PDZ domains are protein-protein interaction modules that organize intracellular signaling complexes. Most PDZ domains recognize specific peptide motifs followed by a required COOH-terminus. However, several PDZ domains have been found which recognize specific internal peptide motifs. The best characterized example is the syntrophin PDZ domain which, in addition to binding peptide ligands with the consensus sequence -E-S/T-X-V-COOH, also binds the neuronal nitric oxide synthase (nNOS) PDZ domain in a manner that does not depend on its precise COOH-terminal sequence. In the structure of the syntrophin-nNOS PDZ heterodimer complex, the two PDZ domains interact in a head-to-tail fashion, with an internal sequence from the nNOS PDZ domain binding precisely at the peptide binding groove of the syntrophin PDZ domain. To understand the energetic basis of this alternative mode of PDZ recognition, we have undertaken an extensive mutagenic and biophysical analysis of the nNOS PDZ domain and its interaction with the syntrophin PDZ domain. Our data indicate that the presentation of the nNOS internal motif within the context of a rigid -hairpin conformation is absolutely essential to binding; amino acids crucial to the structural integrity of the hairpin are as important or more important than residues that make direct contacts. The results reveal the general rules of PDZ recognition of diverse ligand types.PDZ 1 domains are protein-protein interaction modules of approximately 100 amino acids that organize intracellular signaling complexes (for reviews, see refs 1-3). Their name derives from the first three proteins in which they were discovered: PSD-95, Dlg-1, and ZO-1. Since their initial discovery, PDZ domains have been found in all eukaryotic organisms studied to date; 157 PDZ domains have been identified in the Caenorhabditis elegans genome, 208 in the Drosophila melanogaster genome, and 394 in the Homo sapiens genome (4, 5). The most important function of PDZ domains appears to be in localization; many PDZ domains play an essential role in gathering receptors, channels, and downstream effectors at cell-cell communication junctions, as exemplified at neuronal synapses (6, 7). Similarly, PDZcontaining proteins play a central role in regulating apicalbasal polarity in epithelial cells (8).PDZ domains mediate organization of signaling complexes by recognizing specific COOH-terminal amino acid sequence motifs (9). Specificity in PDZ domains is most commonly mediated through the recognition of a small number of amino acid side chains that are necessarily followed by a COOHterminus (10). Peptide library studies show that the requirement for the carboxylate at the terminus is very stringent; addition or deletion of even one amino acid from the consensus sequence eliminates binding. Ligand sequence preferences of most PDZ domains can be divided into two major classes. Class I PDZ domains prefer the -S/T-X-Φ-COOH motif whereas class II PDZ domains the -Φ-X-Φ-COOH motif, where Φ is a hydrophobic amino acid. Recent work s...