Tumor cells cause ischemia/reperfusion (I/R) injury as they arrest within the hepatic microvasculature with the production of nitric oxide (NO) and reactive oxygen species (ROS) that kill both host liver and implanting tumor cells. Carcinoembryonic antigen (CEA) both facilitates the survival of experimental metastasis to nude mouse liver by weakly metastatic human colorectal carcinomas (CRCs) and induces the release of the proinflammatory cytokine IL-6. We hypothesized that CEA also stimulates the release of the antiinflammatory cytokine IL-10 causing inhibition of the toxicity of hepatic I/R injury and indirect stimulation of tumor cell colonization of the liver. Intravenous injection of CEA produced more than 1 ng/ml of IL-10 in the systemic circulation within 1 hr which subsided by 8 hr. The IL-10 response is specific to CEA since the pentapeptide sequence in CEA that binds to the CEA receptor stimulated isolated Kupffer cells to produce IL-10. IL-10, but not IL-6, increased the survival of weakly metastatic CRC cocultured with ischemic-reoxygenated liver fragments but did not affect the survival of CRC exposed to oxidative stress in the absence of any host cells. CEA, IL-6 and IL-10 pretreatment reduced expression of iNOS but only CEA and IL-10 strongly inhibited NO and total reactive species production by ischemic-rexoygenated liver. IL-6 was toxic to CRC exposed to oxidative stress while IL-10 did not have a direct effect on CRC. Thus, CEA stimulates production of IL-10 that may enhance metastasis by promoting the ability of circulating CRC cells to survive the I/R injury of implantation. © 2004 Wiley-Liss, Inc.Key words: metastasis; colorectal carcinoma; ischemia/reperfusion injury; oxidative stress; carcinoembryonic antigen Tumor cells arresting within the hepatic microcirculation must survive several formidable challenges if they are to form metastases successfully. Mechanical deformation kills 50% of arresting tumor cells 1,2 while oxidative stress may kill almost all of the remaining cells. [3][4][5] Oxidative stress is caused by ischemia/reperfusion (I/R) injury when tumor cells entering the hepatic microcirculation obstruct hepatic sinusoids and temporarily occlude blood flow before the hepatic circulation is reestablished by either tumor cell death or invasion into the parenchyma. 6 I/R injury produces nitric oxide (NO) and reactive oxygen species (ROS) 7 that are toxic to both host liver as well as arresting tumor cells. Interestingly, primary explant cultures of murine hepatic sinusoidal endothelial cells constitutively produce NO and superoxide anion that kill tumor cells. 8,9 As a result, weakly metastatic human colorectal carcinoma (CRC) cells are essentially eliminated from the hepatic microcirculation within 4 -24 hr because of their sensitivity to NO and ROS while highly metastatic CRC cells persist within the hepatic microcirculation after 24 hr because of their resistance to NO and ROS. 2,10 Thus, the defense mechanisms that enable tumor cells to resist attack by NO and ROS are import...