IntroductionWe have studied the interaction of the congenitally abnormal type IIA and IIB von Willebrand factor (vWF) molecules, both lacking the larger multimeric forms, with the two vWF binding sites on platelets, the glycoprotein (GP) Ib-IX and GP (8); in the latter, vWF has increased affinity for platelets and, consequently, the larger multimers are removed from the circulation as a result ofplatelet binding (7, 9-1 1). To date, however, there is no detailed information on the modalities of interaction of IIA and IIB vWF with the corresponding binding sites on platelets. The association of vWF with both GP Ib-IX and GP IlbIla appears to be important in thrombus formation (12, 13), and knowledge ofthe molecular mechanisms responsible for it is likely to provide useful information for understanding the processes involved in normal hemostasis as well as pathological vascular occlusion. In this regard, the study of molecular variants of von Willebrand disease is of particular interest if the existence of specific molecular defects can be correlated to relevant abnormalities of interaction with platelets. To address these issues, we have purified the congenitally abnormal vWF molecule from the plasma of patients with type IIA and IIB von Willebrand disease, and evaluated in a quantitative manner the interaction with GP Ib-IX and GP Ib-IhIIa. Our findings demonstrate that IIB vWF can bind to GP Ib-IX in the absence of any mediating or activating molecule, suggesting the existence of a molecular defect resulting in increased affinity for this platelet site. Such increased affinity is also evident in the presence of ristocetin, in spite of the absence of larger multimers. In contrast, IIA vWF interacts with GP Ib-IX with extremely reduced affinity. The severity of this abnormality may reflect the existence of specific structural alterations af-