The proposita and her sister had chronically elevated liver function test results, and needle biopsy specimens showed scattered eosinophilic inclusions within the hepatocytes. On immunoperoxidase staining, the inclusions reacted strongly with anti-fibrinogen antisera; on electron-microscopic (EM) examination, the material appeared confined to the endoplasmic reticulum (ER) and was densely packed into tubular structures with a swirling fingerprint appearance. Coagulation investigations showed low functional and antigenic fibrinogen concentrations that were indicative of hypofibrinogenemia. Amplification and DNA sequencing showed a heterozygous CGG3 TGG mutation at codon 375 of the fibrinogen ␥ chain gene. This novel ␥375 Arg3 Trp substitution segregated with hypofibrinogenemia in 3 family members and was absent from 50 normal controls. When purified plasma fibrinogen chains were examined by sodium dodecyl sulfate/polyacrylamide gel electrophoresis, reverse-phase chromatography, electrospray ionization mass spectrometry, and isoelectric focusing, only normal ␥ chains were detected. In conclusion, we propose that this nonconservative mutation causes a conformational change in newly synthesized molecules and that this provokes aggregation within the ER and in turn causes the observed hypofibrinogenemia. Whereas the mutation site, ␥375, is located in the ␥D domain at the jaws of the primary E-to-D polymerization site, purified plasma fibrinogen showed normal polymerization, supporting our contention that molecules with variant chains never reach the circulation but accumulate in the ER. ( Plasma fibrinogen is synthesized in liver hepatocytes, and a signal peptide is cotranslationally cleaved from each chain as it translocates into the rough endoplasmic reticulum (ER). Chain assembly begins at this point with the formation of A␣-␥ and B-␥ intermediates, 5 and the acquisition of an additional B or A␣ chain respectively leads to the formation of an [A␣-B-␥] half molecule. 6 Dimerization and disulfide bonding completes the assembly process, and further modification in the Golgi network leads to maturation of Nlinked oligosaccharides at positions B 364 and ␥ 52 and the hydroxylation, sulfation, and phosphorylation of other specific side chains. 1 In the Golgi secretory vesicles, a C-terminal propeptide is removed from the A␣ Abbreviations: ER, endoplasmic reticulum; EM, electron microscopy; PBS, phosphate-buffered saline.From the