Kaposi's sarcoma (KS) is a multifocal tumor that appears in four epidemiologically distinct forms: classical, iatrogenic, AIDS-associated, and African endemic KS (63). KS lesions evolve over time from patch- or plaque-like lesions at early stages to nodular lesions characteristic of later stages (for a review, see references 21 and 63). Histologic hallmarks that characterize all stages of KS include a prominent microvasculature and a large inflammatory compartment of CD8+ T cells and monocytes (for a review, see references 21 and 63). Especially in later stages of development, bundles of spindle-shaped cells become the dominant cellular feature. These so-called KS spindle cells (KSC) express markers of lymph vessel endothelial cells and are regarded as the tumor cells of KS (17, 76). As yet, it is unclear whether KSC are derived from lymph or blood vessel endothelial cells, or from both (32, 60, 73). Human herpesvirus 8 (HHV-8), also known as KS-associated herpesvirus, is regarded as the etiological agent of KS (8). In addition, HHV-8 is associated with primary effusion lymphoma and multicentric Castleman's disease (1). In KS lesions, only a few lytically HHV-8-infected cells are detected (6), whereas more than 70% of KSC are latently infected (58, 59). During latency, only a few of the more than 80 viral genes are expressed (22, 53). These genes are crucial to establish latent infection and to protect infected cells from apoptosis (62). The latter is specifically important considering the inflammatory conditions present in KS, which may induce apoptosis in infected cells by cell-mediated cytotoxicity and/or the formation of high concentrations of reactive oxygen species (ROS) (56, 77). A growing body of evidence suggests that the inhibition of cell death rather than increased proliferation may be key for the growth of the lesions. For example, KSC exhibit longer doubling times than normal endothelial cells in vitro (14, 57), which is in agreement with the fact that generally low proliferation rates of KSC are observed in all stages of KS in vivo (14, 57). Most importantly, the numbers of apoptotic cells in KS decrease from early to late stages, and this is inversely related to increasing numbers of HHV-8-infected cells (62). The K13 gene of HHV-8 is a latent gene that is expressed in almost all KSC in vivo (62). This gene encodes a viral Fas-associated death domain-like interleukin-1β (IL-1β)-converting enzyme-inhibitory protein (vFLIP/K13) with homology to cellular FLIP (cFLIP) molecules (cFLIP-long, -short, and -R) and with certain caspases (67, 71, 78). It is well established that vFLIP/K13 has antiapoptotic activity (20, 64) and plays an important role in the pathogenesis of HHV-8-associated tumors, including KS, primary effusion lymphoma, and multicentric Castleman's disease (15, 28, 62). In contrast, the mechanisms of vFLIP/K13 antiapoptotic activities are controversial and continue to be debated. vFLIP/K13 harbors a death effector domain, suggesting that it may bind to caspase 8 and inhibit its activation, which may protect cells from death receptor-induced apoptosis (9, 67). This hypothesis was initially supported by a report showing that vFLIP/K13 and caspase 8 can bind to each other (5). However, these results were questioned in subsequent studies (10, 24, 44). Presently, evidence is accumulating that vFLIP/K13 can interact with and activate the regulatory components of the IκB kinase complex (3, 23, 39). It has been shown that this activates NF-κB signaling (2, 9, 27, 44) and induces the expression of cellular proteins, including antiapoptotic factors, such as cellular inhibitor of apoptosis (cIAP) and cFLIP (28, 64). As yet, the effect of vFLIP/K13 on cellular-gene expression has been investigated only for selected genes. It is not clear whether the respective genes may also encode the proteins most abundantly induced by vFLIP/K13 and whether additional factors may mediate the antiapoptotic activity of vFLIP/K13 in endothelial cells. Using two-dimensional difference gel electrophoresis (2D-DIGE) analysis, we identified manganese superoxide dismutase (MnSOD), a mitochondrial antioxidant and an important antiapoptotic enzyme, as the protein most strongly upregulated by vFLIP/K13 in primary human endothelial cells. Evidence is provided that MnSOD may be an important mediator of the antiapoptotic activity of vFLIP/K13.