The tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) has gained much attention as a possible therapeutic reagent for the treatment of tumors, as TRAIL was originally described to induce apoptosis specifically in cancer cells, but not in normal cells. Fibroblast-like synoviocytes (FLS) in rheumatoid arthritis (RA) patients exhibit tumor-like features and we have described earlier that TRAIL induces apoptosis only in a subset of RA FLS, but an induction of proliferation in the surviving cells. This observation corresponds to the pleiotropic effects of TRAIL observed on primary human tumor cells. Here, we describe that the PI3 kinase/Akt-signaling pathway, but not that of the MAP kinases ERK and p38, protects RA FLS from TRAIL-induced apoptosis by modulating the expression of the cell survival regulators p21, XIAP, Mcl-1 and RIP. Moreover, we found that not only TRAIL-induced apoptosis, but also TRAIL-triggered proliferation in RA FLS is mediated by caspases with a crucial role for caspase 8. TRAIL was found to induce degradation of p21 and p27 that was caspase-dependent, but independent of the ERK, p38 and PI3 kinase/Akt-signaling pathways. The finding that TRAIL-triggered proliferation and apoptosis share intracellular routes has to be taken in consideration in defining therapeutic strategies on the basis of the administration of TRAIL. In recent years, considerable attention has been focused on the potential benefits of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) in cancer therapy, as a broad range of cancer cells are sensitive to TRAIL-induced apoptosis (reviewed in 1 ). In addition, the use of TRAIL in combination with chemotherapeutic agents or irradiation strengthens its apoptotic effects and frequently sensitizes the otherwise TRAIL-resistant tumor cells. It is important that TRAIL does not seem to be toxic to normal cells, as TRAIL exposure shows no toxic side effects of therapeutically relevant doses in primates.Tumor necrosis factor (TNF)-related apoptosis-inducing ligand can interact with five different receptors: four membrane-anchored receptors TRAIL-R1 (DR4), TRAIL-R2 (DR5), TRAIL-R3 (DcR1) and TRAIL-R4 (DcR2) and a soluble decoy receptor osteoprotegerin. The receptors TRAIL-R1 and -R2 contain an intracellular cytoplasmic sequence motif, known as the death domain (DD), and can induce apoptosis through activation of caspases (reviewed in 2 ). Nevertheless, TRAIL-receptors R1 and R2 not only trigger apoptosis, but also proliferation and differentiation depending on the cell type (reviewed in 2 ). This phenomenon has been described for several other members of the TNF family and it is thought that one pathway potentially pre-dominates, but that a build-up of intracellular regulators can flick the switch from cell death to proliferation and vice versa. 2,3 For example, TRAIL has been shown to promote cell survival and proliferation of endothelial and vascular smooth muscle cells 4,5 and to regulate erythroid and monocytic maturation. 6 Evidence is accumulati...