Summary Neoplastic events are marked by uncontrolled cell proliferation. One major focus of cancer research has been to identify treatments that reduce or inhibit cell growth. Over the years, various compounds, both naturally occurring and chemically synthesized, have been used to inhibit neoplastic cell proliferation. Two such oncostatic agents, melatonin and retinoic acid, have been shown to suppress the growth of hormone-responsive breast cancer. Currently, separate clinical protocols exist for the administration of retinoids and melatonin as adjuvant therapies for cancer. Using the oestrogen receptor (ER)-positive MCF-7 human breast tumour cell line, our laboratory has studied the effects of a sequential treatment regimen of melatonin followed by all-trans retinoic acid (atRA) on breast tumour cell proliferation in vitro. Incubation of hormonally responsive MCF-7 and T47D cells with melatonin (10-9 M) followed 24 h later by atRA (10-9 M) resulted in the complete cessation of cell growth as well as a reduction in the number of cells to below the initial plating density. This cytocidal effect is in contrast to the growth-suppressive effects seen with either hormone alone. This regimen of melatonin followed by atRA induced cytocidal effects on MCF-7 cells by activating pathways leading to apoptosis (programmed cell death) as evidenced by decreased ER and Bcl-2 and increased Bax and transforming growth factor beta 1 (TGF-f1) expression. Apoptosis was reflected morphologically by an increase in the number of lysosomal bodies and perinuclear chromatin condensation, cytoplasmic blebbing and the presence of apoptotic bodies. The apoptotic effect of this sequential treatment with melatonin and atRA appears to be both cell and regimen specific as (a) ER-negative MDA-MB-231 and BT-20 breast tumour cells were unaffected, and (b) the simultaneous administration of melatonin and atRA was not associated with apoptosis in any of the breast cancer cell lines studied. Taken together, the results suggest that use of an appropriate regimen of melatonin and atRA should be considered for preclinical and clinical evaluation against ER-positive human breast cancer.Keywords: apoptosis; melatonin; retinoic acid; MCF-7; breast cancer Melatonin, the major hormonal product of the pineal gland, has repeatedly been shown to exert a negative growth-regulatory influence on the development and growth of hormone-responsive breast cancer (Blask et al, 1986(Blask et al, , 1991. In addition, our laboratory (Hill and Blask, 1988) as well as others (Cos and Sanchez-Barcel6, 1994) have shown that melatonin treatment can act directly on hormoneresponsive human breast cancer cells in vitro to suppress their proliferation. We have also recently reported that melatonin not only suppresses the expression of the oestrogen receptor (ER) gene (Molis et al, 1994), but also up-regulates steady-state mRNA levels of transforming growth factor beta (TGF-f) and the proto-oncogene, c-mync (Molis et al, 1995). Even though the effects of melatonin on various growth...