Thiazolidinediones, including rosiglitazone and troglitazone, are insulin-sensitizing drugs and high-affinity ligands for the peroxisome proliferator-activated receptor c (PPARc). Apart from their antidiabetic activity, these molecules possess antitumor properties. We investigated their potential apoptotic effects on RT4 (derived from a well-differentiated Grade I papillary tumor) and T24 (derived from an undifferentiated Grade III carcinoma) bladder cancer cells. Rosiglitazone induced G2/M or G0/G1 phase cell cycle arrest in RT4 and T24 cells, respectively. Only troglitazone triggered apoptosis via extrinsic and intrinsic pathways in both cell lines. Interestingly, rosiglitazone amplified TRAIL-induced apoptosis in TRAIL-sensitive RT4 cells or let TRAIL-resistant T24 cells to respond to TRAIL. Thiazolidinediones acted through PPARc activation-independent mechanisms. The underlying mechanisms involved for the first time in cancer cells the upregulation of soluble and/or membrane-bound TRAIL. This was associated with increased cell surface death receptor 5 expression and c-FLIP and survivin downregulation, mediated in part through proteasome-dependent degradation in troglitazone-promoted cell death. Therefore, the combination of rosiglitazone and TRAIL could be clinically relevant as chemopreventive or therapeutic agents for the treatment of TRAILresistant high-grade urothelial cancers.Bladder cancer accounts for $5% of all cancer deaths in humans. Despite the advances with intravesical immuno-and chemotherapy, surgery and systemic chemotherapy in the management of patients and although new cytotoxic chemotherapeutic agents for either advanced or metastatic bladder cancer are used, no improvement in survival has been observed. Thus, targeted therapy with novel agents is a promising avenue to improve patient outcome.Thiazolidinediones (TZD), including rosiglitazone and troglitazone, are a class of insulin-sensitizing drugs. Besides, rosiglitazone is currently in clinical use for the treatment of type II diabetes.1,2 These TZD are high-affinity chemically synthesized ligands for the peroxisome proliferator-activated receptor c (PPARc).3 PPARc is a ligand-activated transcription factor of the nuclear hormone receptor superfamily. In addition to its known role in regulation of metabolism and inflammation, PPARc has also been implicated in carcinogenesis based on studies showing its ability to modulate cellular differentiation, proliferation and apoptosis. Apart from their antidiabetic activity, TZD elicit growth inhibitory effects in vitro on cancer cells of diverse tissue origins and in vivo. Few studies indicate that certain TZD members exhibited antiproliferative or proapoptotic activities against a broad spectrum of bladder cancer cell lines.5-8 Thus, treatment of the T24 bladder cancer cells with troglitazone induced G0/G1 cell cycle arrest and cell death.5 In addition, depending on TZD member, the induction of apoptosis is PPARc-dependent or -independent. 9 Interestingly, TZD could sensitize tumor cells to TRAI...