Studies were undertaken to determine the effect of portacaval anastomosis on cholesterol homeostasis in rats fed sucrose/lard under conditions of normal body growth. Four to 6 weeks after portacaval shunt surgery, we found decreases in plasma cholesterol and triglyceride concentrations, total liver weight, and hepatic microsomal protein concentration. Measurements of hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase (EC 1.1.1.34) activity showed decreases in specific activity and total liver activity in portacaval shunt rats, but the enzyme diurnal rhythm remained. Decreased reductase activity in shunted rats was not due to an altered Km for D-HMG-CoA, nor was an enzyme inhibitor found in the livers of the portacaval shunt animals. Sterol balance measurements in rats with shunts showed a 22% decrease in whole body cholesterol synthesis rate compared to controls. These metabolic studies, coupled with postmortem data, showed diminished bile acid synthesis, unchanged fecal neutral steroid excretion, and decreased net tissue accumulation of cholesterol during growth. The decreased whole body cholesterol synthesis rate ultimately led to a diminished total carcass cholesterol concentration in the rats with shunts.The surgical procedure of portacaval anastomosis (PCA) has provided an effective therapeutic approach in homozygous familial hypercholesteremia in man, as judged by a decrease in plasma cholesterol level and clinical amelioration in the signs and symptoms of premature coronary artery disease. Since the original report in 1973 by Starzl and coworkers (1), more than 30 other patients with this lethal inborn error of metabolism have been subjected to PCA (2); medical procedures (diets or drugs) have usually been ineffective in controlling the rapid progression of atherosclerotic heart disease in this condition. In an attempt to resolve some of these uncertainties, we undertook studies of whole body cholesterol synthesis rates and hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase (mevalonate:NADP oxidoreductase, EC 1.1.1.34) activity in PCA rats fed a purified high-carbohydrate diet that allows normal body growth to occur after institution of a PCA (11-13). Normal body growth is essential to the proper interpretation of sterol balance data and of enzyme activities, a prerequisite that has not been met in most of the studies thus far reported (8,14,15 t To whom reprint requests should be addressed.