41Despite the many physiological and pathophysiological functions of the human growth 42 hormone receptor (hGHR), a detailed understanding of its modus operandi is hindered 43 by the lack of structural information of the entire receptor at the molecular level. Due 44 to its relatively small size (70 kDa) and large content of structural disorder (>50%), this 45 membrane protein falls between the cracks of conventional high-resolution structural 46 biology methods. Here, we study the structure of the full-length hGHR in nanodiscs 47 63The human growth hormone receptor (hGHR) is ubiquitously expressed 1 , and is 64 activated by human growth hormone (hGH), produced in the pituitary gland. hGHR is 65 important for regulating growth at a cellular and systemic level 1,2 , and is involved in 66 the regulation of hepatic metabolism, cardiac function, bone turnover and the immune 67 system 3 . Besides direct promotion of growth 4 , its ligand hGH can also indirectly 68 regulate growth by initiating the synthesis of insulin-like growth factor-I (IGF-I), an 69 important factor in postnatal growth 2,5,6 . Excess hGH production and mutations in the 70 hGHR gene manifest in different diseases including cancer 7 and growth deficiencies 8-71 11 , with associated cardiovascular, metabolic and respiratory difficulties 8 , and both 72 hGH-based agonists and antagonists of the receptor exist as approved drugs 12,13 . 73
74The hGHR is one of ~40 receptors belonging to the class 1 cytokine receptor family 14 . 75The family is topologically similar with a tripartite structure consisting of a folded 76 extracellular domain (ECD), a single-pass transmembrane domain (TMD), and a 77 disordered intracellular domain (ICD) [14][15][16] . A characteristic trait of these receptors is 78 the lack of intrinsic kinase activity, with the ICD instead forming a binding platform 79 for a variety of signaling kinases and regulatory proteins 15,17,18 , as well as of certain 80 specific membrane lipids 16 (Fig. 1A). Within the ECD, the receptors share a 81 characteristic cytokine receptor homology domain consisting of two fibronectin type 82 III domains (D1, N-terminal and D2, C-terminal), each with a seven stranded b-83 sandwich structure. Two hallmark disulfide bonds and a conserved WSXWS motif (X 84 is any amino acid) 19,20 located in D1 and D2, respectively, are suggested to be important 85 for cell surface localization and discrimination between signaling pathways 19,21 . In 86 hGHR, this motif is instead YGEFS 17 , but the reason for this variation has remained 87 enigmatic. Beside hGHR, group 1 of the class 1 cytokine receptor also encompasses 88 the prolactin receptor (PRLR) and the erythropoietin (EPO) receptor. This group is 89 considered to be the most structurally simple with one cytokine receptor homology 90 domain and ligand binding in a 2:1 complex 17,18 . 91
92Receptor activation is achieved by hGH binding to hGHR via two asymmetric binding 93 sites 22 , leading to structural rearrangements that are propagated through the TMD to the 94 ...