Endothelial cells are the principal source of plasma and basement membrane von Willebrand factor (vWF). To arrive at its biologically active multimeric form, vWF undergoes a series of intracellular processing steps. The protein is synthesized as a large precursor pro-vWF, which dimerizes in the endoplasmic reticulum through disulfide bonds located in the carboxyl-terminal portion of the subunit. Only dimers are transported to the Golgi apparatus. Expression of truncated pro-vWF subunits, which lack the last 20 kd, abolishes the requirement for dimerization and thereby allows the monomeric protein to be secreted. Another requirement for intracellular transport from the endoplasmic reticulum is N-linked glycosylation. Inhibition of N-linked glycosylation prevents exit of both the wild-type and the truncated vWF from the endoplasmic reticulum. In the acidic environment of the trans-Golgi and post-Golgi compartments, pro-vWF dimers multimerize by a second set of interchain disulfide bonds. The presence of the vWF propolypeptide and acidic pH conditions are necessary for the multimerization process. The largest vWF multimers are stored in endothelial cell-specific organelles called Weibel-Palade bodies. At the site of vascular injury and inflammation, physiologic secretagogues such as thrombin, fibrin, and histamine may cause release of these large, biologically potent vWF multimers from the Weibel-Palade bodies into the surrounding blood and subendothelium.