To address the effect of the n-3 fatty acid, docosahexaenoic acid (22:6), on proteins that play a role in cholesterol absorption, CaCo-2 cells were incubated with taurocholate micelles alone or micelles containing 22:6 or oleic acid (18:1). Compared with controls or 18:1, 22:6 did not interfere with the cellular uptake of micellar cholesterol. Apical cholesterol efflux was enhanced in cells incubated with 22:6. Cholesterol trafficking from the plasma membrane to the endoplasmic reticulum was decreased by 22:6. 22:6 decreased Niemann-Pick C1-Like 1 (NPC1L1) protein and mRNA levels without altering gene or protein expression of ACAT2, annexin-2, caveolin-1, or ABCG8. Peroxisome proliferatoractivated receptor d (PPARd) activation decreased NPC1L1 mRNA levels and cholesterol trafficking to the endoplasmic reticulum, suggesting that 22:6 may act through PPARd. Compared with hamsters fed a control diet or olive oil (enriched 18:1), NPC1L1 mRNA levels were decreased in duodenum and jejunum of hamsters ingesting fish oil (enriched 22:6). In an intestinal cell, independent of changes in ABCG8 expression, 22:6 increases the apical efflux of cholesterol. 22:6 interferes with cholesterol trafficking to the endoplasmic reticulum by the suppression of NPC1L1, perhaps through the activation of PPARd. Moreover, a diet enriched in n-3 fatty acids decreases the gene expression of NPC1L1 in duodenum and jejunum of hamster. Hypercholesterolemia is a significant risk factor for atherosclerosis. In addition to de novo cholesterol synthesis, cholesterol derived from the diet also contributes to the amount of cholesterol circulating in plasma (1). Moreover, reducing the intestinal absorption of dietary and biliary cholesterol will decrease plasma cholesterol levels (2). It is clear, therefore, that the intestine plays an important role in maintaining total body cholesterol homeostasis. During the past several years, numerous proteins, including ACAT2, caveolin-1, annexin-2, scavenger receptor class B type I, ABCG5, and ABCG8, have been implicated in facilitating/regulating cholesterol absorption by the intestinal absorptive cell (3-8). None of these proteins, however, has turned out to be the "putative" cholesterol transporter in the intestine, as individually these proteins are not essential for the uptake of luminal cholesterol by the absorptive cell (5, 7, 9-11). In the past few years, Altmann and his group (12-15) have described a plasma membrane transporter, Niemann-Pick C1-Like 1 (NPC1L1), which has been shown to play a critical role in the absorption of cholesterol by the intestine. Mice lacking NPC1L1 have a marked reduction in cholesterol absorption and do not get hypercholesterolemic in response to a high-cholesterol diet. The level of gene expression of NPC1L1 along the length of the small intestine in mice parallels the efficiency of cholesterol absorption, with the highest levels found in proximal intestine (duodenum and jejunum) and less expression found in distal intestine (ileum). NPC1L1 also contains an extrac...