Cytochrome P450 3A4 (CYP3A4) is the dominant xenobiotic-metabolizing enzyme in the liver and intestine and is involved in the disposition of more than 50% of drugs. Owing to its ability to bind multiple substrates, its reaction kinetics are complex, and its association with the microsomal membrane confounds our understanding of how this enzyme recognizes and recruits diverse substrates. Testosterone (TST) hydroxylation is the prototypical CYP3A4 reaction, displaying positive homotropic cooperativity with three binding sites. Here, exploiting the capability of accelerated molecular dynamics (aMD) to sample events in the millisecond regime, I performed > 25-µs aMD simulations in the presence of three TST molecules. These simulations identified high-occupancy surfacebinding sites as well as a pathway for TST ingress into the CYP3A4 active site originating in the membrane. Adaptive biasing force analysis of the latter pathway revealed a metastable intermediate that could constitute a third binding site at high TST concentrations. Prompted by the observation that interactions between TST and the G'-helix mobilize the ligand into the active site, a free-energy analysis of TST distribution in the membrane was conducted and revealed that the depth of the G'-helix is optimal for extracting TST. In summary, these simulations confirm separate, but adjacent substrate-binding sites within the enzyme and the existence of an auxiliary TSTbinding site. The broader impact of these simulations is that they support a mechanism in which cytochromes P450 directly recruit membrane-solubilized substrates.
________________The cytochromes P450s metabolize nearly all drugs and environmental xenobiotics to which humans are exposed. Of the 57 P450s encoded by the human genome, cytochrome P450 3A4 (CYP3A4) is involved in the clearance of more than half of approved drugs and presents s i g n i f i c a n t c h a l l e n g e t o o p t i m i z i n g pharmacokinetics in drug development and avoiding adverse effects in the clinic.(1,2) CYP3A4 enzyme kinetics can demonstrate marked cooperativity.(3) Positive cooperativity is characterized by a continuous, positive increase in the rate of catalysis with increasing substrate concentration; whereas positive heterotropic cooperativity occurs when the rate of substrate turnover is enhanced by a second distinct effector molecule. Cooperativity in CYP catalysis was first recognized in microsome preparations(4-6) and later confirmed using purified CYP3A4 with several substrates including testosterone (TST), 17β-estradiol, amitriptyline, and aflatoxin B1. (7) A shift in the regioselectivity of midazolam (MDZ) oxidation in patients by concurrent fluconazole administration supports that heterotropic CYP3A4 interactions are also relevant in vivo.(8) Cooperativity in CYP3A4 catalysis has been explained by mechanisms invoking simultaneous occupation of the active site by multiple ligands or binding to nearby allosteric sites. (9)(10)(11)(12)(13)(14)(15) The membrane environment can have a profound effec...