Recombinant nematode anticoagulant protein c2 (rNAPc2) is a potent, factor Xa (Ma)-dependent small protein inhibitor of factor VIIa-tissue factor (fVIIa.TF), which binds to a site on fXa that is distinct from the catalytic center (exo-site), In the present study, the role of other M derivatives in presenting rNAPc2 to fVIIa.TF is investigated. Catalytically active and active site blocked fXa, as well as a plasma-derived and an activation-resistant mutant of zymogen M bound to rNAPc2 with comparable affinities (K-D = 1-10 nM), and similarly supported the inhibition of fVIIa.TF (K-i* = similar to 10 pM), The roles of phospholipid membrane composition in the inhibition of fVIIa TF by rNAPc2 were investigated using TF that was either detergent-solubilized (TFS), or reconstituted into membranes, containing phosphatidylcholine (TFPC) or a mixture of phosphatidylcholine and phosphatidylserine (TFPCPS). In the absence of the M derivative, inhibition of fVIIa TF was similar for all three conditions (K-i similar to1 muM), whereas the addition of the M derivative increased the respective inhibition by 35-, 150-, or 100,000-fold for TFS, TFPC, and TFPCPS. The removal of the gamma -carboxyglutamic acid-containing domain from the M derivative did not affect the binding to rNAPc2, but abolished the effect of factor Xa as a scaffold for the inhibition of fVIIa.TF by rNAPcQ, The overall. anticoagulant potency of rNAPc2, therefore, results from a coordinated recognition of an exo-site on fX/fXa and of the active site of fVIIa, both of which are properly positioned in the ternary fVIIa.TF.M(a) complex assembled on an appropriate phospholipid surface.