Edited by Eric R. FearonRenal cell carcinoma (RCC) is polyresistant to chemo-and radiotherapy and biologicals, including TNF-related apoptosisinducing ligand (TRAIL). Sorafenib, a multikinase inhibitor approved for the treatment of RCC, has been shown to sensitize cancer cells to TRAIL-induced apoptosis, in particular by downregulation of the Bak-inhibitory Bcl-2 family protein Mcl-1. Here we demonstrate that sorafenib overcomes TRAIL resistance in RCC by a mechanism that does not rely on Mcl-1 downregulation. Instead, sorafenib induces rapid dissipation of the mitochondrial membrane potential (⌬⌿ m ) that is accompanied by the accumulation of reactive oxygen species (ROS). Loss of ⌬⌿ m and ROS production induced by sorafenib are independent of caspase activities and do not depend on the presence of the proapoptotic Bcl-2 family proteins Bax or Bak, indicating that both events are functionally upstream of the mitochondrial apoptosis signaling cascade. More intriguingly, we find that it is sorafenib-induced ROS accumulation that enables TRAIL to activate caspase-8 in RCC. This leads to apoptosis that involves activation of an amplification loop via the mitochondrial apoptosis pathway. Thus, our mechanistic data indicate that sorafenib bypasses central resistance mechanisms through a direct induction of ⌬⌿ m breakdown and ROS production. Activation of this pathway might represent a useful strategy to overcome the cell-inherent resistance to cancer therapeutics, including TRAIL, in multiresistant cancers such as RCC.Apoptotic cell death induced by the death ligand tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) 2 plays an important role in immune surveillance and is a major immune defense mechanism against tumor cells. Consequently, the use of TRAIL, which preferentially kills cancer cells while sparing non-cancerous tissue, is a promising concept in anticancer therapy. Recombinant TRAIL and agonistic antibodies against the TRAIL receptors are therefore tested in clinical phase I and II studies (1-3).Binding of TRAIL to the death receptors DR4 (TRAIL-R1) and DR5 (TRAIL-R2) initiates receptor oligomerization and, via the adaptor protein Fas-associated protein with death domain (FADD), recruitment of the initiator caspase-8 to the death domain of the activated receptor (4, 5). Formation of this activation platform, the so-called death-inducing signaling complex, results in autocatalytic activation of caspase-8. In type I cells, active caspase-8 triggers, via direct proteolytic processing of caspase-3, a caspase cascade to induce apoptotic cell death. In type II cells, however, the E3-ligase X-linked inhibitor of apoptosis protein (XIAP) prevents accumulation of active caspase-3 by marking it for proteasomal degradation (6). Therefore, in type II cells, efficient caspase-3 activation upon death receptor signaling requires amplification via the mitochondrial apoptosis pathway. Activation of the mitochondrial pathway is achieved by mitochondrial outer membrane permeabilization (MOMP) (7). Upon MOMP, the ...