NO reversibly inhibits mitochondrial respiration via binding to cytochrome c oxidase (CCO). This inhibition has been proposed to be a physiological control mechanism and͞or to contribute to pathophysiology. Oxygen reacts with CCO at a heme iron:copper binuclear center (a 3͞CuB). Reports have variously suggested that during inhibition NO can interact with the binuclear center containing zero (fully oxidized), one (singly reduced), and two (fully reduced) additional electrons. It has also been suggested that two NO molecules can interact with the enzyme simultaneously. We used steady-state and kinetic modeling techniques to reevaluate NO inhibition of CCO. At high flux and low oxygen tensions NO interacts predominantly with the fully reduced (ferrous͞cuprous) center in competition with oxygen. However, as the oxygen tension is raised (or the consumption rate is decreased) the reaction with the oxidized enzyme becomes increasingly important. There is no requirement for NO to bind to the singly reduced binuclear center. NO interacts with either ferrous heme iron or oxidized copper, but not both simultaneously. The affinity (K D) of NO for the oxygen-binding ferrous heme site is 0.2 nM. The noncompetitive interaction with oxidized copper results in oxidation of NO to nitrite and behaves kinetically as if it had an apparent affinity of 28 nM; at low levels of NO, significant binding to copper can occur without appreciable enzyme inhibition. The combination of competitive (heme) and noncompetitive (copper) modes of binding enables NO to interact with mitochondria across the full in vivo dynamic range of oxygen tension and consumption rates.bioenergetics ͉ mitochondria ͉ signaling N O is a physiological signaling molecule produced in vivo by enzymes of the NO synthase family. The NO signaling pathway is classically mediated by activation of soluble guanylate cyclase (1-3). However, in 1994 it was additionally shown that mitochondrial oxygen consumption by cytochrome c oxidase (CCO) is reversibly inhibited by NO in a manner apparently competitive with the oxygen tension (4-6). Inhibition of mitochondrial respiration by NO at CCO has since been implicated in a wide range of physiological processes (7-12), and several of these require a competitive (with respect to oxygen) element to the interaction, e.g., activating hypoxia-inducible factor (13); maintaining flow-metabolism coupling in the brain (14); and allowing cells distant from capillaries to maintain adequate oxygenation (15). Under pathological conditions such as sepsis, the elevated NO concentration, generated by inducible NO synthase, is associated with mitochondrial dysfunction and is implicated in mortality in the critically ill (16).However, the detailed molecular mechanism of CCO inhibition by NO has not yet been unequivocally established. The oxygen-binding center of CCO is bimetallic, and dioxygen reacts at this site only when both the heme a 3 iron and the adjacent copper (Cu B ) are reduced (17). Functional studies initially suggested that NO inhibits by...