Kaposi's sarcoma (KS) is an inflammatory angioproliferative lesion induced by the infection of endothelial cells with the KS-associated herpesvirus (KSHV). Infected endothelial cells assume an elongated (spindle)shape that is one of the histologic signatures of KS. In vitro, latent viral infection of primary endothelial cells (but no other cell type) strikingly recapitulates these morphological findings. Here we report that the spindling phenotype involves major rearrangement of the actin cytoskeleton and can be attributed to the expression of a single viral protein, vFLIP, a known activator of NF-B. Consistent with this, the inhibition of NF-B activation blocks vFLIP-induced spindling in cultured endothelial cells. vFLIP expression in spindle cells also induces the production of a variety of proinflammatory cytokines and cell surface adhesion proteins that likely contribute to the inflammatory component of KS lesions.Kaposi's sarcoma (KS) is a complex angioproliferative lesion that is the most common neoplasm in patients with untreated AIDS, though it also exists in a human immunodeficiency virus-independent form. All KS lesions have three histological components: proliferation, inflammation, and neoangiogenesis. The principal proliferating element in KS is the socalled spindle cell, so named because of its distinctive elongated, spindle-like shape. Spindle cells have long been thought to be the driving force of KS, responsible for the recruitment of the inflammatory and angiogenic components of the lesion; consistent with this, cultured spindle cells produce a number of proinflammatory and angiogenic factors (12,34). The inflammatory infiltrate is also felt to be an important part of KS pathogenesis, since cultured spindle cells require the secreted products of activated T cells for growth (12,28). The histogenesis of spindle cells has long been debated. Based on the expression of markers such as CD31, CD34, CD36, UEA1 lectin, and EN4 by spindle cells, it is generally believed that the cells are most likely of endothelial origin (7). However, the exact endothelial lineage from which spindle cells are derived remains unclear. A number of lines of evidence favor the notion that KS is derived from cells of lymphatic rather than vascular endothelial origin. For instance, KS tumors are never observed in tissues (e.g., brain) that are devoid of lymphatics (47). In addition, KS cells consistently stain for markers of lymphatic endothelium, e.g., VEGF-R3, LYVE-1, and podoplanin (21,36,46). However, the pathogenetic significance of the latter observations has been rendered ambiguous by recent find-
ings that KS-associated herpesvirus (KSHV) infection of lymphatic or vascular endothelial cells can reprogram their expression of endothelial markers (17, 45).Central to the pathogenesis of KS is infection by KSHV (also called human herpesvirus 8). Like all herpesviruses, KSHV has two modes of infection, latent and lytic. In KS tumors, KSHV selectively infects the spindle cells (5), most of which are latently infected (37); ...