Twenty-two amino acid residues from transmembrane domain 3 of the creatine transporter were replaced, one at a time, with cysteine. The background for mutagenesis was a C144S mutant retaining ϳ75% of wild-type transport activity but resistant to methanethiosulfonate (MTS) reagents. Each substitution mutant was tested for creatine transport activity and sensitivity to the following MTS reagents: 2-aminoethyl methanethiosulfonate (MTSEA), 2-(trimethylammonium) ethyl methanethiosulfonate (MTSET), and 2-sulfonatoethyl methanethiosulfonate (MTSES). Two mutants (G134C and Y148C) were inactive, but most mutants showed significant levels of creatine transport. Treatment with MTSEA inhibited the activity of the W154C, Y147C, and I140C mutants. Creatine partially protected I140C from inactivation, and this residue, like Cys-144 in the wild-type CreaT, is predicted to be close to a creatine binding site. MTSEA inactivation of Y147C was dependent on Na Creatine is present at high concentrations in tissues with large and fluctuating demands for energy such as heart, skeletal muscle, and brain. Creatine is converted to phosphocreatine by creatine kinase following ATP synthesis in mitochondria. Phosphocreatine is used to recycle ATP by reversal of this reaction at sites of high energy utilization. In mammals creatine is either obtained by synthesis from sequential reactions occurring in the kidney and liver or from the diet. Interestingly, tissues that contain high levels of creatine/phosphocreatine do not appear to synthesize their own creatine (1). A specific uptake system for creatine was first identified in skeletal muscle (2) and later shown to be present in various cultured cell preparations (3, 4) as well as human monocytes and macrophages (5).Molecular cloning studies identified muscle and brain cDNAs encoding a high affinity Na ϩ -and Cl Ϫ -dependent creatine transporter (6).Rabbit CreaT 2 exhibited significant homology to the GABA and norepinephrine transporters (7,8) and other members of the Na ϩ -and Cl Ϫ -dependent neurotransmitter (9, 10) or solute carrier 6 (SLC6) family of transporters (11). The SLC6 family includes solute transporters for dopamine, serotonin, glycine, taurine, proline, betaine, a system B 0ϩ cationic and neutral amino acid transporter (11), and a system B 0 neutral amino acid transporter mutated in Hartnup disorder (12, 13). The Na ϩ -and Cl Ϫ -dependent creatine transporter (SLC6A8) has been shown recently to be responsible for the absorption of creatine by intestinal epithelia (14) and transport of creatine across the blood-brain and blood-retina barriers (15,16). Mutations in the SLC6A8 gene result in the absence of creatine in the brain and a novel form of X-linked mental retardation. This is characterized by expressive speech and language delays, epilepsy, developmental delay, and autistic behavior (17, 18). All members of the SLC6 family of transporters are predicted to consist of 12 membrane-spanning domains, a large extracellular loop between the third and fourth transmembrane domains ...