Integrins are a large family of ␣/ heterodimeric cell surface receptors that mediate cell-cell and cell-extracellular matrix adhesion and transduce signals bidirectionally across the plasma membrane. Integrin ␣ L  2 (lymphocyte function associated antigen-1 (LFA-1)) 5 belongs to the  2 integrin subfamily and is constitutively expressed on all leukocytes. ␣ L  2 remains in a low affinity state in resting lymphocytes and undergoes dramatic conformational change during lymphocyte activation, which greatly increases its binding affinity for its ligands intercellular adhesion molecule -1, -2, and -3 (ICAM-1, -2, and -3). Regulation of ␣ L  2 activation is pivotal for controlling leukocyte trafficking and immune responses in health and diseases (1-3).␣ L  2 is an important pharmaceutical target for treating autoimmune and inflammatory diseases (4 -8). A humanized antibody to ␣ L  2 that blocks its binding to the ligand ICAM-1 has been approved by the FDA for treatment of psoriasis, a T cellmediated autoimmune disease of the skin (9, 10). Furthermore, small molecule antagonists of ␣ L  2 have been discovered and are in development (11)(12)(13)(14)(15)(16)(17).␣ L  2 contains two von Willebrand factor-type A domains, the inserted (I) domains in the ␣ L and the  2 subunits (18 -20). Both ␣ L I and  2 I domains have a Rossman fold (i.e. a central -sheet surrounded by ␣-helices) with a metal ion-dependent adhesion site (MIDAS) formed by -␣ loops at the "top" face of the domain (20 -23). In ligand binding the Mg 2ϩ ion in the MIDAS of the ␣ L I domain coordinates directly to a Glu residue that is in the center of the ligand binding sites in domain 1 of 24). The affinity of the ␣ L I domain for ICAMs is regulated by downward axial displacement of its C-terminal ␣7 helix, which is conformationally linked to reshaping of MIDAS loops and increases affinity for ligand by up to 10,000-fold (25, 26). During activation, the  I domain undergoes similar ␣7 helix downward axial movement, which is induced by the swing out of the hybrid domain (27)(28)(29)(30). 6 Previous data suggested that when activated, the  2 I domain binds (through the Mg 2ϩ in its MIDAS) to the Glu residue (Glu-310) in the C-terminal linker of the ␣ L I domain, exerts a downward pull on its ␣7 helix, and thereby activates the ␣ L I domain (Fig. 1A) (32, 33).Two distinct classes of small molecule antagonists of ␣ L  2 have been developed as anti-inflammatory agents. One group of antagonists binds the hydrophobic pocket underneath the ␣7 helix of the ␣ L I domain (e.g. LFA703 or BIRT377), blocks the downward axial movement of the ␣7 helix, and inhibits ligand binding of ␣ L  2 allosterically by stabilizing the ␣ L I domain in the low affinity conformation (11)(12)(13)(14)34). These antagonists are called ␣ I allosteric inhibitors. The other group of antagonists appears to bind to the  2 I domain MIDAS near a key regulatory interface with the ␣ L I domain, blocking communication of conformational change to the ␣ L I domain while at the same time ac...