The human multidrug transporter P-glycoprotein (Pgp, ABCB1) contributes to the poor bioavailability of many anticancer and antimicrobial agents as well as to drug resistance at the cellular level. For rational design of effective Pgp inhibitors, a clear understanding of its mechanism of action and functional regulation is essential. In this study, we demonstrate that inhibition of Pgp-mediated drug transport by cis-(Z) Cellular expression of human P-glycoprotein (Pgp), 1 the product of the MDR1 gene, confers resistance to a broad variety of structurally unrelated chemotherapeutic agents and restricts bioavailability of many therapeutic drugs in experimental models (1, 2). Pgp is a 1280-amino acid plasma membrane protein that has two homologous halves separated by a linker region of about 80 amino acids (3). Each half of the protein contains a hydrophobic region with six putative transmembrane (TM) helices, followed by a cytoplasmic consensus ATPbinding/hydrolysis site (3). The TM regions are presumed to form the drug-translocating pathway (4), whereas the ATP sites, through ATP hydrolysis, provide the necessary driving force for transport (5, 6).-Pgp-mediated drug transport is inhibited by a number of structurally unrelated compounds known as reversing agents or modulators (for review see Ref.2). Although some of the modulators are currently being tested for their clinical effectiveness, there remains a growing need for molecules with higher efficacy (7-9). To develop such compounds, a clear knowledge of the mechanisms of action of the existing repertoire is essential. Some of the Pgp modulators themselves, such as verapamil (10) and cyclosporin A (11), are substrates of the pump and inhibit drug transport in a competitive manner without interrupting the catalytic turnover (catalytic cycle) of Pgp (12-15). However, for many others, the inhibitory mechanisms are yet to be fully understood.Recent studies on the mechanism of action of Pgp modulators indicated an allosteric mode of action for several compounds. Martin et al. (16) demonstrated that inhibition of vinblastine transport by the anthranilic acid derivative XR9576 is not through direct physical competition for the drug translocating pathway, indicating an allosteric effect on substrate recognition or ATP hydrolysis (17). A similar study suggested that the indolizin sulfone SR33557 affected vinblastine binding to Pgp through interaction with a site distinct from the site of substrate recognition (17). Boer et al. (18) and Ferry et al. (19) have shown that modulators like dexniguldipine and prenylamine inhibited vinblastine interaction with Pgp by a non-competitive mechanism. Based on these and other similar studies, drug interaction sites of Pgp have been categorized into the following two discrete types: 1) transport sites, where translocation of drug across the lipid bilayer can occur, and 2) regulatory sites, which modulate Pgp function (20,21). Most of these studies investigated the effect of the modulators on substrate binding in isolated membranes, ...