Purpose: Cannabinoids have been recently proposed as a new family of potential antitumor agents. The present study was undertaken to investigate the expression of the two cannabinoid receptors, CB 1 and CB 2 , in colorectal cancer and to provide new insight into the molecular pathways underlying the apoptotic activity induced by their activation. Experimental Design: Cannabinoid receptor expression was investigated in both human cancer specimens and in the DLD-1 and HT29 colon cancer cell lines. The effects of the CB 1 agonist arachinodyl-2'-chloroethylamide and the CB 2 agonist N-cyclopentyl-7-methyl-1-(2-morpholin-4-ylethyl)-1,8-naphthyridin-4(1H)-on-3-carboxamide (CB13) on tumor cell apoptosis and ceramide and tumor necrosis factor (TNF)-a production were evaluated. The knockdown of TNF-a mRNA was obtained with the use of selective small interfering RNA. Results: We show that the CB 1 receptor was mainly expressed in human normal colonic epithelium whereas tumor tissue was strongly positive for the CB 2 receptor. The activation of the CB 1 and, more efficiently, of the CB 2 receptors induced apoptosis and increased ceramide levels in the DLD-1 and HT29 cells. Apoptosis was prevented by the pharmacologic inhibition of ceramide de novo synthesis. The CB 2 agonist CB13 also reduced the growth of DLD-1 cells in a mouse model of colon cancer. The knockdown of TNF-a mRNA abrogated the ceramide increase and, therefore, the apoptotic effect induced by cannabinoid receptor activation.Conclusions: The present study shows that either CB 1 or CB 2 receptor activation induces apoptosis through ceramide de novo synthesis in colon cancer cells. Our data unveiled, for the first time, thatTNF-a acts as a link between cannabinoid receptor activation and ceramide production.