Diosgenin exists in some food supplements and herbal medicines and lowers plasma cholesterol by increasing fecal cholesterol excretion. It is believed that diosgenin promotes fecal cholesterol excretion by stimulating biliary cholesterol secretion and decreasing intestinal cholesterol absorption. Niemann-Pick C1-like 1 (NPC1L1) was recently identified as an essential protein for intestinal cholesterol absorption. To determine the relative contribution of biliary secretion and intestinal absorption of cholesterol in diosgenin-stimulated fecal cholesterol excretion, wild-type (WT) and NPC1L1-knockout (L1KO) mice were fed a diet with or without 1% diosgenin. Fecal cholesterol excretion (mmol/day/100 g body weight) increased in diosgenin-fed WT and L1KO mice from 4.2 to 52 and from 63 to 140, respectively. Surprisingly, this increase in diosgenin-treated versus untreated L1KO mice (77) was even greater than that seen in diosgenin-treated versus untreated WT mice (47.8). Additionally, WT and L1KO mice fed the diosgenin diet had similar increases in biliary cholesterol concentration, despite unaltered hepatic expression of the hepatobiliary cholesterol transporter, ATP binding cassette transporters G5 and G8. Facilitated cholesterol excretion in diosgenin-treated WT and L1KO mice was associated with decreased hepatic and plasma cholesterol and increased liver expression of cholesterol synthetic genes. In contrast, diosgenin had no effect on the intestinal expression of NPC1L1 and cholesterol synthetic genes. In an in vitro assay, diosgenin was unable to block NPC1L1-dependent cholesterol uptake. In conclusion, diosgenin stimulation of fecal cholesterol excretion is independent of NPC1L1-mediated cholesterol absorption. The tubers of Dioscorea, commonly known as yams, have been used for centuries as herbal medicine for the treatment of various conditions, including infections, cancer, diabetes, and rheumatism (1). One pharmacologically active compound found in many Dioscorea species is diosgenin, a steroidal sapogenin. When fed to rats, diosgenin is absorbed, although at a level that is 5-to 10-fold less than that of cholesterol, and accumulates at the highest concentrations in the adrenals, liver, and gastrointestinal tract (2). Through a poorly defined mechanism, diosgenin can dramatically and selectively increase the secretion of biliary cholesterol but not phospholipids or bile salts (3-5). The heterodimer of two ATP binding cassette half-transporters G5 and G8 (ABCG5/G8), which mediates the normal hepatobiliary secretion of cholesterol (6-8), is essential for diosgenin-stimulated biliary cholesterol secretion. However, we and others (9, 10) have shown that diosgenin has no effect on hepatic ABCG5/G8 expression at both the mRNA and protein level. The nuclear receptor pregnane X receptor (PXR) also appears to be important because its genetic disruption moderately attenuates diosgeninstimulated biliary cholesterol secretion (9).In addition to biliary cholesterol secretion, many other aspects of hepatic chole...