Edited by George M. Carman 2-Hydroxy-oleic acid (2OHOA) is a potent anticancer drug that induces cancer cell cycle arrest and apoptosis. Previous studies have suggested that 2OHOA's anticancer effect is mediated by SMS activation in cancer cells, including A549 and U118 cells. To confirm this phenomenon, in this study, we treated both A549 and U118 cells with 2OHOA and measured SMS activity. To our surprise, we found neither 2OHOA-mediated SMS activation nor sphingomyelin accumulation in the cells. However, we noted that 2OHOA significantly reduces phosphatidylcholine in these cells. We also did not observe 2OHOAmediated SMS activation in mouse tissue homogenates. Importantly, 2OHOA inhibited rather than activated recombinant SMS1 (rSMS1) and rSMS2 in a dose-dependent fashion. Intragastric treatment of C57BL/6J mice with 2OHOA for 10 days had no effects on liver and small intestine SMS activities and plasma sphingomyelin levels. The treatment inhibited lysophosphatidylcholine acyltransferase (LPCAT) activity, consistent with the aforementioned reduction in plasma phosphatidylcholine. Because total cellular phosphatidylcholine is used as a predictive biomarker for monitoring tumor responses, the previously reported 2OHOA-mediated cancer suppression could be related to this phosphatidylcholine reduction, which may influence cell membrane structure and properties. We conclude that 2OHOA is not a SMS activator and that its anticancer property may be related to an effect on phosphatidylcholine metabolism.2-Hydroxy-oleic acid (2OHOA) 3 is a potent anticancer drug that induces cancer cell cycle arrest (1), differentiation (2), and death (3-5). The European Medicines Agency has designated 2OHOA as an orphan drug for the treatment of glioma.However, the underlying mechanisms leading to cancer cell death remain largely unknown, although it has been reported that the effect was mediated by activation of sphingomyelin synthase (SMS) in cancer cells and accumulation of cell sphingomyelin levels (6).The biochemical synthesis of SM occurs through the action ofserinepalmitoyltransferase,3-ketosphinganinereductase,ceramide synthase, dihydroceramide desaturase, and SMS (7). SMS catalyzes the conversion of ceramide to sphingomyelin. The SMS gene family consists of three members, SMS1, SMS2, and SMS-related protein (SMSr). SMS1 is found in the trans-Golgi complex, whereas SMS2 is predominantly found in the plasma membranes (8,9). SMSr, the third member of the gene family, has no SMS activity but catalyzes the synthesis of ceramide-phosphoethanolamine in the ER lumen (8, 10). We and another research group reported that systemic SMS1 KO exhibited moderate neonatal lethality (11, 12) (i.e. 25% of homozygotes die during the first 3 weeks; the remainder can grow to adulthood). On the other hand, SMS2 KO mice display no obvious abnormalities and grow to adulthood (13). We and others have suggested that SMS2 might be a therapeutic target for metabolic diseases, including type 2 diabetes, fatty liver, and atherosclerosis (14 -20). However, ...