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Mutations in ABCB7 are linked to X-linked sideroblastic anemia with ataxia (XLSA\/A). Here, we demonstrate that the ATPase activity of ABCB7 is stimulated by iron and cobalt protoporphyrin IX (hemin and CoPP) in the presence of glutathione (GSH), highlighting an additional role for ABCB7 as a metalloporphyrin exporter. Using single-particle cryo-electron microscopy, we determine the structures of human ABCB7 in multiple functional states at resolutions of up to 2.3\u2009\u00c5. Our structures reveal a putative substrate-binding cavity that accommodates two stacked CoPP molecules conjugated by two GSH cysteine thiols. The conserved residue F426 controls substrate entrapment and release as a molecular gate. We further show that at high substrate concentrations excess CoPP easily partitions into the lipid bilayer, where the hydrophobic environment stabilizes the porphyrin macrocycle and limits the aggregation or redox reactivity that is prone to occur with free porphyrins in aqueous solution. Finally, our structure analyses rationalize the pathogenic effect of the E433K mutation associated with XLSA\/A disease.<\/jats:p>","DOI":"10.1038\/s42003-026-10223-x","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T01:34:47Z","timestamp":1778290487000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cryo-EM structures of human ABCB7 reveal the molecular basis of mitochondrial matrix heme export"],"prefix":"10.1038","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4171-9145","authenticated-orcid":false,"given":"Seulgi","family":"Ju","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Hun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4162-6354","authenticated-orcid":false,"given":"Hyeon You","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0516-0284","authenticated-orcid":false,"given":"Mi Sun","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"10223_CR1","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1186\/1479-7364-3-3-281","volume":"3","author":"V Vasiliou","year":"2009","unstructured":"Vasiliou, V., Vasiliou, K. & Nebert, D. 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