Structural basis for hemophilia A caused by mutations in the C domains of blood coagulation factor VIII

Three dimensional homology models for the C1 and C2 domains of factor VIII (FVIII) were generated. Each C domain formed a P-sandwich. and C1 was coval ently connected to C2 in a head-to-head orientation. Of the >250 missense m utations that cause FVIII deficiency and hemophilia A, 34 are in the C doma ins. We used the FVIII C1-C2 model to infer the structural basis for the pa thologic effects of these mutations. The mutated residues were divided into four categories: 15 conserved buried residues that affect normal packing o f the hydrophobic side chains, 2 non-conserved buried residues that affect structure, 11 conserved exposed residues and 6 non-conserved exposed residu es. The effects of all 34 missense mutations can be rationalized by predict able disruptions of FVIII structure while at most four mutations (S2069F, T 2154I, R2209Q/G/L, and E2181D) may, affect residues directly involved in in termolecular interactions of FVIII/VIIIa with other coagulation factors or vWF.