General immunostimulants (adjuvants) are essential for generating immunity to many antigens. In bacterial infections, adjuvants are provided by components of the microorganism, e.g., lipopolysaccharide. However, it is unclear what provides the adjuvant effect for immune responses that are generated to tumors and many viruses. Here we show that cell injury and death of tumor or even normal cells provide a potent adjuvant effect for the stimulation of cytotoxic T lymphocyte responses. This adjuvant activity is constitutively present in the cytoplasm of cells and is increased in the cytoplasm of cells dying by apoptosis. The release of these components stimulates immune responses both locally and at a distance, and provides a simple mechanism to alert the immune system to potential danger in almost all pathological situations.I mmunologists have long known that to elicit optimal antibody or T cell immune responses antigens must be admixed with adjuvants such as killed bacteria or components of their cell wall (1, 2). It is likely that adjuvants work by activating cells of the innate immune system (e.g., macrophages, natural killer cells, and dendritic cells) to become more stimulatory and to produce cytokines and inflammatory mediators, which, in turn, upregulate many of the components that are needed to stimulate lymphocyte responses. In the absence of adjuvants, lymphocytes may fail to respond to an immunization or even be tolerized.Janeway (1-3) hypothesized that cells of the innate immune system would have receptors for unique components of microbial pathogens, which he termed pathogen-associated molecular patterns (PAMPs); these would allow a self-nonself discrimination and stimulate initial immune responses. As predicted, such receptors were identified in Drosophila (e.g., the toll receptor family; refs. 2 and 4) and more recently in mammals (5-8). Some of these receptors recognize PAMPs of bacteria whereas others react with unique molecular features of fungi. Engagement of PAMP receptors stimulates cells of the innate immune system, and this is thought to be the underlying mechanism of action of many microbial adjuvants.The immune system continually monitors tissues for infections with microbes and cancerous cells and must respond rapidly to successfully eliminate these threats. The adjuvant properties of bacteria and some viruses (e.g., double-stranded RNA) promote this process, allowing the generation of robust immune responses in natural infections (1, 2). However, it has been unclear what, if anything, provides an adjuvant effect for immune responses to tumors and other viruses. These pathogens lack any obvious source of PAMPs to stimulate innate immune responses. Nevertheless, immune responses are generated to tumors and viruses, implying that an adjuvant effect is somehow provided.On theoretical grounds, Matzinger (9, 10) has proposed that dying cells might provide a signal that alerts the immune system to danger. Recently, it has been shown in vitro that dying cells are recognized and avidly internali...