CpGâisland methylator phenotype (CIMP)âpositive clear cell renal cell carcinomas (RCCs) are characterized by accumulation of DNA hypermethylation of CpG islands, clinicopathological aggressiveness and poor patient outcome. The aim of this study was to clarify the molecular pathways participating in CIMPâpositive renal carcinogenesis. Genome (wholeâexome and copy number), transcriptome and proteome (twoâdimensional image converted analysis of liquid chromatographyâmass spectrometry) analyses were performed using tissue specimens of 87 CIMPânegative and 14 CIMPâpositive clear cell RCCs and corresponding specimens of nonâcancerous renal cortex. Genes encoding microtubuleâassociated proteins, such as DNAH2, DNAH5, DNAH10, RP1 and HAUS8, showed a 10% or higher incidence of genetic aberrations (nonâsynonymous singleânucleotide mutations and insertions/deletions) in CIMPâpositive RCCs, whereas CIMPânegative RCCs lacked distinct genetic characteristics. MetaCore pathway analysis of CIMPâpositive RCCs revealed that alterations of mRNA or protein expression were significantly accumulated in six pathways, all participating in the spindle checkpoint, including the âThe metaphase checkpoint (pâ=â1.427 Ă 10â6),â âRole of Anaphase Promoting Complex in cell cycle regulation (pâ=â7.444 Ă 10â6)â and âSpindle assembly and chromosome separation (pâ=â9.260 Ă 10â6)â pathways. Quantitative RTâPCR analysis revealed that mRNA expression levels for genes included in such pathways, i.e., AURKA, AURKB, BIRC5, BUB1, CDC20, NEK2 and SPC25, were significantly higher in CIMPâpositive than in CIMPânegative RCCs. All CIMPâpositive RCCs showed overexpression of Aurora kinases, AURKA and AURKB, and this overexpression was mainly attributable to increased copy number. These data suggest that abnormalities of the spindle checkpoint pathway participate in CIMPâpositive renal carcinogenesis, and that AURKA and AURKB may be potential therapeutic targets in more aggressive CIMPâpositive RCCs.