Ubiquitination plays a crucial role in regulating protein turnover. Here we show that ubiquitination regulates the stability of the MDR1 gene product, P-glycoprotein, thereby affecting the functions of this membrane transporter that mediates multidrug resistance. We found that P-glycoprotein was constitutively ubiquitinated in drug-resistant cancer cells. Transfection of multidrug-resistant cells with wild-type ubiquitin or treatment with an N-glycosylation inhibitor increased the ubiquitination of P-glycoprotein and increased P-glycoprotein degradation. Carbobenzoxy-L-leucyl-L-leucyl-L-leucinal (MG-132), a proteasome inhibitor, induced accumulation of ubiquitinated P-glycoprotein, suggesting the involvement of the proteasome in the turnover of the transporter. Treatment of multidrug-resistant cells with 12-O-tetradecanoylphorbol-13-acetate, a phorbol ester that increases the phosphorylation of P-glycoprotein through activation of protein kinase C, or substituting phosphorylation sites of P-glycoprotein by nonphosphorylatable residues did not affect the ubiquitination of the transporter. Enhanced ubiquitination of P-glycoprotein resulted in a decrease of the function of the transporter, as demonstrated by increased intracellular drug accumulation and increased cellular sensitivity to drugs transported by P-glycoprotein. Our results indicate that the stability and function of P-glycoprotein can be regulated by the ubiquitin-proteasome pathway and suggest that modulating the ubiquitination of P-glycoprotein might be a novel approach to the reversal of drug resistance.Drug resistance is a major impediment to successful cancer chemotherapy. Multidrug resistance (MDR) mediated by Pglycoprotein (P-gp), the product of the MDR1 (ABCB1) gene, is believed to be one of the major causes of failure of cancer therapy. P-gp is a 150-to 180-kDa heavily glycosylated and phosphorylated plasma membrane protein that functions as a drug transporter. Overexpression of P-gp confers resistance to a variety of structurally and functionally diverse anticancer drugs such as paclitaxel, doxorubicin, and vinblastine. Despite promising early studies showing that blocking of P-gp by pharmacological means could sensitize drug-resistant cells, the ultimate goal of restoring drug sensitivity has met with limited success in clinical trials. Therefore, we and others began to elucidate the factors that control P-gp synthesis. For example, we have demonstrated that several substances control the expression of MDR1 through activation of phospholipase C and that the transcriptional modulation of MDR1 expression by phospholipase C is mediated by the Raf-mitogen-activated protein kinase pathway (Yang et al., 2001). We recently have become interested in the factors that regulate P-gp stability.P-gp, at steady state, is located in the plasma membrane and undergoes endocytosis and recycling (Kim et al., 1997). Experimentally induced alterations in trafficking of P-gp can change the steady-state distribution of the transporter, thereby affecting the...