The expression of coxsackievirus ± adenovirus receptor ( CAR ) and the integrins v 3 and v 5 was analyzed quantitatively ( flow cytometry ) and qualitatively ( immunocytochemistry ) in five human ovarian cancer cell lines ( PEO1, PEO4, PEO14, SKOV -3, and OVCAR -3 ) and three control cell lines ( 293, HeLa, and CHO -K1 ) . The transduction efficiencies were evaluated by adv / rsv --Gal transduction followed by X -gal staining. The effects of 17 -estradiol on cell growth, CAR and integrins v 3 / 5 expression, adenovirus transduction efficiency, and cell -killing efficacy of adv / rsv -tk plus ganciclovir were determined. The levels of CAR, integrin v 3, and integrin v 5 showed great variation between the cell lines. Whereas the expression of CAR appeared to be essential for and positively correlated with adenovirus transduction efficiency, the integrins v 3 and v 5 were not absolutely necessary for adenovirus transduction even though their presence may facilitate transduction. In PEO4 and PEO1 cells, proliferation was stimulated by 17 -estradiol in a dose -dependent manner. In PEO4 cells, and much less pronounced in PEO1 cells, this was accompanied by an increase in CAR expression. The stimulation of CAR expression was paralleled by an increased transduction efficiency resulting in an increased cell -killing efficacy. Our data suggest that the expression of CAR is one of the most important prerequisites for successful adenovirus -mediated gene therapy of ovarian cancer. Cancer Gene Therapy ( 2001 ) 8, 168 ± 175