title: Misfolding of vWF to pathologically disordered conformations impacts the severity of von Willebrand disease.
abstract: The primary hemostatic von Willebrand factor (vWF) functions to sequester platelets from rheological blood flow and mediates their adhesion to damaged subendothelium at sites of vascular injury. We have surveyed the effect of 16 disease-causing mutations identified in patients diagnosed with the bleeding diathesis disorder, von Willebrand disease (vWD), on the structure and rheology of vWF A1 domain adhesiveness to the platelet GPIbα receptor. These mutations have a dynamic phenotypical range of bleeding from lack of platelet adhesion to severe thrombocytopenia. Using new rheological tools in combination with classical thermodynamic, biophysical, and spectroscopic metrics, we establish a high propensity of the A1 domain to misfold to pathological molten globule conformations that differentially alter the strength of platelet adhesion under shear flow. Rheodynamic analysis establishes a quantitative rank order between shear-rate-dependent platelet-translocation pause times that linearly correlate with clinically reported measures of patient platelet counts and the severity of thrombocytopenia. These results suggest that specific secondary structure elements remaining in these pathological conformations of the A1 domain regulate GPIbα binding and the strength of vWF-platelet interactions, which affects the vWD functional phenotype and the severity of thrombocytopenia.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tischer
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Pranathi
authors.initials: P
authors.lastname: Madde
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Laurie
authors.initials: L
authors.lastname: Moon-Tasson
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: auton.matthew@mayo.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Auton
mesh_terms: D001792:Blood Platelets / Q000378:metabolism; D002448:Cell Adhesion / Q000235:genetics / Q000502:physiology; D002942:Circular Dichroism; D006801:Humans; D016014:Linear Models; D009154:Mutation; D019038:Platelet Glycoprotein GPIb-IX Complex / Q000235:genetics / Q000378:metabolism; D017510:Protein Folding; D017433:Protein Structure, Secondary; D017434:Protein Structure, Tertiary; D012212:Rheology; D012720:Severity of Illness Index; D013057:Spectrum Analysis; D013816:Thermodynamics; D014508:Urea / Q000378:metabolism; D014842:von Willebrand Diseases / Q000235:genetics / Q000378:metabolism*; D014841:von Willebrand Factor / Q000235:genetics / Q000378:metabolism*
chemical_list: D019038:Platelet Glycoprotein GPIb-IX Complex; C094990:adhesion receptor; D014841:von Willebrand Factor; D014508:Urea