ABSTRACT:The objective of this study was to identify CYP3A4 variants in Koreans and to characterize their functional consequences in vitro and in vivo. Four single nucleotide polymorphisms were identified in 50 Koreans by direct DNA sequencing. In an additional genotyping using 248 subjects, CYP3A4*18 was confirmed as the most frequent coding variant in Koreans at 1.7%, and its frequency was similar to that of Asians, suggesting that CYP3A4*18 would be the highest coding variant in Asians. The recombinant CYP3A4.18 protein prepared in baculovirus expression system showed 67.4% lower V max and 1.8-fold higher K m for midazolam 1-hydroxylation compared with the wild type. The mean values of C max and area under the concentration curve (AUC) in the CYP3A4*1/*18 and CYP3A5*1/*3 subjects (n ؍ 8) were 63% and 32% higher than in CYP3A4*1/*1 and CYP3A5*1/*3 carriers (n ؍ 8), respectively. Although the in vitro assay exhibited a significant reduction of the enzyme activity for midazolam, the in vivo differences associated with the CYP3A4*1/*18 tend to be low (P < 0.07 in C max and P < 0.09 in AUC). In summary, the heterozygous CYP3A4*1/*18 does not appear to cause a significant change of midazolam disposition in vivo; however, the clinical relevance of CYP3A4*18/*18 remains to be evaluated.CYP3A is the most abundantly expressed subfamily of cytochrome P450 (P450) enzymes in the human liver (Shimada et al., 1994). The CYP3A enzymes are responsible for the metabolism of more than 50% of clinically used drugs (Komori et al., 1990;Guengerich, 1999;Lamba et al., 2002a). Four human CYP3A enzymes, CYP3A4, CYP3A5, CYP3A7, and CYP3A43, have been identified. CYP3A4 is regarded as the most dominant CYP3A enzyme in the liver and small intestine of humans. It has been reported that CYP3A4 expression shows large interindividual variation (Guengerich, 1999;Ozdemir et al., 2000;Lin et al., 2002). These variations can lead to different responses to human drugs that are substrates for CYP3A4. Because approximately 85% of this variability is attributed to genetic factors (Ozdemir et al., 2000), genetic analysis is needed to understand interindividual variability. To date, more than 39 allelic variants have been described (http://www.cypalleles.ki.se/cyp3a4.htm) (Dai et al., 2001;Eiselt et al., 2001;Kuehl et al., 2001;Lamba et al., 2002a;Fukushima-Uesaka et al., 2004). Among the CYP3A4 variants, alleles with nonsynonymous single nucleotide polymorphisms (SNPs), i.e., CYP3A4*2, *4, *5, *6, *17, and *18, have been shown to alter enzyme activity, compared with the wild type (Lee and Goldstein, 2005). Although some CYP3A SNPs exhibited an altered intrinsic clearance of CYP3A substrates in vitro, there have been few data explaining their meaningful influences on its substrate clearance in humans. The CYP3A4*1B promoter SNP has been extensively studied because of its role in transcriptional regulation in vitro. However, no significant change associated with CYP3A4*1B was observed in midazolam (MDZ) clearance (Wandel et al., 2000;Garcia-Martin...