Binding of the glucagon peptide to the glucagon receptor (GCGR) triggers the release of glucose from the liver during fasting, thus GCGR plays an important role in glucose homeostasis. Here we report the crystal structure of the seven transmembrane (7TM) helical domain of human GCGR at 3.4 Å resolution, complemented by extensive site-specific mutagenesis, and a hybrid model of glucagon bound to GCGR to understand the molecular recognition of the receptor for its natural ligand. Beyond the shared 7TM fold, the GCGR transmembrane domain deviates from class A G protein-coupled receptors with a large ligand binding pocket and the first transmembrane helix having a “stalk” region that extends three alpha-helical turns above the plane of the membrane. The stalk orients the extracellular domain (~12 kDa) relative to the membrane to form the glucagon binding site that captures the peptide and facilitates the insertion of glucagon’s N-terminus into the 7TM domain.

The purpose of this study was to characterize a large group of infants with complete DiGeorge anomaly and to evaluate the ability of thymus transplantation to reconstitute immune function in these infants. DiGeorge anomaly is characterized by varying defects of the heart, thymus, and parathyroid glands. Complete DiGeorge anomaly refers to the subgroup that is athymic (< 1%). The characteristics of 54 subjects at presentation and results from 44 consecutive thymus transplantations are reported. Remarkably, only 52% had 22q11 hemizygosity and only 57% had congenital heart disease requiring surgery. Thirty-one percent developed an atypical phenotype with rash and lymphadenopathy. To date, 33 of 44 subjects who received a transplant survive (75%) with post-transplantation follow-up as long as 13 years. All deaths occurred within 12 months of transplantation. All 25 subjects who were tested 1 year after transplantation had developed polyclonal T-cell repertoires and proliferative responses to mitogens. Adverse events developing after transplantation included hypothyroidism in 5 subjects and enteritis in 1 subject. In summary, diagnosis of complete DiGeorge anomaly is challenging because of the variability of presentation. Thymus transplantation was well tolerated and resulted in stable immunoreconstitution in these infants. (Blood. 2007; 109: [4539][4540][4541][4542][4543][4544][4545][4546][4547]