The molecular structure of FVIII is characterized by a distinct domain structure: A1-a1-A2-a2-B-a3-A3-C1-C2 (Fig. 1). The protein is subject to extensive post-translational modifications, including glycosylation, sulphation and limited proteolytic processing. FVIII comprises over 20 N-linked glycans, only five of

which are located outside the B-domain. In addition, a number of O-linked glycans are located in the B-domain as well [4]. It is unclear if and how these carbohydrate residues contribute to FVIII function. However, it has been well established that FVIII glycosylation plays a major role in intracellular folding and routing of the molecule. They not only provide anchor sites for quality selleckchem control proteins,

like calreticulin and calnexin [5], but also for the transport proteins, lectin mannose-binding protein-1 (LMAN-1, previously known as ERGIC-53) and multiple coagulation factor deficiency-2 (MCFD2) [6,7]. PD0325901 order LMAN1 and MCFD2 act in concert in FVIII trafficking from the endoplasmatic reticulum to the Golgi compartment, and impaired cargo function of either protein is associated with a combined deficiency of FVIII and its homologue factor V [8,9]. Sulphated tyrosines are found in the acidic regions of the molecules (a1, a2 and a3; see Fig. 1), which contain motifs enriched in negatively charged amino acid residues [10]. As will be described next, the sulphated residues play an important role in thrombin-mediated FVIII activation and in the interaction

buy Regorafenib with von Willebrand factor (VWF) [10–12]. Owing to intracellular proteolytic processing, FVIII is secreted as a heterodimeric protein, which contains a metal ion-linked heavy (A1-a1-A2-a2-B region) and light (a3-A3-C1-C2 region) chains [13,14]. A dominant site of FVIII production seems to be located in the liver, as liver transplantations resulted in sustained, normalized levels of FVIII in a number of cases concerning haemophilic patients [15,16]. The observations that FVIII mRNA is also present in other organs, such as spleen, lung and kidneys suggest that these tissues may contribute to circulating FVIII levels as well [17–20]. Indeed, the presence of extrahepatic FVIII production has been demonstrated in pigs that underwent total hepatectomy [21]. Moreover, recent studies by Jacquemin et al. [22] revealed that human lungs are also capable of producing considerable amounts of FVIII protein. These investigators estimated the potential of FVIII production by lungs to be 32 U of FVIII h−1, which would represent approximately one-fifth of the total FVIII supply needed [22]. The cellular origin of FVIII has long been a matter of debate, with reports providing evidence for FVIII production taking place either in hepatocytes or endothelial-like cells.