Secretory clusterin (sCLU) is expressed in numerous cancers and is associated with the resistance to chemotherapy. However, the role of sCLU in the resistance of hepatocellular carcinoma (HCC) to oxaliplatin (OXA), a recently used third-generation platinum agent, remains unclear. The stable transfectants that are depleted of or overexpress sCLU and OXA-resistant cells were generated using human HCC cells. Overexpression of sCLU abrogated OXAinduced inhibition of cell growth and cell apoptosis, but depletion of sCLU synergized with OXA to inhibit cell growth and enhance cell apoptosis, by regulating proteins involved in mitochondrial apoptosis pathways, such as Bcl-2, Bax, Bcl-xL and caspase-9, and affecting phosphorylation of Akt and GSK-3b. Overexpression of sCLU in either OXA-resistant cells or stable transfectants that overexpress sCLU significantly increased phosphorylated Akt. However, specific inhibition of Akt enhanced sensitivity of sCLU-overexpressing cells to OXA, but had no effect on sCLU expression, suggesting that the regulatory effects between sCLU and pAkt may be in a one-way manner in HCC cells. The expression levels of sCLU affected the therapeutic efficacy of OXA to treat HCC tumors established in immunodeficiency mice. The results have demonstrated that sCLU contributes to OXA resistance by activating Akt pathway, indicating that sCLU may be a novel molecular target for overcoming OXA resistance in HCC. (Cancer Sci 2013; 104: 375-382) L iver cancer is the second most frequent cause of cancer death in men worldwide, and hepatocellular carcinoma (HCC) accounts for 70-85% of all liver cancers.(1) However, HCC is extremely resistant to current chemotherapeutic drugs. Sorafenib is currently the most effective drug for HCC,but it prolongs survival for only 2-3 months, and has not been widely adopted because it is cost-prohibitive in Asia and subSaharan Africa, which have the highest incidence of HCC.(1) Therefore, novel drugs and therapeutic strategies for HCC continue to be sought.Oxaliplatin (OXA) is a third-generation platinum-derived chemotherapeutic agent that triggers cell death by inducing platinum-DNA adducts, and appears to block DNA replication more effectively than other platinum compounds.(3) OXA has been used to treat colorectal (4,5) and gastric (6) cancers, and has also displayed anti-tumor activity against HCC.(7) The combination of OXA and gemcitabine or bevacizumab has been investigated to treat advanced HCC in clinical trials, (8,9) but the results achieved were not comparable with the success obtained with colorectal cancer.(5) Furthermore, little data is available regarding the signaling pathways activated by OXA in HCC. Therefore, it remains a priority to find effective methods to enhance the sensitivity of HCC to OXA. Clusterin (CLU) was initially discovered as a secretory glycoprotein with cell-aggregating activity in vitro, (10) and is overexpressed in numerous advanced-stage and metastatic human cancers.(11) Overexpression of CLU has been observed in a majority of HCC ca...