Cholesterol has been shown to be hydroxylated at the 4-position by cytochrome P450 3A4, and the reaction occurs in vivo (Bodin, K., Andersson, U., Rystedt, E., Ellis, E., Norlin, M., Pikuleva, I., Eggertsen, G., Björkhem, I., and Diczfalusy, U. (2002) J. Biol. Chem. 277, 31534 -31540). If cholesterol is a substrate of P450 3A4, then it follows that it should also be an inhibitor, particularly in light of the high concentrations found in liver. Heme perturbation spectra indicated a K d value of 8 M for the P450 3A4-cholesterol complex. Cholesterol inhibited the P450 3A4-catalyzed oxidations of nifedipine and quinidine, two prototypic substrates, in liver microsomes and a reconstituted enzyme system with K i ϳ 10 M in an apparently non-competitive manner. The concentration of cholesterol could be elevated 4 -6-fold in cultured human hepatocytes by incubation with cholesterol; the level of P450 3A4 and cell viability were not altered under the conditions used. Nifedipine oxidation was inhibited when the cholesterol level was increased. We conclude that cholesterol is both a substrate and an inhibitor of P450 3A4, and a model is presented to explain the kinetic behavior. We propose that the endogenous cholesterol in hepatocytes should be considered in models of prediction of metabolism of drugs and steroids, even in the absence of changes in the concentrations of free cholesterol.Cytochrome P450 enzymes are nearly ubiquitous in nature. These hemoproteins are involved in the metabolism of numerous steroids, drugs, carcinogens, and other substrates in mammals and, in addition, in many pathways of secondary metabolism and defense in plants and microorganisms (1). Humans have 57 CYP genes potentially coding for P450 enzymes (2). One of these, P450 3A4, is involved in the metabolism of approximately one-half of the drugs marketed today (of those known to be oxidized) (2-4). In addition to drugs, this enzyme also has roles in both the bioactivation and detoxication of chemical carcinogens, e.g. aflatoxin B 1 (2, 5, 6). P450 3A4 also has relatively high catalytic activities in the oxidation of a number of steroids, e.g. testosterone, progesterone, and 17-estradiol (7,8). More recently, P450 3A4 has been shown to catalyze the 4-hydroxylation of cholesterol (9, 10), and the product has been proposed to be an in vivo biomarker of the activity of P450 3A4 (and the related protein P450 3A5, which is generally expressed at lower levels) (11). P450 3A4 has been described as displaying rather schizophrenic behavior toward some ligands, which has been difficult to understand (2). Evidence for cooperativity (both homotropic and heterotropic) was first described in 1993-1994 (12, 13). Subsequently, considerable work has provided insight into the phenomenon, although not all aspects have been clarified (reviewed in Refs. 2 and 14). A general conclusion is that multiple ligands can be accommodated and that this multiplicity somehow accounts for the cooperative behavior that is seen, e.g. due to forcing substrates into juxtapositions...