The ATP-binding-cassette (ABC) transporter multidrug resistance protein (MRP) 2 (ABCC2) forms a natural barrier and efflux system for various (conjugates of) drugs, other xenotoxins, and endogenous compounds. To obtain insight in the pharmacological and physiological functions of Mrp2, we generated Mrp2 knockout mice, which were viable and fertile but suffered from mild hyperbilirubinemia due to impaired excretion of bilirubin monoglucuronides into bile. The mice also had an 80-fold decreased biliary glutathione excretion and a 63% reduced bile flow. Levels of Mrp3 (Abcc3) in liver and Mrp4 The multidrug transporter MRP2 (ABCC2, cMOAT), a member of the ATP-binding-cassette (ABC) superfamily, confers resistance to a range of anticancer drugs (Borst and Oude Elferink, 2002;Chan et al., 2004). The protein is mainly present in the apical membranes of polarized cells in liver, small intestine, and kidney and mediates active transport of both endogenous and xenobiotic compounds to bile, urine, or feces (Chan et al., 2004). MRP2 is functionally deficient in patients with the Dubin-Johnson syndrome (Zimniak, 1993), in TR Ϫ rats (Jansen et al., 1985), and Eisai hyperbilirubinemic rats (EHBRs) (Hosokawa et al., 1992), which all show impaired secretion of bilirubin glucuronides into the bile and as a consequence suffer from conjugated hyperbilirubinemia (Jansen et al., 1985; Hosokawa et al., 1992;Zimniak, 1993). The mutant rat strains also show substantially reduced biliary excretion of glutathione and glutathione conjugates (Paulusma et al., 1999).Besides its role in transport of endogenous compounds, MRP2 plays an important role in the transport of various 1 These authors contributed equally to this work. Article, publication date, and citation information can be found at