MRP2 (ABCC2), a member of the ATP binding cassette superfamily of efflux transporters that mediates the apical efflux of organic anions from hepatocytes, enterocytes, and renal epithelial cells, is postulated to undergo post-transcriptional regulation. The MRP2 5Ј-untranslated region (5ЈUTR) contains seven upstream start codons and six upstream open reading frames (uORFs). Ribonuclease protection assays in human liver, placenta, kidney, small intestine, and HepG2 cells identified multiple MRP2 transcription initiation sites. We investigated MRP2 5ЈUTRs [Ϫ247 (Ϫ247 to Ϫ1), Ϫ204 (Ϫ204 to Ϫ1), or Ϫ99 (Ϫ99 to Ϫ1)] for their effects on regulation of gene expression with the use of transient gene expression in HepG2 cells and in vitro translation assays. In HepG2 cells transfected with SV40-MRP2-5ЈUTR-Luciferase cassettes, luciferase activities of constructs Ϫ247 and Ϫ204 were significantly lower than that of Ϫ99. Disruption of the uORFs at Ϫ105 and Ϫ74 nucleotides by mutation of ATGs to AAG enhanced luciferase activity significantly without affecting luciferase mRNA expression. The translation efficiencies of T7-5ЈUTR-Luciferase cassettes determined in vitro were consistent with transfected HepG2 cells and showed that inhibition of translation by the Ϫ105 uORF occurred only in the cis configuration and not in the trans configuration and that inhibition of translation by the Ϫ105 uORF was independent of the encoded peptide sequence. Characterization of an MRP2 polymorphism, Ϫ24CϾT, in the MRP2 5ЈUTR, demonstrated no effect on mRNA expression or downstream ORF translation. These data indicate for the first time that the 5ЈUTR of MRP2 mRNA transcripts and the uORF at Ϫ105 markedly influence MRP2 translation.