The structural basis for the cooperativity of diazepam oxidation catalyzed by human cytochrome P450 3A4 (CYP3A4) and 40 mutants has been investigated. An ordered two-site model in which substrates bind first to a catalytic/effector site and then to the catalytic site was used to explain sigmoidal kinetics for temazepam formation but hyperbolic kinetics for nordiazepam formation. In this model diazepam binds to the enzyme-substrate complex with a greater affinity (K(S2)=140 microM) than to free enzyme (K(S1)=960 microM). Residues 107, 119, 211, 301, 304, 309, 369, 370, and 373 play an important role in determining regioselectivity of diazepam oxidation. Interestingly, S119F and A370F displayed sigmoidal kinetics for nordiazepam formation, whereas I301F exhibited hyperbolic kinetics for both products. In the presence of increasing concentrations of testosterone, K(S1) for diazepam decreased, whereas K(S2) increased. The data suggest that three sites exist within the active pocket.