To investigate the factors influencing the bystander effect Ð a key element in the efficacy of suicide gene therapy against cancer Ð we compared the effect triggered by four extremely efficient gene / prodrug combinations, i.e., VZVtk / BVDU, the thymidine kinase of Varicella zoster virus associated with ( E ) -5 -( 2 -bromovinyl ) -2 H -deoxyuridine; VZVtk / BVaraU, the same enzyme associated with ( E ) -5 -( 2 -bromovinyl ) -1 --D -arabinofuranosyluracil; HSVtk / BVDU, the association of the Herpes simplex virus thymidine kinase with BVDU; and the classical HSVtk / GCV ( ganciclovir ) paradigm. The cells used, the human MDA -MB -435 breast cancer, and the rat 9L glioblastoma lines were equally sensitive in vitro to these four associations. In both cell types, the combinations involving pyrimidine analogues ( BVDU, BVaraU ) displayed a smaller bystander killing than the combination involving the purine analogue ( GCV ) . In addition, the bystander effect induced by all the tk / prodrug systems was reduced in MDA -MB -435 cells in comparison to 9L cells; albeit, the viral kinases were produced at a higher level in the breast cancer cells. All systems induced apoptotic death in the two cell types, but the MDA -MB -435 cells, deprived of connexin 43, were noncommunicating in striking contrast with the 9L cells. That functional gap junctions have to be increased in order to improve the breast cancer cell response to suicide gene therapy was demonstrated by transducing the Cx43 gene: this modification enhanced the bystander effect associated in vitro with GCV treatment and, by itself, decreased the tumorigenicity of the untreated cells. However, the noncommunicating MDA -MB -435 cells triggered a significant bystander effect both in vitro and in vivo with the HSVtk / GCV system, showing that communication through gap junctions is not the only mechanism involved. Cancer Gene Therapy ( 2000 ) 7, 1456 ± 1468Key words: Suicide gene therapy; viral thymidine kinases; bystander effect; connexin 43.G ene therapy is a promising approach for the treatment of human cancers. The introduction into tumoral cells of à`s uicide'' gene, whose product is able to activate a nontoxic prodrug into a toxic compound, is a powerful method to selectively kill the modified cells. The most frequently used system consists of transferring the Herpes simplex thymidine kinase gene ( HSVtk ) into tumor cells and to treat them with ganciclovir (GCV ) . This guanosine analogue is specifically monophosphorylated by the viral kinase and then converted by cellular enzymes into the triphosphate derivative, which, upon incorporation into elongating DNA, induces cell death by premature chain termination. The efficacy of the HSVtk / GCV system first described by Moolten 1 in 1986 has been demonstrated in many different types of tumoral cells in vitro and in vivo, and it is currently under clinical investigation as treatment for a wide variety of cancers.A major obstacle to successful cancer gene therapy is the poor efficiency of the gene transfer process r...