Extrahepatic cholesbsis in man is known to be associated with high phosphoglyceride and cholesterol concentrations in serum. Moreover, an abnormal lipoprotein, often referred to as lipoprotein-X (LP-X), appears in serum in cases of extrahepatic cholesbsis.The purpose of this study was to determine the rate of incorporation of precursors into hepatic lipids and proteina in uitro and to compare these changes with the lipoproteins in plasma in patients with extrahepatic cholestasis. The rate of incorporation of glycerol into triglycerides and into different classes of phosphoglycerides was determined. The rate of incorporation of leucine into proteins was also determined in liver slices from 16 patients with extrahepatic cholestasis and compared with controls. In cholestatic liver tissue, the rate of incorporation of glycerol into choline phosphoglycerides and into ethanolamine phosphoglycerides was significantly increased. The rate of incorporation of leucine into hepatic proteins was also increaaed significantly in these patients. The results suggest that the changed metabolism of phospholipids and protein in liver tissue in cholestatic conditions may contribute to the changes in the serum lipoprotein pattern.