Reverse transcriptase (RT) inhibitors are emerging as a novel class of anticancer differentiating agents, active in several human tumor cell models, such as melanoma and prostate, thyroid and colon carcinoma. Indeed, much evidence suggests that they may act by inhibiting endogenous RT, a gene highly expressed in undifferentiated and transformed cells. We therefore evaluated whether endogenous RT may represent a new molecular target in the treatment of human renal clear-cell carcinoma, a neoplasm with very low sensitivity to standard pharmacological therapies. Efavirenz and nevirapine, 2 non-nucleosidic RT inhibitors commonly used in HIV patients, either induced a reversible downregulation of cell proliferation or enhanced cell differentiation in primary cultures of human renal carcinoma cells characterized by high levels of endogenous RT activity. Both agents upregulated the expression of the vitamin D receptor and calbindin 28k genes, which are constitutively expressed in renal tubular cells, and induced vitamin D signaling by enhancing the ability of tumor cells to upregulate the vitamin D-dependent gene, CYP24. Furthermore, efavirenz-and nevirapine-differentiated tumor cells exhibited an immunogenic phenotype with an increased expression of HLA-I and CD40 antigens and an enhanced ability to elicit a specific T-cell response in mixed lymphocyte/tumor-cell cultures. Indeed, renal carcinoma cells exposed to efavirenz induced a CD8 1 CCR7-CD45RA 2 effector memory T-cell phenotype, whereas untreated RCC cells induced a CD8 1 CCR7 1 CD45RA 2 central memory T-cell phenotype. These data suggest that RT inhibitors may be a novel tool in the treatment of human renal clear-cell carcinoma, potentially able to enhance the immunogenic potential of tumor cell. ' 2008 Wiley-Liss, Inc.Key words: reverse transcriptase; renal cell carcinoma; differentiation; vitamin D receptor; immune response Renal clear-cell carcinoma represents 75-80% of all human renal epithelial neoplasms, and its incidence and mortality have steadily worsened over the last decades.1 Surgical excision is the only effective treatment in the localized form of the disease; however, 20-50% of patients experience relapse after radical surgery. Since chemotherapeutic agents are ineffective, several other therapeutic strategies are being evaluated for the treatment of advanced stages of the disease.2 A number of immunotherapeutic approaches have been developed based on the observation that renal cell carcinoma (RCC) can induce an antitumor response by activating immune cells. Indeed, in vitro expansion of T-cell lymphocytes infiltrating RCC lesions yields T-cell responders that exhibit HLA-restricted antitumor activity.3,4 Immunotherapy with IL-2 and interferon (INF)-a achieves a response in 10-20% of cancers, with durable tumor regression occurring only in a limited subset of patients. 5 Furthermore, allogenic stem cell transplantation after nonmyeloablative chemotherapy has recently been evaluated and has been suggested to obtain complete and partial responses ...