Conserved serines of transmembrane segment (TM) five (TM5) are critical for the interactions of endogenous catecholamines with ␣ 1 -and ␣ 2 -adrenergic,  2 -adrenergic, and D1, D2, and D3 dopamine receptors. The unique high-affinity interaction of the D4 dopamine receptor subtype with both norepinephrine and dopamine, and the fact that TM5 serine interactions have never been studied for this receptor subtype, led us to investigate the interactions of ligands with D4 receptor TM5 serines. Serine-to-alanine mutations at positions 5.42 and 5.46 drastically decreased affinities of dopamine and norepinephrine for the D4 receptor. The D4-S5.43A receptor mutant had substantially reduced affinity for norepinephrine, but a modest loss of affinity for dopamine. In functional assays of cAMP accumulation, norephinephrine was unable to activate any of the mutant receptors, even though the agonist quinpirole displayed wild-type functional properties for all of them. Dopamine was unable to activate the S5.46A mutant and had reduced potency for the S5.43A mutant and reduced potency and efficacy for the S5.42A mutant. In contrast, Ro10-4548 [RAC-2Ј-2-hydroxy-3-4-(4-hydroxy-2-methoxyphenyl)-1-piperazinyl-propoxy-acetanilide], a catechol-like antagonist of the wild-type receptor unexpectedly functions as an agonist of the S5.43A mutant. Other noncatechol ligands had similar properties for mutant and wild-type receptors. This is the first example of a dopamine receptor point mutation selectively changing the receptor's interaction with a specific antagonist to that of an agonist, and together with other data, provides evidence, supported by molecular modeling, that catecholamine-type agonism is induced by different ligand-specific configurations of intermolecular H-bonds with the TM5 conserved serines.The D4 dopamine receptor has had a checkered history of popularity. It was for a time believed to be the ideal target for an atypical antipsychotic drug (for review see Schetz and Sibley, 2007;Schetz, 2009). The D4 receptor has also been pursued as a drug target for treating attention-deficit hyperactivity disorder (ADHD) and erectile dysfunction, but these possibilities remain controversial. A D4 polymorphic variant (D4.7) was reported to be hyporesponsive to dopamine and associated with a higher risk for ADHD (LaHoste et al., 1996). However, the relevance of a low-magnitude hyporesponsiveness is unclear, and the association of the D4.7 polymorphic variant has not always been replicated by different laboratories (for a review see Schetz and Sibley, 2007) with some studies even suggest-