates VWF. In particular, the A1 domain binds to platelet surface receptors glycoprotein Iba and this interaction has been shown to be strengthened by tensile force. A necessary element for proper physiologic function however is the secretion of so called ultralarge VWF multimers which are more active in binding to platelets than smaller VWF proteins. This mechanism is counteracted by the metalloprotease ADAMTS13 which cleaves a scissile bond contained in the A2 domain of VWF, thus converting ultralarge VWF into smaller forms. ADAMTS13 is also a multi-domain protein and the interaction of its constituent domains with VWF is still an area of investigation. Shear stress present in flowing blood is responsible for stretching the VWF protein and exposing the proteolytic site of the A2 domain such that ADAMTS13 can dock and cleave it. Taken together, shear stress is essential to activate VWF but at the same time it triggers its downregulation; this constitutes a very refined mechanism optimized to prevent the formation of blood clots where they are not needed. This delicate blood coagulation mechanism can become out of balance when one of its constituent elements fails. For example, absence or malfunction of ADAMTS13 causes the disruption of the downregulation mechanism of VWF. This get LY2109761 ultimately leads to pathologic thrombus formation and occlusion of atherosclerotic arteries which poses a life threatening risk. On the other hand, mutations in the A2 domain are clinically known to cause excessive cleavage leading to the bleeding disorder called type 2A von Willebrand disease. The exact mechanism by which type 2A mutations alter the stability of the A2 domain and increase its susceptibility to ADAMTS13 cleavage has not been elucidated yet at the molecular level, although the structure and function of this protein have been investigated by numerous experimental studies. The structure of the A2 domain solved through X-ray crystallography presents a similar fold as the neighboring A1 and A3 domains, i.e., a central b sheet PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/22210479 consisting of six strands surrounded by mainly a helices. However, the A2 Structural Basis of Type 2A VWD domain presents only five instead of six a helices because a relatively long unstructured loop replaces the fourth helix at the analogous location in the folds of A1 and A3. This region is thus termed a4 -less loop. In this manuscript, the same numbering for helices and strands is used as in a previous study . Buried inside the protein is the proteolysis site located in the b4 strand. Several single molecule force spectroscopy studies have shown that tensile forces exerted by rapidly flowing blood onto VWF are able to unfold the A2 domain. Furthermore, ADAMTS13 can cleave the A2 domain only if it is denatured. However, no study has reported so far how mutations alter the mechanical regulation of the A2 domain thereby enhancing or decreasing its susceptibility to ADAMTS13. In particular, the absence of a disulfide bond linking the N-terminus of the protein with the C-terminal end of helix a6 suggests that this region might be sensitive to tensile force. This disulfide bond is present in the homologous A1 and A3 domains and might be responsi

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