Previously, we demonstrated that intrahepatic upregulation of the immunoactivating molecules CD40 and CD40 ligand (CD40L) are early mechanisms for liver cell damage in human and murine fulminant hepatic failure (FHF). In the present study, we investigated the functional effects of intrahepatic overexpression of CD40L by adenoviral-mediated gene transfer (AdCD40L) in mice. AdCD40L injection induced severe liver cell damage, which was associated with increased alanine aminotransferase (ALT) levels peaking at day 5 after vector administration (AdCD40L, 1,707 ؎ 279 U/L; AdLacZ, 213 ؎ 25 U/L) and with lethality in half of the mice. Except for mild splenomegaly, no organs other than the liver were involved in inflammatory reactions. CD40 -CD40L interaction was mandatory for liver damage, because CD40 ؊/؊ mice were completely protected. F ulminant hepatic failure (FHF) is a life-threatening condition induced by pathogens such as hepatitis B virus infection and drug toxicity. The underlying pathophysiological mechanisms are not fully understood. This renders a causal therapeutic approach difficult. 1,2 Uncontrolled hepatic immunoactivation is discussed as a pivotal pathomechanism of FHF. 3-5 Recently, we described significant intrahepatic upregulation of the immunoactivating molecules CD40 and its ligand (CD40L/ CD154) in patients with FHF. 3 In human FHF, CD40 was upregulated in hepatocytes, sinusoidal and vascular endothelial cells, and macrophages/Kupffer cells, whereas CD40L was expressed in an increased number of intrahepatic lymphocytes. Taking into account our observation of strongly enhanced hepatic CD40 and CD40L expression in FHF and the potent immunoactivating properties of the CD40 -CD40L interaction, we hypothesized that the interaction of CD40 with CD40L is a pivotal trigger of immune cascade-inducing FHF.CD40L is a member of the tumor necrosis factor receptor superfamily and is expressed on activated CD4 ϩ T cells and platelets. 6,7 The CD40 -CD40L interaction induces strong immunoactivation at different levels of the immune system, including T cells, B cells, macrophages, and dendritic cells. Interaction of CD40 -CD40L on dendritic cells and other antigen-presenting cells such as monocytes/macrophages and B lymphocytes upregulates Abbreviations: FHF, fulminant hepatic failure; CD40L, CD40 ligand; AdCD40L, adenoviral CD40 ligand; ALT, alanine aminotransferase; NKT cell, natural killer T cell; pfu,