In vivo cisplatin resistance of rat ascites hepatoma AH66 cells is suggested to result from the induction of multidrug resistance-associated protein 2 (MRP2) expression by ascites fluid (ASF) in the peritoneal cavity. The in vitro cisplatin sensitivity of AH66 cells grown in assay medium containing 5% fetal bovine serum in Dulbecco's modified Eagle's medium (5% FBS DMEM) did not change when the cells were treated with probenecid, an inhibitor of anion transporters, while the decreased cisplatin sensitivity of AH66 cells cultured in an assay medium containing 5% ASF (5% ASF DMEM) was restored by probenecid. Furthermore, in an in vivo study, the survival span (%ILS) of AH66-bearing rats was markedly extended by combination therapy with cisplatin and probenecid, compared with either agent alone. The expression of MRP2 mRNA was increased when AH66 cells were cultured in medium containing 5% ASF or 5% bile for 24 h. The induction of MRP2 mRNA expression in AH66 cells was also observed in the presence of heat-denatured ASF. The bilirubin content in ASF was characteristically higher than that in FBS, normal rat serum or AH66-bearing rat serum. Unconjugated bilirubin did not change the expression of MRP2 mRNA, whereas conjugated bilirubin markedly increased it. The cisplatin uptake in AH66 cells after culture in 5% FBS DMEM containing conjugated bilirubin was about half that of the cells cultured in 5% FBS DMEM alone (p < 0.01). In addition, the cisplatin sensitivity of the cells was significantly lowered by the addition of conjugated bilirubin. The expression of MRP2 mRNA in rat normal hepatocytes was also increased after culture in medium containing 5% ASF or 5% bile. These results indicated that conjugated bilirubin, a component of ASF, induces the mRNA expression of MRP2, which is a determinant of the in vivo cisplatin resistance of AH66 cells.