The importance of factor VIII (FVIII) 1 and FIX in hemostatic reactions is evident by the fact that hemophilia A (FVIII deficiency) and hemophilia B (FIX deficiency) are the two most serious congenital coagulation defects, both producing severe, life-threatening and life-long hemorrhagic disease. FVIII is synthesized as a single polypeptide chain containing 2,351 amino acids (1) and shows a discrete domain structure, A1-a1-A2-a2-B-a3-A3-C1-C2; the domains are separated by short spacers (a1, a2, and a3) composed of acidic regions that contain clusters of Asp and Glu residues (2). The A domains display ϳ30% homology to each other, and they also share sequence homology with ceruloplasmin and FV. The B domain is unique to FVIII. The C domains share homology with FV and discoidin 1, a lectin (1). During proteolytic activation of pro-cofactor (FVIII), the B domain that does not contribute to cofactor function is excised. The heavy chain (HC) and light chain (LC) remain noncovalently associated through the A1 and A3 domains in a metal ion-dependent manner and participate as an active cofactor in tenase complex formation (1). The following terminology, suggested by Lenting et al. (2), for FVIII subunits was used: A1 ϭ HC-derived fragment containing residues 1-372; A2 ϭ HC-derived fragment containing residues 373-740; A1-A2 ϭ HC subunit of FVIII containing residues 1-740 (without the B domain); B ϭ HC subunit residues 741-1648; LC ϭ LC of FVIII; A3-C1-C2 ϭ LC-derived fragment arising from the cleavage at position 1689. Thrombin cleaves FVIII at one specific site within the LC, Arg 1689 , and at two sites in the HC, Arg 372 and Arg 750 , resulting in a heterodimer of 50 kDa (A1 domain), 43 kDa (A2 domain), and 73 kDa (A3-C1-C2 dimer); all of these subunits are required for the procoagulant activity (3). More specifically, the cleavages at Arg 372 and Arg 1689 are required to exert full cofactor activity (4, 5), whereas cleavage of the LC at Arg 1689 is also responsible for dissociation of FVIII from von Willebrand factor (vWF) (6).FVIII in the circulation forms a tight, noncovalent complex with vWF, and both the amino-terminal and the carboxylterminal regions of FVIII are involved in this interaction (6, 7). The formation of the FVIII-vWF complex is essential for the survival of FVIII in the circulation. Another functional consequence of FVIII-vWF complex formation is to prevent binding of FVIII to components of the FX-activating complex, e.g. the binding of FVIII LC to FIXa has been shown to be inhibited by vWF (8). Furthermore, FVIII-vWF complex is less susceptible to proteolytic degradation by proteases like activated protein C (9) and FXa (10). vWF also prevents FVIII binding to phospholipids (11) and platelets (12). In contrast, vWF does not protect FVIII from thrombin cleavage (13,14). Recently, it has been shown (15) that FIXa displays similar affinity for pro-cofactor (FVIII) and active cofactor (FVIIIa), but as mentioned above, the FIXa-binding site is not accessible when FVIII is in com-