G protein-coupled receptors (GPCRs) play central roles in almost all physiological functions; mutations in GPCRs are responsible for more than 30 disorders. There is a great deal of information about GPCR structure but little information that directly relates structure to protein trafficking or to activation. The gonadotropin releasing hormone receptor, because of its small size among GPCRs, is amenable to preparation of mutants and was used in this study to establish the relation among a salt bridge, protein trafficking, and receptor activation. This bridge, between residues E 90 [located in transmembrane segment (TM) 2] and K 121 (TM3), is associated with correct trafficking to the plasma membrane. Agonists, but not antagonists, interact with residue K 121 , and destabilize the TM2-TM3 association of the receptor in the plasma membrane. The hGnRHR mutant E 90 K has a broken salt bridge, which also destabilizes the TM2-TM3 association and is typically retained in the endoplasmic reticulum. We show that this mutant, if rescued to the plasma membrane by either of two different means, has constitutive activity and shows modified ligand specificity, revealing a role for the salt bridge in receptor activation, ligand specificity, trafficking, and structure. The data indicate that destabilizing the TM2-TM3 relation for receptor activation, while requiring an intact salt bridge for correct trafficking, provides a mechanism that protects the cell from plasma membrane expression of constitutive activity.constitutive activity | hormone action | receptor | G-protein coupled receptor | receptor trafficking H undreds of gonadotropin releasing hormone receptor (GnRHR) mutants have been reported but none have constitutive activity (CA) (1). This observation is surprising, because many G protein coupled receptors (GPCRs) have mutants (2) or WT receptors (3) with CA. A highly conserved (4) structural feature of the GnRHR is a salt bridge between transmembrane segment (TM) 2 and TM3 (residues E 90 and K 121 in the human sequence) (5, 6). Gonadotropin releasing hormone (GnRH) agonists, but not peptide antagonists, bind receptor residues D 98 and K 121 (5, 6) and alter the relation between TM2 and TM3; this same relation is important for trafficking of the human GnRHR (hGnRHR) to the plasma membrane (4, 7). We considered that perturbing this relation is also a determinant of receptor activation.Another way to perturb this relation, other than ligand binding, is to alter the charge of one of its constituents; mutant E 90 K would result in charge repulsion between K 90 and K 121 . This mutant, which occurs in some cases of human hypogonadotropic hypogonadism, is typically recognized by the quality control system (QCS) as a misfolded protein (8), retained in the endoplasmic reticulum (ER) (9) and does not traffic to the plasma membrane. E 90 K can be rescued by pharmacoperones, drugs that diffuse into cells and provide a folding template. This template enables (otherwise) misfolded mutants to fold or refold correctly (10), pass a qua...