The kinesin spindle protein (KSP), a microtubule motor protein, is essential for the formation of bipolar spindles during mitosis. Inhibition of KSP activates the spindle checkpoint and causes apoptosis. It was shown that prolonged inhibition of KSP activates Bax and caspase-3, which requires a competent spindle checkpoint and couples with mitotic slippage. Here we investigated how Bax is activated by KSP inhibition and the roles of Bax and p53 in KSP inhibitor-induced apoptosis. We demonstrate that small interfering RNA-mediated knockdown of Bax greatly attenuates KSP inhibitor-induced apoptosis and that Bax activation is upstream of caspase activation. This indicates that Bax mediates the lethality of KSP inhibitors and that KSP inhibition provokes apoptosis via the intrinsic apoptotic pathway where Bax activation is prior to caspase activation. Although the BH3-only protein Puma is induced after mitotic slippage, suppression of de novo protein synthesis that abrogates Puma induction does not block activation of Bax or caspase-3, indicating that Bax activation is triggered by a posttranslational event. Comparison of KSP inhibitor-induced apoptosis between matched cell lines containing either functional or deficient p53 reveals that inhibition of KSP induces apoptosis independently of p53 and that p53 is dispensable for spindle checkpoint function. Thus, KSP inhibitors should be active in p53-deficient tumors.The kinesin spindle protein (KSP), also termed kinesin-5 or Eg5, is a microtubule motor protein that is essential for the formation of bipolar spindles and the proper segregation of sister chromatids during mitosis (2,8,11,34). Inhibition of KSP causes the formation of monopolar mitotic spindles, activates the spindle assembly checkpoint, and arrests cells at mitosis, which leads to subsequent cell death (2,16,24,36). Since KSP functions exclusively in mitosis, KSP inhibitors should spare postmitotic cells and thus do not cause peripheral neuropathy, a major liability suffered by the microtubule inhibitors, such as taxanes and vinca alkaloids, that have been widely used in the clinic for cancer treatment. In addition, KSP inhibitors should remain efficacious in taxane-resistant tumors where the resistance may arise from acquired mutations on -tubulin, altered expression of tubulin isoforms, or changed microtubule dynamics (12, 28, 33). As a result, KSP inhibitors have been developed as a new generation of antimitotic agents with a novel mechanism of action for cancer therapy, and several KSP inhibitors have entered clinical trials.An in-depth understanding of the mechanism by which KSP inhibitors induce apoptosis and elucidation of the factors that determine cell sensitivity to KSP inhibitor-mediated killing will not only advance our knowledge in cell biology but also provide insights for a rational development and application of these agents in the clinic. The induction of apoptotic cell death by different death cues is mainly mediated by two pathways, the death receptor-dependent extrinsic pathway and t...