Adrenomedullin (AM)
and calcitonin gene-related peptide (CGRP)
receptors are critically important for metabolism, vascular tone,
and inflammatory response. AM receptors are also required for normal
lymphatic and blood vascular development and angiogenesis. They play
a pivotal role in embryo implantation and fertility and can provide
protection against hypoxic and oxidative stress. CGRP and AM receptors
are heterodimers of the calcitonin receptor-like receptor (CLR) and
receptor activity-modifying protein 1 (RAMP1) (CGRPR), as well as
RAMP2 or RAMP3 (AM1R and AM2R, respectively).
However, the mechanistic basis for RAMP modulation of CLR phenotype
is unclear. In this study, we report the cryo-EM structure of the
AM1R in complex with AM and Gs at a global resolution of
3.0 Å, and structures of the AM2R in complex with
either AM or intermedin/adrenomedullin 2 (AM2) and Gs at 2.4 and 2.3
Å, respectively. The structures reveal distinctions in the primary
orientation of the extracellular domains (ECDs) relative to the receptor
core and distinct positioning of extracellular loop 3 (ECL3) that
are receptor-dependent. Analysis of dynamic data present in the cryo-EM
micrographs revealed additional distinctions in the extent of mobility
of the ECDs. Chimeric exchange of the linker region of the RAMPs connecting
the TM helix and the ECD supports a role for this segment in controlling
receptor phenotype. Moreover, a subset of the motions of the ECD appeared
coordinated with motions of the G protein relative to the receptor
core, suggesting that receptor ECD dynamics could influence G protein
interactions. This work provides fundamental advances in our understanding
of GPCR function and how this can be allosterically modulated by accessory
proteins.