Acid sphingomyelinase (A-SMase) is an important enzyme in sphingolipid metabolism and plays key roles in apoptosis, immunity, development, and cancer. In addition, it mediates cytotoxicity of cisplatin and some other chemotherapeutic drugs. The mechanism of A-SMase activation is still undefined. We now demonstrate that, upon CD95 stimulation, ASMase is activated through translocation from intracellular compartments to the plasma membrane in an exocytic pathway requiring the t-SNARE protein syntaxin 4. Indeed, downregulation of syntaxin 4 inhibits A-SMase translocation and activation induced by CD95 stimulation. This leads to inhibition of the CD95-triggered signaling events, including caspase 3 and 9 activation and apoptosis, activation of the survival pathway involving the protein kinase Akt, and important changes in cell cycle and proliferation. The molecular interaction between A-SMase and syntaxin 4 was not known and clarifies the mechanism of A-SMase activation. The novel actions of syntaxin 4 in sphingolipid metabolism and exocytosis we describe here define signaling mechanisms of broad relevance in cell pathophysiology.Acid sphingomyelinase (A-SMase) 3 (EC 3.1.4.12) is a phosphodiesterase that catalyzes the hydrolysis of membrane lipid sphingomyelin to ceramide and phosphorylcholine. The enzyme plays important roles in pathophysiology, as it mediates the action of several apoptogenic molecules, cytokines, and neurotrophins, regulating neuronal function, immunity, and infections (1-3).Enzymatic dysfunction of A-SMase leads to Niemann-Pick diseases types A and B (4). The enzyme is also important in cancer development and therapy; tumor growth is enhanced in A-SMase knock-out mice (5), and the enzyme contributes significantly to the cytotoxic effects of several anticancer drugs (6 -9). The biology of A-SMase under resting conditions, including its localization to lysosomal compartments, has been clarified (6, 9). Less clear is how A-SMase is activated. Activation has been suggested to require translocation from intracellular compartments to the extracellular surface of the cell through pathways as yet unknown (3, 9) or to occur within the lysosomes (10). Elucidating the molecular mechanisms of A-SMase activation is of biological relevance and might reveal novel candidate targets for therapy, including cancer therapy.Using U373, a human glioma cell line expressing the death receptor CD95, we have now established that translocation of A-SMase to the plasma membrane is required for its early activation, that this process takes place by exocytosis, and that a key role in it is played by syntaxin 4, an ubiquitously expressed t-SNARE implicated in several regulated exocytic pathways including the translocation of Glut4 to the plasma membrane, exocytosis of secretory granules, and the calcium-dependent release of lysosomes (11,12). Furthermore, we demonstrate that the blockade of syntaxin 4-dependent exocytosis inhibits CD95 receptor clustering and internalization, caspase activation and loss of mitochondrial membr...