Autophagy is associated with cell survival and cell death. Autophagy is implicated in the pathophysiology of various human diseases. In order to identify autophagy regulatory molecules, we screened a chemical drug library in SH-SY5Y cells and selected Sertindole as a potent autophagy inducer. Sertindole was developed as an antipsychotic drug for Schizophrenia. Sertindole treatment highly induced the formation of autophagosomes as well as LC3 conversion. Subsequently, Sertindole-induced autophagy was efficiently suppressed by down regulation of ATG5. Sertindole also increased reactive oxygen species (ROS) production, which contributes to autophagy-associated cell death in neuroblastoma cells. ROS scavengers such as Nacetylcysteine and Trolox suppressed not only ROS generation but also autophagy activation by Sertindole. These results suggest Sertindole induces autophagy and autophagy-associated cell death by ROS production in neuroblastoma cells.Key words Sertindole; autophagy; ATG5; reactive oxygen species; SH-SY5Y cell Autophagy refers to a highly conserved lysosome-dependent degradation mechanism that involves the removal of cytoplasmic proteins and organelles.1,2) Autophagy plays important role in development, immune defense, and cell death. The fundamental role of autophagy helps cell survival under stressful conditions by enhancing metabolic homeostasis. However, autophagy may also contribute to non-apoptotic cell death processes under some conditions. 3-6) Indeed, autophagy has been implicated in many pathophysiologic conditions such as neurodegenerative diseases such as cancer, type 2 diabetes, infectious diseases, cardiomyopathies, and innate immune diseases.3-6) Therefore, understanding the molecular mechanism of autophagy may help to develop new therapeutic strategies for those diseases. Based on this notion, several groups reported on small molecules that modulate autophagy and can be used as potential therapeutic drugs. 7,8) For example, Rapamycin, an autophagy inducer, enhances clearance of intracellular aggregate proteins associated with Huntington's disease. 9,10) In addition, some autophagy regulators sensitize tumor cells to anticancer therapy. 11) However, the precise mechanisms of autophagy in pathological conditions are not fully understood.Schizophrenia (SZ) is a complex mental disorder often associated with cognitive impairment and depressive symptoms that affects about 1% of the population. SZ is caused by environmental and genetic risk factors or their interactions.12) Although, several genome wide association studies have identified SZ-related genes, the molecular mechanism is still largely unknown. [13][14][15] The primary treatment for SZ is antipsychotic medications.16,17) Sertindole, a phenylindole derivative was developed as an antipsychotic drug. It is a potent antagonist at dopamine D 2 , serotonin 5-HT 2 , and α 1 -adrenergic receptors with high affinity. 18,19) Additionally, Sertindole suppresses potassium channel in the brain and heart. 20,21) In contrast to other antipsychotic...