The multidrug-resistant cancer cell lines NCI/AdR RES and MES-SA/DX-5 have higher glycolipid levels and higher P-glycoprotein expression than the chemosensitive cell lines MCF7-wt and MES-SA. Inhibiting glycolipid biosynthesis by blocking glucosylceramide synthase has been proposed to reverse drug resistance in MDR cells by causing an increased accumulation of proapoptotic ceramide during treatment of cells with cytotoxic drugs. We treated both multidrug-resistant cell lines with the glucosylceramide synthase inhibitors PDMP (D-threo-1-phenyl-2-decanoylamino-3-morpholino-1-propanol), C 9 DGJ (N-nonyl-deoxygalactonojirimycin) or C 4 DGJ (N-butyl-deoxygalactonojirimycin). PDMP achieved a significant reversal of drug resistance in agreement with previous reports. However, the Nalkylated iminosugars C 9 DGJ and C 4 DGJ, which are more selective glucosylceramide synthase inhibitors than PDMP, failed to cause any reversal of drug resistance despite depleting glycolipids to the same extent as PDMP. Our results suggest that (a) inhibition of glucosylceramide synthase does not reverse multidrug resistance and (b) the chemosensitization achieved by PDMP cannot be caused by inhibition of glucosylceramide synthase alone.A major limitation in chemotherapy for cancer is multidrug resistance (MDR), 1 an innate or acquired phenotype, which allows cancer cells to resist a broad spectrum of chemotherapeutic drugs. One of the most extensively studied and clinically relevant mechanisms of drug resistance is the overexpression by cancer cells of the transmembrane multidrug transporter P-glycoprotein (MDR1, ABCB1, EC 3.6.3.44) (1). However, a drug resistance phenotype comprises many, often interacting, mechanisms of resistance (2). These include increased DNA repair, altered target sensitivity, decreased apoptotic response and numerous aberrant signal transduction pathways. Elevated levels of glycolipids have been correlated with multidrug resistance in cancer (3, 4). Manipulation of glycolipid levels in some MDR cancer cells was able to reverse drug resistance (5-12). This led to the hypothesis that elevated glucosylceramide synthase (GCS, EC 2.4.1.80) activity is a novel form of multidrug resistance and that inhibition of GCS is a promising therapeutic strategy for combating multidrug resistance. The biochemical basis is that an elevated GCS activity prevents the accumulation of ceramide, which is thought to precede, and trigger, apoptosis in response to some cytotoxic drugs (13-16). Therefore, inhibition of GCS activity will promote the accumulation of pro-apoptotic ceramide and enhance cell death in response to cytotoxic agents (17-21).This hypothesis rests largely on three lines of evidence. The first is that multidrug resistance correlates with elevated glycolipid levels (4), which is unfortunately hindered by the small number of samples analyzed and the fact that variability of glycolipid levels in cancers remains unknown.Second, genetic manipulation of the GCS enzyme in MCF7 cells can affect their sensitivity to various cytot...