von Willebrand Factor (vWF) is a multimeric protein that mediates platelet adhesion to exposed subendothelium at sites of vascular injury under conditions of high flow/shear. The A1 domain of vWF (vWF-A1) forms the principal binding site for platelet glycoprotein Ib (GpIb), an interaction that is tightly regulated. We report here the crystal structure of the vWF-A1 domain at 2.3-Å resolution. As expected, the overall fold is similar to that of the vWF-A3 and integrin I domains. However, the structure also contains N-and C-terminal arms that wrap across the lower surface of the domain. Unlike the integrin I domains, vWF-A1 does not contain a metal ion-dependent adhesion site motif. Analysis of the available mutagenesis data suggests that the activator botrocetin binds to the right-hand face of the domain containing helices ␣5 and ␣6. Possible binding sites for GpIb are the front and upper surfaces of the domain. Natural mutations that lead to constitutive GpIb binding (von Willebrand type IIb disease) cluster in a different site, at the interface between the lower surface and the terminal arms, suggesting that they disrupt a regulatory region rather than forming part of the primary GpIb binding site. A possible pathway for propagating structural changes from the regulatory region to the ligand-binding surface is discussed. von Willebrand Factor (vWF) 1 is a multimeric protein that mediates platelet adhesion to exposed subendothelium at sites of vascular injury (1). The adhesive properties of vWF are tightly regulated so that plasma vWF does not normally interact with circulating platelets. vWF, however, will bind to platelets after it is "activated" by poorly understood conformational changes that occur after it binds to the vessel wall. A reduction in the plasma concentration of vWF or mutations that impair binding, activation, or assembly of vWF multimers cause von Willebrand disease (vWD), a common bleeding disorder characterized by decreased platelet adhesion and mucocutaneous bleeding (2).vWF-mediated adhesion of platelets to the vessel wall, under the high flow/shear conditions present in circulating blood, is mediated by sequences within the first (A1 domain) and third (A3 domain) A type repeats of vWF. The A1 domain (residues 479 -717) binds to platelet glycoprotein Ib⅐IX⅐V complex (GpIb), subendothelial heparans, cell surface sulfatides (reviewed in Ref. 3), and the non-fibrillar collagen type VI (4). The vWF-A3 domain contains the principal site for binding the fibrillar collagens types I and III (5, 6).Although initially noted in the primary sequence of vWF, the A domain has been subsequently discovered in a large number of cell matrix-associated or adhesive proteins and receptors (7). For example, varying numbers of A domains are found in several of the atypical, short chain collagens. A single A domain is inserted into the sequence of several integrin receptors, where it is generally referred to as the I domain. A/I domains are frequently involved in either cell adhesion or cell ligand interactions...