Tumor necrosis factor-related apoptosis-inducing ligand receptors death receptor (DR) 4 and DR5 are potential targets for antibody-based cancer therapy. Activation of the proapoptotic DR5 in various cancer cells triggers the extrinsic and/or intrinsic pathway of apoptosis. It has been shown that there are several functional domains in the DR5 extracellular domain. The cysteine-rich domains of DR5 have a conservative role in tumor necrosis factor-related apoptosis-inducing ligand-DR5-mediated apoptosis, and the pre-ligand assembly domain within the N1-cap contributes to the ligand-independent formation of receptor complexes. However, the role of the N-terminal region (NTR) preceding the N1-cap of DR5 remains unclear. In this study, we demonstrate that NTR could mediate DR5 activation that transmits an apoptotic signal when bound to a specific agonistic monoclonal antibody. A novel epitope in the NTR of DR5 was identified by peptide array. Antibodies against the antigenic determinant showed high affinities for DR5 and triggered caspase activation in a time-dependent manner, suggesting the NTR of DR5 might function as a potential death-inducing region. Moreover, permutation analysis showed that Leu 6 was pivotal for the interaction of DR5 and the agonistic antibody. Synthetic wild-type epitopes eliminated the cytotoxicity of all three agonistic monoclonal antibodies, AD5-10, Adie-1, and Adie-2. These results indicate that the NTR of DR5 could be a potential target site for the development of new strategies for cancer immunotherapy. Also, our findings expand the current knowledge about DR5 extracellular functional domains and provide insights into the mechanism of DR5-mediated cell death.Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) 4 is a attractive candidate for cancer therapy because it can triggers the extrinsic and/or intrinsic pathway of apoptosis in a variety of tumor cells by engaging the death receptors DR4 and DR5, while sparing most normal cells (1-5). However, decoy receptors (DcR1, DcR2, and OPG) compete for binding of TRAIL and protect cells from TRAIL-mediated cell death (6 -10). In this case, agonistic monoclonal antibodies (mAbs) against DR4/5 have shown encouraging results and potential in the therapeutic aspect of diseases.There are a number of agonistic mAbs against human DR4 or DR5 reported in the literature (11-13), and they have demonstrated more specific cell death-inducing activities. Most of these mAbs either need a cross-linker to ensure effective killing of tumor cells (14, 15) or compete with TRAIL for binding with DR5 (12, 16), mimicking the apoptosis-inducing mechanism of TRAIL. Guo et al. (17) from our laboratory reported that a novel anti-human DR5 monoclonal antibody AD5-10 induces the apoptosis of various carcinoma cell lines without cross-linking in vitro and exhibits strong tumoricidal activity in vivo. Furthermore, AD5-10 does not induce cell death of normal human hepatocytes or primary peripheral blood lymphocytes, and injection of AD5-10 into mice causes n...