IntroductionHuman T-cell leukemia virus type 1 (HTLV-1) is the etiologic agent of adult T-cell leukemia-lymphoma (ATLL). 1 Treatment of patients with ATLL using conventional chemotherapy has limited benefit given that HTLV-1 cells are resistant to most apoptosis-inducing agents. 2,3 This may in part be because HTLV-1 leukemic cells overexpress the multidrug resistance protein and the lungresistance protein, resulting in the pumping of a wide spectrum of agents from the plasma membrane and preventing them from entering the cytoplasm. 4,5 In addition, the down-regulation of Fas-ligand expression and rare cases of mutations in the Fas gene sequence have been reported and could also impair the induction of apoptosis through this pathway. 6 In vivo, but not in vitro, the combination of zidovudine (AZT) with interferon-␣ is a partially effective treatment that induces cell death in HTLV-1-infected cells. 7,8 In vitro, retinoic acid 9,10 or arsenic trioxide (As 2 O 3 ), in combination with IFN-␣, can also induce cell death in HTLV-1-transformed cells 11,12 through mechanisms that remain unclear but that may involve the down-regulation of NF-B in the latter case. 13 Programmed cell death, or apoptosis, consists of a highly regulated series of events allowing the organism to control cell number and tissue size. 14 It occurs in 3 phases-initiation, commitment to cell death, and execution. During apoptosis, a complex set of proteins is activated. Among them, caspases play a key role and act as initiators (for review, see 15 ). These cysteine proteases are normally present as pro-enzymes and are proteolytically cleaved to active heterodimers. They have an active-site cysteine and mediate apoptosis by proteolysis of specific substrates. Substrate specificity is determined by the 4-residue amino-terminal to the cleavage site. Caspase-dependent cleavage can either activate or inactivate the target protein. Close to 100 caspase substrates have been reported. 16 Poly (ADP-ribose) polymerase (PARP), a regulator of DNA repair, and Bcl-2 are known substrates of caspase-3. Mitochondria have been recently recognized to play a major role in the control of apoptosis or programmed cell death. 14,17 Members of the Bcl-2 family that interact with the permeability transition pore complex regulate permeabilization of mitochondrial membranes, a decisive feature of early cell death.Bcl-2 is a member of an expanding family of related proteins. Some of them are proapoptotic (Bax, Bak, Bid, Bcl-X S ) and some are antiapoptotic (Bcl-2, Bcl-X L ) (for review, see 14,18 ). It has been shown that the presence of Bcl-2 blocked the activation of caspase-3. However-and adding another level of complexityBcl-2, which inhibits cell death, can also be converted to a Bax-like death effector through its cleavage at Asp-34 by caspase-3. 19,20 Interestingly, Bcl-2 and Bcl-X L are overexpressed in HTLV-1 cells. 21,22 In the latter case, this phenomenon is linked with the constitutive activation of the NF-B pathway by Tax. 23 Tax is a 42-kd protein whose express...