X-linked agammaglobulinemia (XLA) is a hereditary defect of B-cell differentiation in man caused by deficiency of Bruton tyrosine kinase (BTK). A three-dimensional model for the BTK kinase domain, based on the core structure of cAMP-dependent protein kinase, was used to interpret the structural basis for disease in eight independent point mutations in patients with XLA. As Arg-525 of BTK has been thought to functionally substitute for a critical lysine residue in proteinserine kinases, the mutation Arg-525 -* Gln was studied and found to abrogate the tyrosine kinase activity of BTK. All of the eight mutations Glu, Arg-520 -+ Glu, Arg-525 --Gln, Arg-562 -+ Pro, Ala-582 --Val, Glu-589 --Gly, Gly-594 --Glu, and Gly-613-* Asp) were located on one face ofthe BTK kinase domain, indicating structural clustering of functionally important residues. X-linked agammaglobulinemia (XLA) is a human immunodeficiency disease characterized by a lymphocyte differentiation block that results in a deficiency of B cells and immunoglobulins, leading to increased susceptibility to infections (1). Recently, the gene mutated in XLA was shown to encode a cytoplasmic protein-tyrosine kinase (PTK) designated Bruton XLA tyrosine kinase (BTK; formerly ATK or BPK) (2, 3). XLA is thus the first Mendelian disease in which a cytoplasmic PTK was found to be mutated. BTK has a single kinase domain (also designated Src homology 1 [SH1] domain) and SH2 and SH3 domains, but lacks both an N-terminal consensus myristoylation sequence and a C-terminal regulatory region. Together with murine Tec and Itk/Tsk it forms a new family ofcytoplasmic PTKs (4-7). The two point mutations reported to cause XLA have both been found in the kinase domain (2), whereas the murine X-linked immunodeficiency defect represents the first missense mutation (8, 9) in the recently identified pleckstrin homology region located in the N terminus of BTK (10-13).The catalytic core of the large protein kinase family contains 9 invariant and 15 highly conserved residues involved in ATP binding and catalysis (14)(15)(16) (23).The x-ray structures, including the independently solved ternary complex (24), provide a comprehensive description of the enzyme, which has been used in modeling of myosin light chain kinase (25), cell division cycle 2 (CDC2) protein kinase (26), and epidermal growth factor receptor PTK (27). The crystal structures of the human cyclin-dependent kinase 2 (CDK2) (28) and mitogen-activated protein (MAP) kinase ERK2 (extracellular signal-related kinase 2) (29) have the same overall fold as cAPK, suggesting that the kinase homology models are valid.In addition to the previously known point mutations in XLA (Lys-430 -* Glu and Arg-525 --Gln) (2), six new missense mutations were found in this disease: Arg-520 -)Glu, Arg-562 -* Pro, Ala-582 -* Val, Gly, Gly-594 --Glu, and Gly-613 --Asp. The functional implications of these mutants were investigated in structural terms by modeling the BTK structure to provide the first three-dimensional model of a cytoplasmic PTK...