Interaction of glycoprotein Ib␣ (GPIb␣) with von Willebrand factor (VWF) initiates platelet adhesion to injured vascular wall to stop bleeding. A major contact between GPIb␣ and VWF involves the -switch region, which is a loop in the unliganded GPIb␣ but switches to a -hairpin in the complex structure. Paradoxically, flow enhances rather than impedes GPIb␣-VWF binding. Gain-offunction mutations (e.g., M239V) in the -switch reduce the flow requirement for VWF binding, whereas loss-of-function mutations (e.g., A238V) increase the flow requirement. These phenomena cannot be explained by crystal structures or energy calculations. Herein we demonstrate that the -hairpin is unstable without contacting VWF, in that it switches to a loop in free molecular dynamics simulations. Simulations with a novel flow molecular dynamics algorithm show that the loop conformation is unstable in the presence of flow, as it switches to -hairpin even without contacting VWF. Compared with the wild-type, it is easier for the M239V mutant but harder for the A238V mutant to switch to -hairpin in the presence of flow. These results elucidate the structural basis for the two mutants and suggest a regulatory mechanism by which flow activates GPIb␣ via inducing a loop-to--hairpin conformational transition on the -switch, thereby promoting VWF binding. flow molecular dynamics ͉ Platelet-type von Willebrand disease ͉ von Willebrand factor ͉ conformational change ͉ mechanical sensing B inding of glycoprotein Ib␣ (GPIb␣) to von Willebrand factor (VWF) initiates a multistep platelet adhesion and signaling cascade of the hemostatic process (1, 2). Dysfunction of GPIb␣-VWF interaction may cause bleeding disorders such as von Willebrand diseases (VWD) (3). A rapid kinetic on-rate of GPIb␣-VWF binding is required for flowing platelets to tether to injured vessel wall. Counterintuitively, however, GPIb␣-VWF binding is enhanced by blood flow, despite the fact that increasing flow shortens contact time for molecular interaction (4). A minimum flow is required for platelets to tether to VWF (4, 5). The kinetic rates of GPIb␣-VWF binding and their mechanical regulation by flow can be altered by structural variations. Mutations may require higher or lower flows for platelet to tether to VWF compared with the wild-type (WT) GPIb␣ (6). The former is referred to as a gain-of-function (GOF) mutant, whereas the latter is a loss-of-function (LOF) mutant. GOF mutations G233V and M239V naturally occur in some patients with platelet-type (PT) VWD (5,7,8).GPIb␣ consists of a glycosylated N-terminal domain (GPIb␣N), a long mucin stalk, a transmembrane domain, and a cytoplasmic tail (9, 10). The binding site for VWF resides on GPIb␣N, which contains eight tandem leucine-rich repeats (Fig. 1A) (11). The monomeric subunit of VWF consists of multiple copies of A, B, C, and D type domains (12). The binding site for GPIb␣ resides on the A1 domain ( Fig. 1 B, cyan) (13). Regions of GPIb␣N at each end of the leucine-rich repeats bind, respectively, to the top and botto...