Previous studies have demonstrated that CD44 isoforms containing the alternatively spliced exon v10 promote cell-cell adhesion via a mechanism that involves the recognition of chondroitin sulfate side chains presented on the surface of interacting cells in association with other CD44 molecules. Sequence analysis revealed the presence within exon v10 of two motifs that may be relevant to this interaction, a B[X 7 ]B motif that may contribute to the recognition and binding of chondroitin sulfate and a serine-glycine motif that may serve as a site of chondroitin sulfate attachment. To determine whether either of these two motifs explain the unique adhesive activity of exon v10-containing CD44 isoforms, each was targeted by site-directed mutagenesis, and the adhesive activity of the resultant mutants was determined using a quantitative cell-cell binding assay. The data obtained demonstrate conclusively that it is the exon v10-encoded B[X 7 ]B motif that is solely responsible for the enhanced adhesive activity of exon v10-containing CD44 isoforms.Numerous studies have documented a striking correlation between the presence of certain alternatively spliced isoforms of the adhesion protein CD44 on the surface of tumor cells and both metastatic propensity and poor prognosis (1). For example, in the case of colorectal carcinoma, patients with Duke's C and D tumors that express high levels of CD44R1, a CD44 isoform that contains sequences encoded by the alternatively spliced exons v8, v9, and v10, exhibit a far worse 5-year disease-free survival rate than equivalent patients with tumors that express predominantly CD44H, an isoform that lacks these differentially utilized exons (2, 3). Similar findings have been reported for a wide range of other hemopoietic and nonhemopoietic malignancies (1, 4). Recent studies from our group and others have provided insights into the molecular mechanisms that underlie this important relationship. Thus, although CD44H and the exon v10-containing CD44 isoforms CD44R1 and CD44R2 appear equivalent in their ability to bind the glycosaminoglycan hyaluronan (HA) 1 (5), only exon v10-containing CD44 isoforms possess the unique ability to directly bind to one another when expressed on the cell surface (5). The novel adhesive phenotype conferred by the inclusion of sequences encoded by exon v10 appeared not to be dependent upon the presence of HA but instead involved the recognition of chondroitin sulfate (CS) moieties presented in association with other CD44 molecules (6). This finding is in agreement with previous studies showing that CD44 can bind a variety of CS-modified protein ligands, including serglycin (7), the invariant chain of major histocompatibility complex/HLA class II (8), aggrecan (9), and versican (10). The precise molecular nature of the CS-dependent interaction that occurs between exon v10-containing CD44 isoforms remains to be determined. Exon v10 encodes an additional B [X 7 ]B motif that in CD44 and other proteins has been shown to play a pivotal role in mediating the bindin...