The human multidrug resistance P-glycoprotein uses ATP to transport a wide variety of structurally unrelated cytotoxic compounds out of the cell. In this study, we used cysteine-scanning mutagenesis and cross-linking studies to identify residues that are exposed to the drug-binding site upon vanadate trapping. In the absence of nucleotides, C222(TM4) was cross-linked to C868(TM10) and C872(TM10); C306(TM5) was cross-linked to C868(TM10), C872(TM10), C945(TM11), C982(TM12), and C984(TM12); and C339(TM6) was cross-linked to C868(TM10), C872(TM10), C942(TM11), C982(TM12), and C985(TM12). These cysteines are in the middle of the predicted transmembrane (TM) segments and form the drug-binding site. Cross-linking between 332C(TM6) and cysteines introduced at the extracellular side of other TM segments was also done. In the absence of nucleotides, residues 332C and 856C on the extracellular side of TMs 6 and 10, respectively, were cross-linked with a 13-Å cross-linker (M8M, 3,6-dioxaoctane-1,8-diyl bismethanethiosulfonate). ATP plus vanadate inhibited cross-linking between 332C(TM6) and 856C(TM10) as well as those in the drug-binding site. Instead, vanadate trapping promoted cross-linking between 332C(TM6) and 976C(TM12) with a 10-Å cross-linker (M6M, 1,6-hexanediyl bismethanethiosulfonate). When ATP hydrolysis was allowed to proceed, then 332C(TM12) could form a disulfide bond with 975C(TM12). The cross-linking pattern of 332C(TM6) with residues in TM10 and TM12 indicates that the drug-binding site undergoes dynamic and relatively large conformational changes, and that different residues are exposed to the drug-binding site during the resting phase, upon vanadate trapping and at the completion of the catalytic cycle.T he human multidrug resistance P-glycoprotein (P-gp) is an ATP-dependent drug pump located at the plasma membrane that can transport a wide variety of structurally diverse compounds of different sizes (recently reviewed in ref. 1). P-gp is clinically important because overexpression of P-gp contributes to the phenomenon of multidrug resistance during treatment of AIDS and cancer. Many of these compounds in these treatment regimens are also substrates of P-gp (2-4). P-gp also plays an important role in mediating the bio-availability of oral drugs because of its relatively higher level of expression in the intestine, brain, liver, and kidney (5-10).P-gp consists of 1,280 aa that are organized in two repeating units of 610 aa that are joined by a linker region of about 60 aa (11). Each repeat has six transmembrane (TM) segments and a hydrophilic domain containing an ATP-binding site (11-13).An important goal in understanding the mechanism of drug transport by P-gp is to determine how ATP hydrolysis is coupled to drug efflux. Both halves of P-gp can hydrolyze ATP (14, 15), but drug-stimulated ATPase activity (14) and conferring of drug resistance (16) requires interaction between the two halves of P-gp. Both halves of P-gp are required for activity because drug binding requires interaction between the NH 2 an...