During translation, a plethora of protein factors bind to the ribosome and regulate protein synthesis. Many of those factors are guanosine triphosphatases (GTPases), proteins that catalyze the hydrolysis of guanosine 5′-triphosphate (GTP) to promote conformational changes. Despite numerous studies, the function of elongation factor 4 (EF-4/LepA), a highly conserved translational GTPase, has remained elusive. Here, we present the crystal structure at 2.6-Å resolution of the Thermus thermophilus 70S ribosome bound to EF-4 with a nonhydrolyzable GTP analog and A-, P-, and E-site tRNAs. The structure reveals the interactions of EF-4 with the A-site tRNA, including contacts between the C-terminal domain (CTD) of EF-4 and the acceptor helical stem of the tRNA. Remarkably, EF-4 induces a distortion of the A-site tRNA, allowing it to interact simultaneously with EF-4 and the decoding center of the ribosome. The structure provides insights into the tRNA-remodeling function of EF-4 on the ribosome and suggests that the displacement of the CCA-end of the A-site tRNA away from the peptidyl transferase center (PTC) is functionally significant.T ranslation of the genetic information requires protein factors that interact with the ribosome sequentially, regulate its activity, and guide it through the protein synthesis cycle in a concerted manner. Many of those factors are guanosine triphosphatases (GTPases), proteins that use energy from guanosine 5′-triphosphate (GTP) to promote conformational changes that lead to transitions between ribosome functional states (1, 2). In bacteria, for instance, initiation of protein synthesis is largely regulated by initiation factor 2 (IF-2), a GTPase that stabilizes the initiator tRNA in the P site of the ribosome (3). Subsequently, the elongation step is catalyzed by two universally conserved GTPases, elongation factor Tu (EF-Tu) and elongation factor G (EF-G). The ternary complex, consisting of EF-Tu, GTP, and the aminoacyl-tRNA, interacts with the ribosome to decode the codon in the A site of the ribosome. Following accommodation of the aminoacyl-tRNA in the A site of the ribosome and subsequent peptide bond formation, the tRNA-mRNA duplex is translocated by one codon-a process catalyzed by EF-G and GTP (4-6). Termination of protein synthesis is triggered when a stop codon is reached, upon which the newly synthesized protein is released with the help of release factor 3 (RF-3), yet another GTPase (7).Elongation factor 4 (EF-4/LepA) is a highly conserved protein structurally similar to EF-G (8) and has a ribosome-dependent GTPase activity (9-13). However, despite numerous studies, its function has remained elusive (9-20). Fast kinetic studies showed that EF-4 competes with EF-G during elongation for binding to the pretranslocation (PRE) ribosome, with tRNAs in the A and P sites (17). Despite this, EF-4 was also shown to increase the rate of protein synthesis at high intracellular ionic strength (16), without any effect on translational accuracy (16, 18). Conversely, EF-4 was also reported...