Sulindac, a non-steroidal anti-inflammatory prodrug, is metabolized into pharmacologically active sulfide and sulfone derivatives. Sulindac sulfide, but not sulindac sulfone, inhibits cyclooxygenase (COX) enzyme activities, yet both derivatives have growth inhibitory effects on colon cancer cells. Microarray analysis was used to detect COX-independent effects of sulindac on gene expression in human colorectal cells. Spermidine/spermine N 1 -acetyltransferase (SSAT) gene, which encodes a polyamine catabolic enzyme, was induced by clinically relevant sulindac sulfone concentrations. Northern blots confirmed increased SSAT RNA levels in these colon cancer cells. Deletion analysis and mutational studies were done to map the sulindac sulfone-dependent response sequences in the SSAT 5-flanking sequences. This led us to the identification of two peroxisome proliferator-activated receptor (PPAR) response elements (PPREs) in the SSAT gene. PPRE-2, at ؉48 bases relative to the transcription start site, is required for the induction of SSAT by sulindac sulfone and is specifically bound by PPAR␥ in the Caco-2 cells as shown by transfection and gel shift experiments. PPRE-1, at ؊323 bases relative to the start site, is not required for the induction of SSAT by sulindac sulfone but can be bound by both PPAR␦ and PPAR␥. Sulindac sulfone reduced cellular polyamine contents in the absence but not in the presence of verapamil, an inhibitor of the export of monoacetyl diamines, inhibited cell proliferation and induced apoptosis. The induced apoptosis could be partially rescued by exogenous putrescine. These data suggest that apoptosis induced by sulindac sulfone is mediated, in part, by the COX-independent, PPAR-dependent transcriptional activation of SSAT, leading to reduced tissue polyamine contents in human colon cancer cells.Numerous epidemiological, animal, and in vitro studies indicate that non-steroidal anti-inflammatory drugs (NSAIDs) 1 have antitumorigenic activities against colorectal cancer (1-4).Sulindac, an NSAID, inhibits colorectal carcinogenesis in rodent models (5, 6) and causes regression of adenomas (7,8) in patients with familial adenomatous polyposis coli. NSAIDs work by inhibiting cyclooxygenases (COXs) of which there are at least two distinct forms, COX-1 and COX-2. Physiologically sulindac is metabolized into sulfide-or sulfonecontaining derivatives. The sulfide derivative inhibits colon carcinogenesis by inhibiting COX-1 and COX-2 enzyme activities (9). However, sulindac sulfone also inhibits chemical carcinogenesis in rodents but by a mechanism that cannot be explained solely by the inhibition of prostaglandin synthesis (10, 11), yet both derivatives inhibit growth and induce apoptosis in a variety of human tumor-derived cell lines (12, 13). Sulindac sulfone, at clinically relevant concentrations ranging from 35 M (in humans) to around 150 M (in mice), has been shown to have chemopreventive effects on colon cancer (12, 14 -16).One of the COX-independent mechanisms of action of sulindac and its metabolites...