Abnormal collagen binding activity of 2A von Willebrand factor: Evidence that the defect depends only on the lack of large multimers

It is well established that the large von Willebrand factor (vWf) multimers bind with high affinity to the extracellular matrix. To explore the different roles of intermediate and large vWf multimers, we studied the collagen-binding activity (vWf:CBA) of 2A vWf under nonflowing conditions in relation to the multimer organization of the molecule. Regardless of the anticoagulant used for blood collection, vWf:CBA was significantly decreased, in 4 patients with 2A von Willebrand's disease (vWd), in accordance with the lack of high and intermediate vWf multimers. After 1-deamino-8-D-arginine vasopressin (DDAVP) infusion, the appearance of circulating large and unusually large vWf multimers, in samples collected in the presence of protease inhibitors, induced a complete normalization of vWf:CBA. The peak was observed 15 minutes after DDAVP, when large and unusually large multimers were maximally represented. These effects were transient because vWf:CBA decreased after 60 minutes, even though values were still significantly higher than pre-DDAVP figures; at the same time, large vWf multimers appeared to be decreased. In contrast, samples anticoagulated with sodium citrate after DDAVP did not show a normalized vWf multimer pattern and were characterized by a persistently decreased vWf:CBA. Moreover, in all of the patients studied, platelet vWf presented normal vWf:CBA values in accordance with the normal levels and multimer organization of the vWf molecule. Our findings indicate that the collagen-binding defect displayed in vitro by type 2A vWf depends only on the lack of circulating large vWf multimers. Moreover, the observation of normal platelet vWf:CBA seems to indicate a primary role of plasma rather than platelet vWf in assuring platelet plug formation.