Prestin is a voltage-dependent membrane-spanning motor protein that confers electromotility on mammalian cochlear outer hair cells, which is essential for normal hearing of mammals. Voltage-induced charge movement in the prestin molecule is converted into mechanical work; however, little is known about the molecular mechanism of this process. For understanding the electromechanical coupling mechanism of prestin, we simultaneously measured voltage-dependent charge movement and electromotility under conditions in which the magnitudes of both charge movement and electromotility are gradually manipulated by the prestin inhibitor, salicylate. We show that the observed relationships of the charge movement and the physical displacement (q-d relations) are well represented by a three-state Boltzmann model but not by a two-state model or its previously proposed variant. Here, we suggest a molecular mechanism of prestin with at least two voltage-dependent conformational transition steps having distinct electromechanical coupling efficiencies.Electromotility (1) of mammalian cochlear outer hair cells (OHCs) 2 is a rapid voltage-induced force-generating cell length change that is indispensable for the frequency selectivity and sensitivity of mammalian hearing (2). The membranebased motor protein, prestin, which is a member of the solute carrier 26 anion transporter family (3), is known to be responsible for generating electromotility (4). Accompanying OHC electromotility, charge movement in the lateral membrane of the cell is observed. This charge movement is manifested in the bell-shaped voltage-dependent cell membrane capacitance, which is often referred to as nonlinear capacitance (NLC) (5, 6)).The question of how prestin functions as a membranebased molecular motor has received a great deal of attention; however, even some fundamental issues are still obscure. To understand the mode of operation of the molecule, the relationship between charge movement, which initiates conformational change, and motor function needs to be quantified. However, only minimal attempts have been made to this effect (6, 7). Under normal operating circumstances NLC data are usually well explained by the simple two-state Boltzmann model with an apparent valency of charge of less than unity. Interesting theoretical work suggested that three-or higher-state models might provide superior description of the process (8, 9). In some work three-state fits were dictated by the data (10). To explain some properties of NLC at extreme membrane voltages, a modified two-state model has also been proposed (11). However, those models have not been subjected to rigorous examination as to their generality under various experimental conditions. It is one purpose of the present work to provide such an examination. We find that a Boltzmann model with at least two voltage-dependent steps is required for explaining prestin function.Since the discovery of prestin, assessments of effects of mutations and drugs on its function have become readily feasible using heter...