Activated leukocyte cell adhesion molecule (ALCAM/ CD166), a member of the immunoglobulin superfamily with five extracellular immunoglobulin-like domains, facilitates heterophilic (ALCAM-CD6) and homophilic (ALCAM-ALCAM) cell-cell interactions. While expressed in a wide variety of tissues and cells, ALCAM is restricted to subsets of cells usually involved in dynamic growth and/or migration processes. A structure-function analysis, using two monoclonal anti-ALCAM antibodies and a series of amino-terminally deleted ALCAM constructs, revealed that homophilic cell adhesion depended on ligand binding mediated by the membranedistal amino-terminal immunoglobulin domain and on avidity controlled by ALCAM clustering at the cell surface involving membrane-proximal immunoglobulin domains. Co-expression of a transmembrane ALCAM deletion mutant, which lacks the ligand binding domain, and endogenous wild-type ALCAM inhibited homophilic cell-cell interactions by interference with ALCAM avidity, while homophilic, soluble ligand binding remained unaltered. The extracellular structures of ALCAM thus provide two structurally and functionally distinguishable modules, one involved in ligand binding and the other in avidity. Functionality of both modules is required for stable homophilic ALCAM-ALCAM cell-cell adhesion.Adhesion molecules play an important role in development, leukocyte function, and homeostasis in multicellular organisms, which are mainly governed by inter-and intracellular communication via cell-cell interactions. Alterations in cellular adhesion and communication can contribute to uncontrolled cell growth (1) and life-threatening syndromes like leukocyte adhesion deficiency (2). Activation of adhesion molecules generally involves both modulation of affinity and avidity. The affinity of adhesion molecules often reflects a specific conformation of the extracellular ligand-binding domain. Avidity modulation involves changes in the cell surface distribution of adhesion molecules (e.g. lateral oligomerization), which leads to clusters of molecules and thereby specifically increases the number of available receptors at the site of cell-cell interaction.Activated leukocyte cell adhesion molecule (ALCAM/MEMD/ CD166) 1 is a type I transmembrane protein and a member of the Ig superfamily. It has over 90% homology with the chicken adhesion molecule BEN/SC1/DM-GRASP (3-5), and it has 30% identity and 50% similarity with the human melanoma cell adhesion molecule Mel-CAM/MUC18/CD146 (6). Furthermore, ALCAM has 93% sequence identity with the candidate liver high density lipoprotein receptor HB2 (7). ALCAM is involved in various physiological processes including hematopoiesis (8, 9), thymus development (10), the immune response (11), neurite extension (12), neural cell migration (13), and osteogenesis (14).ALCAM has a short cytoplasmic tail and its extracellular part comprises five Ig domains: two amino-terminal variable (V) type Ig domains followed by three constant (C) type Ig domains (V 1 V 2 C 1 C 2 C 3 ). ALCAM was first ident...