Mutations in LMAN1 (ERGIC-53) and MCFD2 are the causes of a human genetic disorder, combined deficiency of coagulation factor V and factor VIII. LMAN1 is a type 1 transmembrane protein with homology to mannose-binding lectins. MCFD2 is a soluble EF-handcontaining protein that is retained in the endoplasmic reticulum through its interaction with LMAN1. We showed that endogenous LMAN1 and MCFD2 are present primarily in complex with each other with a 1:1 stoichiometry, although MCFD2 is not required for oligomerization of LMAN1. Using a cross-linking-immunoprecipitation assay, we detected a specific interaction of both LMAN1 and MCFD2 with factor VIII, with the B domain as the most likely site of interaction. We also present evidence that this interaction is independent of the glycosylation state of factor VIII but requires native calcium concentration in the endoplasmic reticulum. The interaction of MCFD2 with factor VIII appeared to be independent of LMAN1-MCFD2 complex formation. These results suggest that LMAN1 and MCFD2 form a cargo receptor complex and that the primary sorting signals residing in the B domain direct the binding of factor VIII to LMAN1-MCFD2 through calcium-dependent protein-protein interactions. MCFD2 may function to specifically recruit factor V and factor VIII to sites of transport vesicle budding within the endoplasmic reticulum lumen.Correctly folded proteins destined for secretion by anterograde transport toward the Golgi are packaged in the ER 1 into COPII-coated vesicles (1). These vesicles then uncoat and fuse with each other to form the ER-Golgi intermediate compartment (ERGIC). Resident proteins recycle from the ERGIC back to the ER in COPI-coated vesicles. Many transmembrane cargo proteins, such as the SNAREs, bind to Sec24p in the COPII coat through ER exit motifs in their cytoplasmic tails. The transport mechanism for the exit of soluble cargo proteins from the ER has been explained by two distinct models. Secretion of certain abundant proteins is consistent with a bulk flow model in which cargo moves by default and requires no export signals (2, 3). In contrast, the receptor-mediated export model envisions selective packaging of secreted proteins into budding vesicles with the help of membrane-anchored cargo receptors that interact with COPII coat proteins and is supported by recent observations of sorting in ER-derived transport vesicles (4 -7). In yeast, a heteromeric complex of Emp24p and Erv25p was shown to directly cross-link with Gas1p and to be required for its efficient packaging (8). Similarly, the ER-localized membrane protein Erv29p functions by binding and directing glycosylated pro-␣-factor into COPII-coated transport vesicles (9, 10).Our recent genetic studies identified mutations in LMAN1 (also referred to as ERGIC-53) and MCFD2 as the causes of an inherited human bleeding disorder, combined deficiency of coagulation factor V and factor VIII (F5F8D) (11,12). This disorder is associated with plasma levels of factor V (FV) and factor VIII (FVIII) in the range of 5-3...