A universal step in the biosynthesis of membrane sterols and steroid hormones is the oxidative removal of the 14␣-methyl group from sterol precursors by sterol 14␣-demethylase (CYP51). This enzyme is a primary target in treatment of fungal infections in organisms ranging from humans to plants, and development of more potent and selective CYP51 inhibitors is an important biological objective. Our continuing interest in structural aspects of substrate and inhibitor recognition in CYP51 led us to determine (to a resolution of 1.95 Å ) the structure of CYP51 from Mycobacterium tuberculosis (CYP51 Mt ) cocrystallized with 4,4-dihydroxybenzophenone (DHBP), a small organic molecule previously identified among top type I binding hits in a library screened against CYP51 Mt . The newly determined CYP51 Mt -DHBP structure is the most complete to date and is an improved template for three-dimensional modeling of CYP51 enzymes from fungal and prokaryotic pathogens. The structure demonstrates the induction of conformational fit of the flexible protein regions and the interactions of conserved Phe-89 essential for both fungal drug resistance and catalytic function, which were obscure in the previously characterized CYP51 Mt -estriol complex. DHBP represents a benzophenone scaffold binding in the CYP51 active site via a type I mechanism, suggesting (i) a possible new class of CYP51 inhibitors targeting flexible regions, (ii) an alternative catalytic function for bacterial CYP51 enzymes, and (iii) a potential for hydroxybenzophenones, widely distributed in the environment, to interfere with sterol biosynthesis. Finally, we show the inhibition of M. tuberculosis growth by DHBP in a mouse macrophage model.2 is a cytochrome P450 (P450, CYP) heme thiolate containing enzyme involved in biosynthesis of membrane sterols, including cholesterol in animals, ergosterol in fungi, and a variety of C24-modified sterols in plants and protozoa in most organisms in biological kingdoms from bacteria to animals (1). CYP51 has been a therapeutic target for several generations of azole antifungal agents including fluconazole, voriconazole, itraconazole, ravuconazole, and posaconazole (2). These drugs inhibit microbial growth by disrupting biosynthesis of ergosterol, a major component of fungal membrane. Protozoa share with fungi the requirement of ergosterol and ergosterol-related sterols for cell viability and proliferation (3). Inhibition of sterol biosynthesis has been proven to be effective in trypanosomatids (3-5) and Leishmania spp (6), which cause such tropical diseases as African sleeping sickness, Chagas disease, and leishmaniasis.Although mammalian CYP51 enzymes perform the same catalytic reaction (7) as their fungal and protozoan orthologs (1), they share relatively modest overall sequence identity (within 30%) with them. This accounts for the reduced sensitivity of mammalian CYP51 to azole and triazole drugs. Despite the lack of the full sterol biosynthetic pathway in Mycobacterium tuberculosis (8), and hence, de novo sterol biosynthesis...