A conserved hydrophobic region in the bilirubin-type UDP-glucuronosyltransferase isozyme was first uncovered as a consequence of a deleterious mutation in the UGT1A1 (HUG-Br1) isozyme of a Crigler-Najjar (CN) Type I patient. According to analysis by the RAOARGOS computer program, this hydrophobic region in UGT1A1 is located between residues 159-177 and defines a buried helix centered over position 169-172 with a positive factor of 1.22. Further analysis showed that the planar phenol-type UGT1A6 (HLUG P1) isoform, unlike the steroid-type UGT2B7 (UDPGTh2) isozyme, has a similar conserved hydrophobic region and that the positive factor for its buried helix is 1.14 compared to the threshold of 1.13 for such a structure. The analysis detected the typical membrane-insertion-signal sequence and a membrane-anchoring domain in each isoform. The different amino acid sequence patterns between positions 168-172 for the three types of isoforms and the deleterious mutations in this microregion (MRA) of UGT1A1 in CN-I patients are evidence of a critical and descriminating role for MRA. With the recombinant UGT1A1 enzyme and its mutants, P167G, F170del, F170L, F170I, F170V, F170A, F170Y, F170E, F171L, F171I, F171V, F171A, F171Y, or L175Q, expressed in COS-1 cells, bilirubin glucuronidating activity at both pH 6.4 and 7.6 demonstrated that Phe-170 is not replaceable, whereas Phe-171 can be replaced by Leu without any loss of activity. The less hydrophobic buried helix in the phenolic-type UGT1A6 has a Tyr/Leu at position 170/171; this isoform glucuronidated bilirubin at 1/10 the level of that by UGT1A1 with a Km (bilirubin) of 25 microM compared to that for UGT1A1 of 5. 0 microM.