Structural and dynamic studies uncover a distinct allosteric modulatory site at the mu-opioid receptor

Positive allosteric modulators (PAMs) of the μ opioid receptor (MOR) offer a promising path toward safer opioid therapeutics, yet their mechanisms of action remain poorly understood. Here, we uncover the structural and mechanistic basis of BMS-986187, a chemically distinct MOR PAM with in vivo efficacy, using an integrated approach combining cryogenic electron microscopy (cryo-EM), molecular dynamics (MD) simulations, signaling assays, and site-directed mutagenesis. We identify a previously uncharacterized allosteric site for BMS-986187, a lipid-facing pocket formed by MOR transmembrane helices 2, 3, and 4, distinct from sites occupied by other known MOR PAMs or negative allosteric modulators. BMS-986187 engages both receptor residues and a neighboring cholesterol molecule, suggesting a cooperative ligand-lipid mechanism. Our studies pinpoint residues essential for allosteric modulation, while information-theory analysis of MD trajectories uncovers specific allosteric communication pathways linking the PAM site to both the orthosteric agonist DAMGO and the G protein interface. Together, these findings redefine the landscape of MOR allosteric modulation by revealing a novel binding site, a potentially lipid-sensitive allosteric mechanism, and the molecular wiring of long-range communication within MOR. This work provides a new molecular framework for the rational design of PAMs targeting opioid receptors with improved precision and possible therapeutic potential.