Cytochrome P450 3A4 (CYP3A4) is the main P450 enzyme
for drug metabolism
and drug–drug interactions (DDIs), as it is involved in the
metabolic process of approximately 50% of drugs. A detailed mechanistic
elucidation of DDIs mediated by CYP3A4 is commonly believed to be
critical for drug optimization and rational use. Here, two typical
probes, midazolam (MDZ, substrate) and testosterone (TST, allosteric
effector), are used to investigate the molecular mechanism of CYP3A4-mediated
heterotropic allosteric interactions, through conventional molecular
dynamics (cMD) and well-tempered metadynamics (WT-MTD) simulations.
Distance monitoring shows that TST can stably bind in two potential
peripheral sites (Site 1 and Site 2) of CYP3A4. The binding of TST
at these two sites can induce conformational changes in CYP3A4 flexible
loops on the basis of conformational analysis, thereby promoting the
transition of the MDZ binding mode and affecting the ratio of MDZ
metabolites. According to the results of the residue interaction network,
multiple allosteric communication pathways are identified that can
provide vivid and applicable insights into the heterotropic allostery
of TST on MDZ metabolism. Comparing the regulatory effects and the
communication pathways, the allosteric effect caused by TST binding
in Site 2 seems to be more pronounced than in Site 1. Our findings
could provide a deeper understanding of CYP3A4-mediated heterotropic
allostery at the atomic level and would be helpful for rational drug
use as well as the design of new allosteric modulators.