36The β 1 -adrenoceptor (β 1 AR) is a G protein-coupled receptor (GPCR) 37 activated by the hormone noradrenaline, resulting in the coupling of the 38 heterotrimeric G protein G s 1 . G protein-mediated signalling is terminated by 39 phosphorylation of the receptor C-terminus and coupling of β-arrestin 1 (βarr1, 40 also known as arrestin-2), which displaces G s and induces signalling through the 41 MAP kinase pathway 2 . The ability of synthetic agonists to induce signalling 42 preferentially through either G proteins or arrestins (biased agonism) 3 is 43 important in drug development, as the therapeutic effect may arise from only 44 one signalling cascade, whilst the other pathway may mediate undesirable side 45 effects 4 . To understand the molecular basis for arrestin coupling, we determined 46 the electron cryo-microscopy (cryo-EM) structure of the β 1 AR-βarr1 complex in 47 lipid nanodiscs bound to the biased agonist formoterol 5 , and the crystal structure 48 of formoterol-bound β 1 AR coupled to the G protein mimetic nanobody Nb80 6 . 49 βarr1 couples to β 1 AR in a distinct manner to how G s couples to β 2 AR 7 , with the 50 finger loop of βarr1 occupying a narrower cleft on the intracellular surface 51 closer to transmembrane helix H7 than the C-terminal α5 helix of G s . The 52 conformation of the finger loop in βarr1 is different from that adopted by the 53 finger loop in visual arrestin when it couples to rhodopsin 8 , and its β-turn 54 configuration is reminiscent of the loop in Nb80 that inserts at the same position. 55 β 1 AR coupled to βarr1 showed significant differences in structure compared to 56 β 1 AR coupled to Nb80, including an inward movement of extracellular loop 3 57 (ECL3) and the cytoplasmic ends of H5 and H6. In the orthosteric binding site 58 there was also weakening of interactions between formoterol and the residues 59 Ser211 5.42 and Ser215 5.46 , and a reduction in affinity of formoterol for the β 1 AR-60 βarr1 complex compared to β 1 AR coupled to mini-G s . These differences provide 61 a foundation for the development of small molecules that could bias signalling in 62 the β-adrenoceptors. 63 64 65Ligand bias arises through differential activation of the G protein pathway 66 compared to the arrestin pathway and has been observed in ligands binding to many 67 different GPCRs such as the µ-opioid receptor 9 , the angiotensin receptor (AT 1 R) 10 68 10 th December 2019 3 and the β-adrenoceptors, β 1 AR and β 2 AR 5,11 . The ligands can show complex 69 pharmacology. For example, carvedilol is an inverse agonist of β 1 AR when G protein 70 activity is measured, but it is a weak agonist of the MAPK pathway activated by 71 βarr1 11 . In contrast formoterol is an agonist of both pathways, but stimulates the βarr1 72 pathway more than the G protein pathway 5 . Current theories favour the hypothesis 73 that GPCRs exist in an ensemble of conformations and that ligands preferentially 74 stabilise specific conformations 12 . This suggests that the conformation of a receptor 75 bound to a h...