Clodronate, a halogenated bisphosphonate, can inhibit the growth of human thyroid carcinoma (TC) cells. Previously, we found that a clodronate-induced Ca 2ϩ transient was correlated with clodronate-induced growth inhibition in TC cells. However, the details of the signaling process underlying the antiproliferative effect of clodronate on TC cells are not clear. In this study, we investigated the antiproliferative mechanism of clodronate on papillary TC (PTC) cells and xenotransplanted animals using a combination of pharmacological drugs. Reverse transcription-polymerase chain reaction analysis confirmed the endogenous expression of P2Y receptor isoforms in PTC cells. The P2 antagonist suramin not only inhibited the antiproliferative effect of clodronate and ATP on TC cells but also blocked all the Ca 2ϩ transients induced by clodronate and ATP. The release of Ca 2ϩ from the endoplasmic reticulum and membrane depolarization of mitochondria was observed during the clodronate-induced Ca 2ϩ transients. The results of terminal deoxynucleotidyltransferase dUTP nick-end labeling assays and flow cytometry with annexin V and caspase-3 staining suggest that both ATP and clodronate induce apoptosis. Significant inhibition of tumor invasion and colony formation was also observed in clodronate-treated PTC cells. We further demonstrated that only the cAMP inhibitor 9-(tetrahydro-2-furanyl)-9H-purin-6-amine (SQ22536), and not inhibitors of phospho-or store-operated Ca 2ϩ entry (2-aminoethyl diphenylborinate), can significantly reverse the effect of clodronate. Finally, in vivo animal and green fluorescent protein imaging studies further proved that the tumor inhibitory effect of clodronate on xenotransplanted CG3 cells can be reversed by treatment with suramin. In conclusion, we demonstrated that clodronate-induced PTC cell apoptosis and tumor inhibition are partially mediated by the P2Y receptorcAMP cascade.Papillary thyroid carcinoma (PTC) is one of the most commonly differentiated thyroid carcinomas (TCs) (Kondo et al., 2006;Kung et al., 2006). Genomic research has revealed that RET rearrangement and BRAF mutation are important in the carcinogenesis of TC/PTC (Lee et al., 1998;Kondo et al., 2006). Thus far, the treatment choice for TC is surgery in combination with postoperative radioiodine therapy (Huang et al., 2005). However, in patients with postoperative recurrent or lymphoid metastatic lesions without radioiodative uptake, the success of TC therapy is limited (Huang et al., 2005;Muresan et al., 2008).Anticancer or chemotherapeutic drugs are limited in effect and duration of response for the treatment of TC (Muresan et al., 2008). Recently, bisphosphonates (BPs) were found to have a broad range of in vivo and in vitro antitumor effects