Despite evidence that mucin overproduction is critical in the pathogenesis of gallstones, the mechanisms triggering mucin production in gallstone disease are unknown. Here, we tested the potential implication of an inflammation-dependent epidermal growth factor receptor (EGF-R) pathway in the regulation of gallbladder mucin synthesis. In gallbladder tissue sections from subjects with cholesterol gallstones, mucus accumulation was associated with neutrophil infiltration and with increased expressions of EGF-R and of tumor necrosis factor-␣ (TNF-␣). In primary cultures of human gallbladder epithelial cells, TNF-␣ induced EGF-R overexpression. In the presence of TNF-␣, EGF-R ligands (either EGF or transforming growth factor-␣) caused significant increases in MUC5AC mRNA and protein production, whereas expression of the other gallbladder mucins MUC1, MUC3, and MUC5B was unchanged. In addition, on Gallstone disease is very common and has a major economic impact in developed countries.1,2 The vast majority of gallstones are of cholesterol or cholesterol-predominant type. Previous observations suggest that gallbladder mucins are overproduced and act as pronucleating factors in gallstone disease. Mucins are found within the insoluble matrix of gallstones.3 In supersaturated model bile, they accelerate the nucleation of cholesterol monohydrate crystals. 4,5 In animals fed a lithogenic diet, an increase in the synthesis and secretion of gallbladder mucins occurs before crystal formation, and, subsequently, crystals grow predominantly within a mucin gel that accumulates on the gallbladder wall.6 -9 Likewise, in humans (eg, in morbidly obese subjects) who develop gallstones during rapid weight loss, the concen-