Biliary phospholipid secretion is tightly coupled to the secretion of free cholesterol and bile salts. The secretion of phospholipids across the canalicular membrane of hepatocytes occurs via the multidrug resistance 2 (mdr2) P-glycoprotein (Pgp). The mechanism underlying the coupling of bile salt and phospholipid secretion has not been elucidated. The aims of this study were to determine the effects of bile acid structure on the expression of mdr2 in vitro and in vivo. Under optimal culture conditions, taurine-conjugated bile acids (50 mol/L) increased mdr2 messenger RNA (mRNA) levels in the following order: taurocholate (TCA) (288 ؎ 36%, P < .005) ؍ taurodeoxycholate (TDCA) (276 ؎ 36%, P < .025) > taurochenodeoxycholate (TCDCA) (216 ؎ 34%, P < .025) > tauroursodeoxycholate (TUDCA) (175 ؎ 28%, P < .05) of control levels. The increase in mdr2 mRNA levels by TCA was both time and concentration dependent. Cholate feeding to rats with intact enterohepatic circulation increased mdr2 transcriptional activity by 4-fold and protein mass by 1.9-fold. Chronic biliary diversion (CBD) decreased mdr2 mRNA levels to 66 ؎ 9% (P < .025) of shamoperated controls. Intraduodenal infusion of TCA for 48 hours in CBD rats caused a significant increase in mdr2 mRNA levels (224%) as compared with CBD controls. A diet high in cholesterol (4%) decreased mdr2 mRNA levels to 57% ؎ 2 (P < .001) of pair-fed controls. Squalestatin (1 mol/L), an inhibitor of cholesterol biosynthesis, increased mdr2 mRNA levels by 8.8-fold (P < .005) in hepatocyte cultures after 24 hours. In conclusion, in the rat, bile acids up-regulated mdr2 transcriptional activity whereas cholesterol decreased mdr2 mRNA both in vitro and in vivo. (HEPATOLOGY 2000;32:341-347.)The coupling of biliary secretion of bile salts, phosphatidylcholine (PC) and cholesterol is important in the maintenance of bile flow, biliary lipid composition, and the solubilization of cholesterol. The secretion of PC into the bile is tightly linked to that of cholesterol and the flux of both lipids are coordinated with that of bile salts. 1-3 The biliary cholesterol: phospholipid ratios vary substantially in different species (human 0.3, rat 0.1). 4 However, these ratios are maintained during moderate changes in overall secretion rates, as bile acid output rises and falls. 5,6 In certain pathologic conditions where the secretion of cholesterol is excessive, i.e., out of balance with phospholipids and bile salts, the bile becomes supersaturated with cholesterol. This leads to the precipitation of cholesterol crystals in bile and eventually to the formation of cholesterol gallstones. 4,7 Several studies have described a hyperbolic relationship between rates of bile salt, phospholipid, and cholesterol secretion. 3,8 As bile salt output increases, the rate of biliary lipid secretion also increases until a maximum is reached. 9,10 Moreover, the rate of lipid secretion is proportional to the hydrophobicity of the secreted bile salt species. 7,11 Because hydrophobic bile salts have a greater detergent ...