DNA methyltransferase (DNMT)-inhibiting nucleoside analogs reactivate the expression of tumor suppressor genes and apoptosis-related genes silenced by methylation, thus favoring the induction of apoptosis in tumor cells. Moreover, induction of DNA damage seems to contribute to their antitumor effect. However, the apoptotic signaling pathway induced by these demethylating drugs is not well understood. Here, we have investigated the induction of apoptosis by two nucleoside DNMT inhibitors, decitabine and zebularine, in leukemic T cells. Both inhibitors induced caspase-dependent apoptosis in Jurkat, CEM-6 and MOLT-4 leukemia T cell lines, all with mutant p53, whereas resting and activated normal T lymphocytes were highly resistant to these demethylating agents. Although decitabine and zebularine showed different ability to induce apoptosis and cell cycle arrest among the three cell lines, they similarly activated the intrinsic apoptotic pathway by inducing mitochondrial alterations such as Bak activation, loss of transmembrane potential and generation of reactive oxygen species (ROS). Accordingly, Bcl-2-and Bcl-x L -overexpressing Jurkat cells, as well as caspase-9-deficient Jurkat cells, were resistant to apoptosis induced by decitabine and zebularine. Interestingly, ROS production seemed to be necessary for the induction of apoptosis. Apoptotic events, such as Bak and caspase activation, started as soon as 20 hr after treatment with either decitabine or zebularine. In addition, progression of apoptosis triggered by both DNMT inhibitors was paralleled by the induction of DNA damage. Our results suggest that the mitochondrial apoptotic pathway activated by decitabine and zebularine in p53 mutant leukemic T cells depends mainly on the induction of DNA damage.Abnormal DNA methylation of CpG sequences is one of the most common epigenetic modifications observed in tumors. Hypermethylation of promoter regions of tumor suppressor genes causes their silencing, thus favoring tumor progression. [1][2][3] This has focused attention on drugs that reactivate methylated cancer genes as a promising antitumor strategy.The cytosine nucleoside analogs 5-azacytidine and 5-aza-2 0 -deoxycytidine (decitabine) are the best known demethylating agents. 4 These compounds are metabolized and phosphorylated inside the cell and then incorporated into DNA, where they are recognized by DNA methyltransferases (DNMTs), the enzymes responsible for DNA methylation. The covalent complexes formed by the abnormal bases and DNMT result in degradation of the trapped enzymes.5 Both DNMT inhibitors have been approved by the Food and Drug Administration for the treatment of myelodysplastic syndromes (MDS), despite being quite toxic and unstable. 5,6 Another cytidine analog, zebularine, although originally described as a cytidine deaminase inhibitor, also has DNA demethylating activity. In vitro and in vivo studies have demonstrated that zebularine is highly stable and shows minimal toxicity. 7,8 It exhibits selective activity against various cancer cells ...