To test the hypothesis that impaired activity of the bile canalicular organic anion transporting system mrp2 (cmoat) is a key event in the etiology of 17␣-ethinylestradiol (EE)-induced intrahepatic cholestasis in rats, EE (5 mg/kg subcutaneously daily) was administered to male normal Wistar (NW) and mrp2-deficient Groningen Yellow/Transport-deficient Wistar (GY/TR ؊ ) rats. Elevated plasma bilirubin levels in GY/TR ؊ rats increased upon EE-treatment from 65 ؎ 8.4 mol/L to 183 ؎ 22.7 mol/L within 3 days, whereas bilirubin levels remained unaffected in NW rats. Biliary bilirubin secretion was 1.5-fold increased in NW rats but remained unaltered in GY/TR ؊ rats. Plasma bile salt concentrations remained unchanged in both strains, although hepatic levels of the sinusoidal Na ؉ -taurocholate cotransporting protein (ntcp) were markedly reduced. Biliary secretion of endogenous bile salt was not affected in either strain. A clear reduction of mrp2 levels in liver plasma membranes of NW rats was found after 3 days of treatment. The bile salt-independent fraction of bile flow (BSIF) was reduced from 2.6 to 2.0 L/min/100 g body weight in NW rats with a concomitant 62% reduction of biliary glutathione secretion. The absence of mrp2 and biliary glutathione in GY/TR ؊ rats did not prevent induction of EE-cholestasis; a similar absolute reduction of BSIF, i.e., from 1.1 to 0.6 L/min/100 g body weight, was found in these animals. EE treatment caused a reduction of the maximal biliary secretory rate (S RM ) of the mrp2 substrate, dibromosulphthalein (DBSP), from 1,040 to 695 nmol/min/ 100 g body weight (؊38%) in NW rats and from 615 to 327 nmol/min/100 g body weight (؊46%) in GY/TR ؊ rats. These results demonstrate that inhibition of mrp2 activity and/or biliary glutathione secretion is not the main cause of EE-induced cholestasis in rats. The data indicate that alternative pathways exist for the biliary secretion of bilirubin and related organic anions that are also affected by EE. (HEPATOLOGY 1998;27:537-545.)The synthetic estrogen, 17␣-ethinylestradiol (EE), causes a reversible intrahepatic cholestasis in experimental animals, mainly by reducing the bile salt-independent fraction of bile flow (BSIF). 1 Although EE-induced cholestasis has been claimed to represent a model of cholestasis of pregnancy in humans, 2 the mechanism(s) underlying the reduction in bile flow have not been defined. Suggestions that increased permeability of tight junctions 3,4 and reduced activity of Na ϩ / K ϩ -adenosine triphosphatase (ATPase) at the sinusoidal membrane 5-7 represent primary events in the onset of cholestasis could not be substantiated in more recent studies. [8][9][10][11] Likewise, the relevance of the reported decrease in sinusoidal membrane fluidity after EE treatment remains questionable, because decreased membrane fluidity has also been found in experimental conditions associated with increased bile flow. 11,12 More recently, it was shown that EE differentially affects the activity of transport systems involved in bile formation ...