TRAIL receptor signalling and modulation: Are we on the right TRAIL?

Cancer Treat Rev. 2009 May;35(3):280-8. doi: 10.1016/j.ctrv.2008.11.006. Epub 2008 Dec 30.


Tumour necrosis factor-related apoptosis-inducing ligand or Apo2 ligand (TRAIL/Apo2L) is a member of the tumour necrosis factor (TNF) superfamily of cytokines that induces apoptosis upon binding to its death domain-containing transmembrane receptors, death receptors 4 and 5 (DR4, DR5). Importantly, TRAIL preferentially induces apoptosis in cancer cells while exhibiting little or no toxicity in normal cells. To date, research has focused on the mechanism of apoptosis induced by TRAIL and the processes involved in the development of TRAIL resistance. TRAIL-resistant tumours can be re-sensitized to TRAIL by a combination of TRAIL with chemotherapeutics or irradiation. Studies suggest that in many cancer cells only one of the two death-inducing TRAIL receptors is functional. These findings as well as the aim to avoid decoy receptor-mediated neutralization of TRAIL led to the development of receptor-specific TRAIL variants and agonistic antibodies. These molecules are predicted to be more potent than native TRAIL in vivo and may be suitable for targeted treatment of particular tumours. This review focuses on the current status of TRAIL receptor-targeting for cancer therapy, the apoptotic signalling pathway induced by TRAIL receptors, the prognostic implications of TRAIL receptor expression and modulation of TRAIL sensitivity of tumour cells by combination therapies. The mechanisms of TRAIL resistance and the potential measures that can be taken to overcome them are also addressed. Finally, the status of clinical trials of recombinant TRAIL and DR4-/DR5-specific agonistic antibodies as well as the pre-clinical studies of receptor-selective TRAIL variants is discussed including the obstacles facing the use of these molecules as anti-cancer therapeutics.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies, Monoclonal / immunology
  • Antibodies, Monoclonal / pharmacology
  • Antibodies, Monoclonal / therapeutic use
  • Antineoplastic Agents / pharmacology*
  • Antineoplastic Agents / therapeutic use
  • Apoptosis / drug effects
  • Apoptosis / physiology*
  • Apoptosis Regulatory Proteins / physiology
  • Clinical Trials as Topic / statistics & numerical data
  • Combined Modality Therapy
  • Drug Delivery Systems
  • Drug Resistance, Neoplasm
  • GPI-Linked Proteins
  • Humans
  • Neoplasm Proteins / agonists
  • Neoplasm Proteins / immunology
  • Neoplasm Proteins / physiology*
  • Neoplasms / drug therapy
  • Neoplasms / pathology
  • Neoplasms / radiotherapy
  • Neoplasms / therapy*
  • Receptors, TNF-Related Apoptosis-Inducing Ligand / agonists
  • Receptors, TNF-Related Apoptosis-Inducing Ligand / physiology*
  • Receptors, Tumor Necrosis Factor / agonists
  • Receptors, Tumor Necrosis Factor / physiology*
  • Receptors, Tumor Necrosis Factor, Member 10c
  • Recombinant Proteins / pharmacology
  • Recombinant Proteins / therapeutic use
  • Signal Transduction / drug effects
  • TNF-Related Apoptosis-Inducing Ligand / agonists
  • TNF-Related Apoptosis-Inducing Ligand / immunology
  • TNF-Related Apoptosis-Inducing Ligand / physiology*
  • TNF-Related Apoptosis-Inducing Ligand / therapeutic use
  • Tumor Necrosis Factor Decoy Receptors / agonists
  • Tumor Necrosis Factor Decoy Receptors / immunology
  • Tumor Necrosis Factor Decoy Receptors / physiology*
  • Up-Regulation / drug effects


  • Antibodies, Monoclonal
  • Antineoplastic Agents
  • Apoptosis Regulatory Proteins
  • GPI-Linked Proteins
  • Neoplasm Proteins
  • Receptors, TNF-Related Apoptosis-Inducing Ligand
  • Receptors, Tumor Necrosis Factor
  • Receptors, Tumor Necrosis Factor, Member 10c
  • Recombinant Proteins
  • TNF-Related Apoptosis-Inducing Ligand
  • TNFRSF10A protein, human
  • TNFRSF10C protein, human
  • TNFRSF10D protein, human
  • TNFSF10 protein, human
  • Tumor Necrosis Factor Decoy Receptors