ABSTRACT: BACKGROUND:Neurosteroids like alphaxalone are potent anxiolytics, anticonvulsants, amnestics, and sedative-hypnotics, with effects linked to enhancement of ?-aminobutyric acid type A (GABAA) receptor gating in the central nervous system. Data locating neurosteroid binding sites on synaptic ??? GABAA receptors are sparse and inconsistent. Some evidence points to outer transmembrane ?-? interfacial pockets, near sites that bind the anesthetics etomidate and propofol. Other evidence suggests that steroids bind more intracellularly in ?-? interfaces. METHODS:The authors created 12 single-residue ?3 cysteine mutations: ?3T262C and ?3T266C in ?3-M2; and ?3M283C, ?3Y284C, ?3M286C, ?3G287C, ?3F289C, ?3V290C, ?3F293C, ?3L297C, ?3E298C, and ?3F301C in ?3-M3 helices. The authors coexpressed ?1 and ?2L with each mutant ?3 subunit in Xenopus oocytes and electrophysiologically tested each mutant for covalent sulfhydryl modification by the water-soluble reagent para-chloromercuribenzenesulfonate. Then, the authors assessed whether receptor-bound alphaxalone, etomidate, or propofol blocked cysteine modification, implying steric hindrance. RESULTS:Eleven mutant ?3 subunits, when coexpressed with ?1 and ?2L, formed functional channels that displayed varied sensitivities to the three anesthetics. Exposure to para-chloromercuribenzenesulfonate produced irreversible functional changes in ten mutant receptors. Protection by alphaxalone was observed in receptors with ?3V290C, ?3F293C, ?3L297C, or ?3F301C mutations. Both etomidate and propofol protected receptors with ?3M286C or ?3V290C mutations. Etomidate also protected ?3F289C. In ?1?3?2L structural homology models, all these protected residues are located in transmembrane ?-? interfaces. CONCLUSIONS:Alphaxalone binds in transmembrane ?-? pockets of synaptic GABAA receptors that are adjacent and intracellular to sites for the potent anesthetics etomidate and propofol.