Acute renal failure often occurs in the clinical setting of multiple renal insults. Tumor necrosis factor-␣ (TNF-␣) has been implicated in the pathogenesis of cisplatin nephrotoxicity, ischemia-reperfusion injury, and endotoxininduced acute renal failure. The current studies examined the interactions between cisplatin and endotoxin with particular emphasis on TNF-␣ production. Treatment of cultured murine proximal tubule cells (TKPTS cells) with cisplatin resulted in a modest production of TNF-␣, while treatment with endotoxin did not result in any TNF-␣ production. However, the combination of cisplatin and endotoxin resulted in large amounts of TNF-␣ synthesis and secretion. The stimulation of TNF-␣ production was dependent on cisplatin-induced activation of p38 MAPK and was associated with phosphorylation of the translation initiation factor eIF4E and its upstream kinase Mnk1. Inhibition of p38 MAPK and, to a lesser extent, ERK, reduced cisplatinϩendotoxin-stimulated TNF-␣ production and phosphorylation of Mnk1 and eIF4E. Synergy between cisplatin and endotoxin was also observed in certain tumor cell lines, but not in macrophages. In macrophages, in contrast to TKPTS cells, endotoxin alone activated p38 MAPK and stimulated TNF-␣ production with no added impact by cisplatin. The combination of cisplatin and endotoxin did not result in synergistic production of other cytokines, e.g., MCP-1 and MIP2, by TKPTS cells. In summary, these studies indicate that cisplatin sensitizes renal epithelial cells to endotoxin and dramatically increases the translation of TNF-␣ mRNA in a p38 MAPK-dependent manner. These interactions between cisplatin and endotoxin may be relevant to the pathogenesis of cisplatin nephrotoxicity in humans. p38 MAPK; Mnk1; eIF4E; acute renal failure; LPS ACUTE RENAL FAILURE CAN DEVELOP in a variety of clinical situations such as ischemia, sepsis, and administration of nephrotoxic agents. Studies using experimental models of acute renal failure have identified a large number of putative pathophysiological mediators (42, 45). The majority of these studies have employed models of acute renal injury subsequent to a single renal insult (25). However, acute renal failure in humans often occurs in complex clinical settings in which patients may be exposed to a number of different renal insults (45). It has been suggested that the failure in humans of therapeutic interventions based on single-insult animal studies may be due, in part, to the multiplicity of renal insults in human acute renal failure (13,25).Sepsis is a common cause of acute renal failure, accounting for up to 60% of cases in some series (3, 41). The prognosis for sepsis-associated acute renal failure is particularly grim, with reported mortality rates as high as 95% (3,20). TNF-␣ is an important mediator of the systemic and renal effects of sepsis. The production of TNF-␣ in sepsis results from the activation of TLR receptors by bacterial products such as endotoxin (1, 7). Neutralization of TNF-␣ using a soluble receptor protected against ...