EOC (epithelial ovarian cancer) is a leading cause of death from gynecological cancers. The majority of the patients with EOC are diagnosed at a late stage. The survival of these patients is limited due to recurrence of chemotherapy resistant disease. Therefore, the development of novel therapeutic agents for the treatment of EOC is urgently needed and it is a high priority in the field. TNF-related apoptosis-inducing ligand (TRAIL) is a promising novel agent for the treatment of cancer, including EOC, because of its unique ability to trigger apoptosis in cancer cells and spare normal cells. Our laboratory has previously shown that a significant number of EOC cell lines and primary EOC samples are intrinsically resistant to TRAIL-induced apoptosis. The mechanisms leading to intrinsic resistance are largely unknown. TRAIL-resistant cells often display increased activation of the pro-survival PI3K/Akt pathway. Based on our observations that EOC ascites induced activation of the PI3K/Akt pathway in TRAIL-sensitive EOC cells which resulted in inhibition of the TRAIL-mediated apoptosis, we hypothesized that activation of the pro-survival PI3K/Akt pathway in EOC cells plays an important role in the resistance to TRAIL-induced apoptosis. The objectives of my project were to demonstrate that Akt is implicated in the regulation of TRAIL-induced apoptosis in EOC cells and to investigate the mechanisms by which Akt contributes to TRAIL resistance. We report that Akt activation reduces the sensitivity of ovarian cancer cells to TRAIL. TRAIL-resistant cells were sensitized to TRAIL-induced apoptosis by treatment with P13K or Akt inhibitors but inhibition of PI3K/Akt signaling pathway did not interfere with the recruitment and processing of the pro-caspase-8 to the death-inducing signaling complex (DISC). Conversely, overexpression of Akt1 in TRAIL-sensitive cells promoted resistance to TRAIL. Despite the fact that TRAIL-induced caspase-8 activation was observed in both TRAIL-sensitive and -resistant cell lines, Bid cleavage occurred only in TRAIL-sensitive cells. Akt activation in TRAIL-sensitive cells inhibited TRAIL-induced Bid cleavage. Furthermore, Bid expression was downregulated by Akt activation. Depletion of Bid by siRNA in TRAIL-sensitive EOC cells was associated with a decrease in TRAIL-mediated apoptosis and Bid overexpression in TRAIL-resistant cells resulted in increased TRAIL-mediated apoptosis. Altogether, these results suggest that Akt is a critical factor for mediating intrinsic TRAIL resistance among EOC cells and that an important mechanism by which Akt activation contributes to TRAIL resistance is by regulating the expression of pro-apoptotic protein Bid. Given these data, we speculate that Akt activation may be a potential biomarker to predict patient's response to TRAIL therapy and that the inhibition of the PI3K/Akt pathway can become one of the strategies to overcome resistance to TRAIL therapy in ovarian cancer.