the equilibrium between active e and inactive e* forms of thrombin is assumed to be governed by the allosteric binding of a na + ion. Here we use molecular dynamics simulations and Markov state models to sample transitions between active and inactive states. With these calculations we are able to compare thermodynamic and kinetic properties depending on the presence of na +. For the first time, we directly observe sodium-induced conformational changes in long-timescale computer simulations. thereby, we are able to explain the resulting change in activity. We observe a stabilization of the active form in presence of na + and a shift towards the inactive form in na +-free simulations. We identify key structural features to quantify and monitor this conformational shift. These include the accessibility of the S1 pocket and the reorientation of W215, of R221a and of the Na + loop. the structural characteristics exhibit dynamics at various timescales: conformational changes in the na + binding loop constitute the slowest observed movement. Depending on its orientation, it induces conformational shifts in the nearby substrate binding site. Only after this shift, residue W215 is able to move freely, allowing thrombin to adopt a binding-competent conformation. The serine protease thrombin plays a key role in the blood coagulation cascade as it catalyses the cleavage of fibrinogen, which ultimately leads to the formation of blood clots 1-4. Due to its central role for the blood coagulation, it is a compelling drug target and its structure has been examined thoroughly, with the first X-ray structure published in 1989 5. Thrombin is fully active in the presence of Na + , leading to the description of thrombin as allosterically regulated by Na + binding 6. This leads to the common distinction between 'slow' Na +-free, and 'fast' Na +-bound thrombin 7. While the fast form cleaves fibrinogen and protease-activated receptors, the slow form is more specific towards protein C, imparting an anticoagulant effect to it 8. The ratio between fast and slow forms was estimated to be 3:2 at physiologic temperature and salt concentration 8,9. Na + binds over 15 Å away from the catalytic triad, embedded in the Na + binding loop and coordinated by two backbone carbonyl oxygen atoms and four buried water molecules 10,11. Based on stopped-flow fluorescence measurements, a two-step mechanism of thrombin activation has been proposed 9,12. The active form E can bind to Na + to build the fully active E:Na + form, while the E* form cannot bind Na +. Na + binding stabilizes the E form and thus shifts the equilibrium towards active thrombin 9,13,14. Under physiological conditions the E* form is barely present 9 but it can be stabilized in mutants. Thus, X-ray structures of E* often feature mutations 15,16 , which allow structural interpretation of their observed catalytic inactivity. E* structures typically display a disarrayed conformation of substrate binding site residues W215−E217, which hinders substrate binding. Particularly, the sidechain of ...