Steroid hormones working through their receptors regulate a wide variety of physiologic processes necessary for normal homeostasis. Recent years have witnessed great advances in our understanding of how these hormones interact with their receptors, and have brought us closer to the era of directed drug design. We previously described a novel intramolecular interaction between helix 3 and helix 5 which is responsible for a Mendelian form of human hypertension. Further studies revealed that this interaction is highly conserved throughout the steroid hormone receptor family and functions as a key regulator of steroid hormone receptor sensitivity and specificity. Here, we review the contribution of helix 3-helix 5 interaction to steroid hormone receptor activity, with an eye towards how this knowledge may aid in the creation of novel therapeutic agonists and antagonists.Steroid hormones play a critical regulatory role in a wide variety of physiologic processes, including development, cellular differentiation, and maintenance of cellular homeostasis and blood pressure. Their effects are primarily achieved through activation of specific steroid hormone receptors (SHRs), a subgroup of the larger family of nuclear receptors (NRs), which are activated by specific interactions between the hormone agonist and a C-terminal ligandbinding domain (LBD). In recent years, the availability of high resolution three-dimensional structural information for the LBD of all five steroid hormone receptors has provided a detailed mechanistic understanding of steroid receptor agonism and antagonism [1][2][3][4][5][6][7][8]. Insights gained from such study have greatly improved our understanding of the molecular requirements for ligand-binding and receptor activation and inhibition, and this will prove invaluable as we move forward into the era of directed drug design. However, the relationship between ligandbinding and receptor activation remains poorly understood, and events required beyond ligandbinding for receptor activation have not been well-defined.The LBDs of NR's share a common architecture, with 12 alpha helices and one beta turn arranged around a central hydrophobic core [9]. Comparisons of the crystal structures of ligandfree and ligand bound NRs have shown that, upon ligand binding, NRs undergo a conformational change, including movement of helix 12 (H12) and a bending of helix 3 (H3) towards helix 5 (H5). The repositioned H12 aligns itself with H3 and H5 to form a pocket where transcriptional coactivators bind [9,10]. In recent years, the precise ligand-receptor contacts which allow these molecular events to occur have begun to be elucidated. Residues within the LBDs of nuclear receptors which interact with specific steroid functional groups have been identified, providing a structural basis for the steroid specificity of these receptors [11][12][13][14][15][16][17]. For example, in the human mineralocorticoid receptor (hMR), conserved residues in H3 and H5, Q776 and R817, form hydrogen bonds with the 3-ketone group o...