Purpose: Recently, 14-member macrolide antibiotics such as clarithromycin and roxithromycin have been shown to have anticancer and antiangiogenic effects.We investigated the suppressive effect of roxithromycin on accelerated hepatocellular carcinoma growth in a rat hepatocarcinogenetic model and compared results with effects from TNP-470. Experimental Design: Tumor was induced by oral diethylnitrosamine administration for 17 weeks. Normal saline,TNP-470 (50 mg/kg), or roxithromycin (40 or 100 mg/kg) was administered i.p. thrice per week from week 10 to 17. Results: Carcinomatous tissue growing outside dysplastic nodules and a marked expression of placental glutathione S-transferase were detected in rats with induced carcinogenesis. Tumor growth was accompanied by augmented expression of inducible nitric oxide synthase, activation of nuclear factor nB, and increased lipid peroxidation level. All these effects were absent in animals that received roxithromycin or TNP-470. The inhibitory effect of roxithromycin was dose dependent and no clear differences were noted between groups given roxithromycin 100 mg/kg and TNP-470 50 mg/kg. Conclusions: Our results indicate that roxithromycin inhibits oxidative stress, nitric oxide production, and nuclear factor nB activation induced by experimental hepatocarcinogenesis. The data provide additional evidence for the potential use of roxithromycin in treatment of hepatocellular carcinoma prevention.Hepatocellular carcinoma is one of the most common malignancies in the world, especially in Asia and Africa. The vast majority of patients have preexisting cirrhosis at the time they develop hepatocellular carcinoma. Despite many treatments for this disease in recent decades, its long-term therapeutic outcome remains poor. Prevention seems to be the best strategy in lowering the present incidence of the disease. A preventive effect of an acyclic retinoid on the development of a second tumor after ablation of an original tumor has been shown by one group (1, 2). Conflicting results on the potential preventive effect of IFN have also been reported (3-5). To validate and expand the concept of chemoprevention to other therapeutics, the molecular events that contribute to hepatocarcinogenesis in the liver with cirrhosis need to be identified and targeted.It was reported that tumor growth is angiogenesis dependent by the discovery of angiostatin or endostatin, both of which specifically inhibit endothelial proliferation (6, 7). There are several drugs that have angiogenesis inhibitory properties; however, most of these are restricted by excessive toxicity and limited efficacy. Roxithromycin is a new 14-member macrolide antibiotic that has a wide antibacterial spectrum against pathogens and an immunomodulatory effect. Interestingly, on tumor angiogenesis, Yatsunami et al. (8) reported that roxithromycin at concentrations >20 Amol/L inhibited endothelial cell migration and tube formation. Moreover, we previously reported the strong inhibitory effect of roxithromycin on tumor necro...