Ursodeoxycholic acid (UDCA), a relatively nontoxic bile acid, enhanced the apoptotic response of tumor cells to both photosensitizers that cause photodamage to Bcl-2 and to the nonpeptidic Bcl-2/Bcl-x L antagonist HA14-1. The latter agent binds to the surface pocket formed by the BH1, BH2 and BH3 domains of Bcl-2 and Bcl-x L . Fluorescence polarization studies indicated that affinity of HA14-1 for Bcl-2 was enhanced in the presence of UDCA. Moreover, Bcl-2 photodamage was promoted by UDCA using a photosensitizing agent with affinity for the endoplasmic reticulum, a site of Bcl-2 localization. Fluorescence resonance energy transfer (FRET) studies revealed that the proximity of Bcl-2 to a hydrophobic photosensitizing agent embedded in liposomes was enhanced by UDCA. Since photodamage will occur only if a protein is in close contact with a photosensitizing agent, we propose that these findings support the hypothesis that UDCA causes a conformational change in Bcl-2, promoting HA14-1 binding and enhancing affinity for certain membrane-bound photosensitizers. Cell Death and Differentiation (2004) 11, 906-914. doi:10.1038/sj.cdd.4401433 Keywords: apoptosis; Bcl-2; CPO; NPe6; SnET2; photodynamic therapy (PDT)Abbreviations: CPO, 9-capronyloxy-tetrakis(methoxyethyl) porphycene; DCA, deoxycholic acid; DEVD-R110, asp-glu-valasp-rhodamine 110 (fluorogenic caspase-3 substrate); ER, endoplasmic reticulum; flu-Bak, 5-carboxyfluorecein coupled to the N terminus of a peptide GQVGRQLAIIGDDINR derived from the BH3 domain of Bak; HA14-1, ethyl 2-amino-6-bromo-4-(1-cyano-2-ethoxy-2-oxoethyl)-4H-chromene-3-carboxylate; HO342, Höchst dye HO33342; mTHPC, meta-(tetrahydroxyphenyl) chlorin; NPe6, N-aspartyl chlorin e6; P, fluorescence polarization value; PDT, photodynamic therapy; SnET2, tin etiopurpurin; UDCA, ursodeoxycholic acid.