Retinoblastoma (RB) is the most common intraocular cancer in children worldwide. Current treatments mainly involve combinations of chemotherapies, cryotherapies, and laser-based therapies. Severe or late-stage disease may require enucleation or lead to fatality. Recently, RB has been shown to arise from cone precursor cells, which have high MDM2 levels to suppress p53-mediated apoptosis. This finding leads to the hypothesis that restoring apoptosis mechanisms in RBs could specifically kill the cancer cells without affecting other retinal cells. We have previously reported involvement of an extrapituitary signaling pathway of the growth hormone-releasing hormone (GHRH) in the retina. Here we show that the GHRH receptor (GHRH-R) is highly expressed in RB cells but not in other retinal cells. We induced specific apoptosis with two different GHRH-R antagonists, MIA-602 and MIA-690. Importantly, these GHRH-R antagonists do not trigger apoptosis in other retinal cells such as retinal pigmented epithelial cells. We delineated the gene expression profiles regulated by GHRH-R antagonists and found that cell proliferation genes and apoptotic genes are down-and up-regulated, respectively. Our results reveal the involvement of GHRH-R in survival and proliferation of RB and demonstrate that GHRH-R antagonists can specifically kill the RB cells.GHRH pathway | GHRH-R antagonist | retinoblastoma | growth hormonereleasing hormone | apoptosis R etinoblastoma (RB) is the most common childhood intraocular malignancy and accounts for approximately 3% of all childhood cancers (1). It has been reported to arise from the cone precursor cells of the retina that transduce light into electrical signals (2). RB is thought to result largely from the loss of function of both copies of RB1 gene located on human chromosome 13q14 (3, 4). Functional disruption of RB1 can be generated by the somatic inactivation of both RB1 alleles, or with a germline RB1 mutation in one allele and a somatic inactivation of the second RB1 allele (5). The RB1 protein acts as a signal transducer connecting cell cycle progression with the transcription machinery (6). There are four steps in the mitotic cycle of a cell: G1, S, G2, and cell division. In the G1 phase, cyclin D is highly expressed, which leads to activation of cyclin-dependent kinases (CDKs) 4 and 6. CDK4 and CDK6 then phosphorylate RB1, inhibiting RB1 binding to the transcription factor E2F (7, 8). As a result, the RB1-free E2F binds to promotors of several genes and turns on their expressions to induce cell cycle progression into S phase, the DNA synthesis phase. Similarly, cells carrying RB1 mutations would also progress into S phase. Normally, this premature progression into S phase would trigger apoptosis to prevent uncontrolled cell proliferation (9). However, it has been reported that the cone precursor cells express high levels of MDM2, a protein that suppresses apoptosis mediated by p53 (2). Therefore, cone precursor cells in patients carrying RB1 mutations pass through the cell cycle faster an...