Elongation factor 4 (EF4) is a member of the family of ribosome-dependent translational GTPase factors, along with elongation factor G and BPI-inducible protein A. Although EF4 is highly conserved in bacterial, mitochondrial, and chloroplast genomes, its exact biological function remains controversial. Here we present the cryo-EM reconstitution of the GTP form of EF4 bound to the ribosome with P and E site tRNAs at 3.8-Å resolution. Interestingly, our structure reveals an unrotated ribosome rather than a clockwise-rotated ribosome, as observed in the presence of EF4-GDP and P site tRNA. In addition, we also observed a counterclockwise-rotated form of the above complex at 5.7-Å resolution. Taken together, our results shed light on the interactions formed between EF4, the ribosome, and the P site tRNA and illuminate the GTPase activation mechanism at previously unresolved detail.In all cells, proteins are synthesized based on mRNA templates via charged tRNAs by large macromolecular RNA-protein assemblies called ribosomes. Ribosomes harbor three tRNA binding sites, A (aminoacyl tRNA), 2 P (peptidyl tRNA), and E (exiting tRNA) sites, and oscillate between two main states during the peptide chain elongation process, the pretranslocation (PRE) and post-translocation (POST) states, with tRNAs bound to either the A and P or P and E sites, respectively.