INTRODUCTION: Multidrug resistance 3 (MDR3)
P-glycoprotein is
a lipid floppase that is encoded by the
ATP-binding cassette sub-family B member 4 (ABCB4) gene and plays a crucial role in proper bile formation by transporting
phosphatidylcholine across the canalicular plasma membrane of the hepatocyte into bile. The relevance of this function is underscored by the severe pathology that develops in patients with ABCB4 deficiency. This deficiency leads to the destruction of hepatocytes and cholangiocytes by
bile salts, because their cytolytic action is not reduced by formation of mixed
micelles with phospholipid. AREAS COVERED: Evidence that phospholipid secretion into bile is also essential for biliary
cholesterol secretion as
cholesterol dissolves much better in mixed
micelles of
bile salts and phospholipid than in pure bile salt
micelles. As a consequence, net biliary
cholesterol secretion depends on the amount of phospholipid secreted and hence, the expression of ABCB4 indirectly determines biliary
cholesterol output. EXPERT OPINION: It can be argued that upregulation of the ABCB4 gene expression may not only be beneficial for liver pathology in patients with partial ABCB4 deficiency, but also for the prevention of
gallstone formation and optimal
cholesterol disposition in a much larger population.