Molecular arrangement and modulation of extrasynaptic αβδ GABAA receptors
γ-aminobutyric acid Type-A (GABAA) αβδ receptors regulate neuronal excitability and contribute to sleep, mood and motor coordination. However, the molecular arrangements of these receptors and the basis of GABA activation and δ-selective drug modulation remain unclear. We solve cryo-EM structures of α4β3δ receptors in an α-β-α-β-δ arrangement that contains two GABA binding pockets. GABA binding supports a classical β-subunit tilt and an outward configuration of the β-subunit M2-M3 loops. However, the δ subunit M2-M3 loop is orientated inward and the 9’ activation gate in the pore is closed, consistent with the low efficacy for these receptors. Addition of a δ-selective positive allosteric modulator (PAM), DS2-Me, reveals binding to an α-δ pocket that causes the 9’ activation gate to open. In this work we provide key insights into the stoichiometry, arrangement and molecular modes of GABA activation and δ-selective modulation of these critical regulators of neuronal excitability. GABAA αβδ receptors regulate tonic inhibitory neurotransmission neuronal excitability and contribute to sleep, mood and motor coordination. Here, we show the subunit arrangement and molecular mechanism of modulation by a δ-subunit selective drug.