Introduction of a single-point mutation (Asn to Tyr) at position 410 at the junction between transmembrane domain 6 and the third extracellular loop of the human M 2 muscarinic acetylcholine (mACh) receptor generated a mutant receptor (N410Y) that possesses many of the hallmark features of a constitutively active mutant receptor. These included enhanced agonist binding affinity and potency, in addition to agonist-independent accumulation of [ 3 H]inositol phosphates in cells coexpressing the chimeric G␣ qi5 protein and the N410Y mutant M 2 mACh receptor. Constitutive activity was sensitive to inhibition by a range of muscarinic ligands, including those used clinically in the management of overactive bladder (oxybutynin, tolterodine, and darifenacin), indicating that these ligands behave as inverse agonists at the M 2 mACh receptor. Long-term (24-h) treatment of Chinese hamster ovary cells expressing the N410Y mutant M 2 mACh receptor with certain mACh receptor inverse agonists (atropine, darifenacin, and pirenzepine) elicited a concentration-dependent up-regulation of cell surface receptor expression. However, not all ligands possessing negative efficacy in the [ 3 H]inositol phosphate accumulation assays were capable of significantly up-regulating receptor expression, perhaps indicating a spectrum of negative efficacies among ligands traditionally defined as mACh receptor antagonists. Finally, structurally distinct agonists exhibited differences in their relative potencies for the activation of G␣ i/o versus G␣ s , consistent with agonist-directed trafficking of signaling at the N410Y mutant, but not at the wild-type M 2 mACh receptor. This indicates that the N410Y mutation of the M 2 mACh receptor alters receptor-G-protein coupling in an agonist-dependent manner, in addition to generating a constitutively active receptor phenotype.A crucial development in our understanding of G-proteincoupled receptor (GPCR) function has been the identification of the ability of receptors to activate their cognate G-proteins in the absence of an agonist (Costa and Herz, 1989). Thus, certain ligands (termed inverse agonists and previously characterized as competitive antagonists) can inhibit agonist-independent receptor activity (Costa and Herz, 1989). Subsequent research has identified significant agonist-independent (constitutive) activity at a wide variety of both endogenously and recombinantly expressed GPCRs (for review, see Seifert and Wenzel-Seifert, 2002).One of the most powerful tools used by researchers in this area has been the development of GPCRs harboring specific mutations known to enhance the agonist-independent coupling of receptor and G-protein [so-called constitutively active mutant (CAM) receptors] (Seifert and Wenzel-Seifert, 2002). Mutations in a number of well conserved domains, including the D/ERY motif at the intracellular interface of the third transmembrane domain (TM3) and the BBXXB motif (where B is Arg or Lys) toward the C-terminal end of the third intracellular loop, have been reported to ...