The nuclear hormone receptors farnesoid X receptor (FXR) and pregnane X receptor have been implicated in regulating bile acid, lipid, carbohydrate, and xenobiotic metabolism. Bile duct ligation was used to increase endogenous bile acids and evaluate the roles of these receptors in modulating cholestatic liver injury. FXR knockout (KO) mice were found to be protected from obstructive cholestasis. Concurrent deletion of FXR also could ameliorate an increase in liver injury that is seen usually in pregnane X receptor KO mice with cholestasis. Mechanisms proposed for this protection include the lowering of bile acid concentrations and altered expression of the hepatic transporters Mdr1, Mdr2, BSEP, and Mrp4. FXR KO mice also exhibit a biphasic lipid profile after bile duct ligation, with an increase in high-density lipoprotein cholesterol and triglycerides by day 6. The expression of apolipoprotein AV was reduced in these mice, implicating FXR in triglyceride regulation. We show that FXR modulates cholestasis by controlling bile acids within the hepatocyte and is involved in bile acid synthesis, bile excretion via BSEP, and serum export via Mrp4. This study strongly suggests a potential clinical role for FXR antagonists in the treatment of obstructive cholestatic liver disorders.bile acids ͉ Mrp4 ͉ pregnane X receptor ͉ apolipoprotein AV ͉ triglycerides C holestatic liver disorders include a spectrum of hepatobiliary diseases of diverse etiologies that are characterized by impaired hepatocellular secretion of bile, resulting in accumulation of bile acids, bilirubin, and cholesterol. Pharmacological therapy for cholestasis is limited, and ursodeoxycholic acid (UDCA) is the only disease-modifying therapy with evidence of efficacy, so new therapeutic approaches are essential.Farnesoid X receptor (FXR) (NR1H4) and pregnane X receptor (PXR) (NR1I2) are nuclear hormone receptors that function as ligand-activated transcription factors. FXR is known to regulate genes involved in lipid and lipoprotein metabolism, including apolipoprotein (apo) AI, apoCII, very low-density lipoprotein (VLDL) receptor, PPAR␣, and the phospholipid transfer protein (1, 2), but the role of FXR in lipid homeostasis remains to be clarified. Other FXR targets include genes involved in bile acid synthesis such as cytochrome P450 7A1 (CYP7A1) and CYP8B1, and bile acid transporters including bile salt export pump (BSEP; ABCB11), sodium-taurocholate cotransporting polypeptide (NTCP; SLC10A1), and intestinal bile acid-binding protein (1, 3). PXR also regulates genes involved in bile acid synthesis, metabolism, and transport, including CYP7A1, CYP3A, sulfotransferase, and Na ϩ -dependent organic anion transporter 2 (Oatp2; Slc21a6) (4, 5).Bile acids are the end products of hepatic cholesterol metabolism, which also act as signaling molecules that regulate their own synthesis and metabolism and other metabolic pathways, via nuclear receptors (1). Bile acids are ligands for both PXR and FXR, with affinities differing for individual bile acids (6, 7). It has...