Folates can induce the expression and activity of the breast-cancer-resistance-protein (BCRP) and the multidrug-resistance-protein-1 (MRP1). Our aim was to study the time-dependent effect of folate deprivation/supplementation on (i) BCRP and MRP expression and (ii) on drug resistance mediated by these transporters. Therefore Caco-2 colon cancer cells usually grown in standard RPMI-medium containing supraphysiological folic acid (FA) concentrations (2.3 lM; high-folate, HF) were gradually adapted to more physiological folate concentrations (1 nM leucovorin (LV) or 1 nM FA; low-folate, LF), resulting in the sublines Caco-2-LF/LV and Caco-2-LF/FA. Caco-2-LF/LV and LF/FA cells exhibited a maximal increase of 5.2-and 9.6-fold for BCRP-mRNA and 3.9-and 5.7-fold for BCRP protein expression, respectively, but no major changes on MRP expression. Overexpression of BCRP in the LF-cells resulted in 3.6-to 6.3-fold resistance to mitoxantrone (MR), which was completely reverted by the BCRP inhibitor Ko143. On the other hand, LF-adapted cells were markedly more sensitive to methotrexate than the HF-counterpart, both after 4-hr (9,870-and 23,923-fold for Caco-2-LF/LV and LF/FA, respectively) and 72-hr (11-and 22-fold for Caco-2-LF/LV and LF/FA, respectively) exposure. Immunofluorescent staining observed with a confocal-laser-scan-microscope revealed that in Caco-2 cells (both HF and LF), BCRP is mainly located in the cytoplasm. In conclusion, folate deprivation induces BCRP expression associated with MR resistance in Caco-2 cells. The intracellular localization of BCRP in these cells suggests that this transporter is not primarily extruding its substrates out of the cell, but rather to an intracellular compartment where folates can be kept as storage. ' 2008 Wiley-Liss, Inc.Key words: BCRP (ABCG2); Caco-2 cells; folate; mitoxantrone; multidrug resistance Folate supplementation is increasingly an essential part of current cancer chemotherapeutic regimens, because it reduces toxicity and enhances the efficacy of several chemotherapy-based treatments. Supplementation of the folates leucovorin (LV) or folic acid (FA) is a common practice to reduce methotrexate (MTX) toxicity in leukemia or rheumatoid arthritis 1,2 while LV increases the efficacy of 5-fluorouracil in some solid tumors, especially colon cancer.3,4 A recent clinical study showed that FA supplementation reduced toxicity of the combination of the antifolate pemetrexed with cisplatin.5 Interestingly, FA also increased the efficacy of this combination, and of cisplatin as a single drug. Homocysteine appeared to be good predictive factor for severe toxicity caused by pemetrexed.6 Therefore, further development of pemetrexed-based therapies has been changed by the addition of FA and vitamin B 12 to all treatment protocols. 5,7 In addition, individual patients may take vitamin supplements themselves during treatments.Some ATP-binding cassette (ABC) transporters have the ability to transport folates and antifolates such as MTX.8 Multidrug resistance proteins 1 through 4 (MRP...