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rhTRAIL is a recombinant form of the human Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL), also known as TNFSF10 or APO-2 ligand. It is a type II transmembrane protein belonging to the TNF superfamily and functions primarily by binding to death receptors 4 (DR4) and 5 (DR5) on target cells. This interaction triggers receptor trimerization and activates the extrinsic apoptotic pathway via caspase 8 activation, leading to downstream activation of executioner caspases (3, 6, and 7) and ultimately cell death through apoptosis. The key therapeutic appeal of rhTRAIL is its ability to selectively induce apoptosis in cancer cells while sparing normal cells. However, clinical development has been hampered by resistance mechanisms in many tumors due to downregulation or mutation of DRs or upregulation of anti-apoptotic proteins such as survivin. Clinical trials have shown that monotherapy with rhTRAIL was well-tolerated but had limited efficacy; combination therapies are being explored to overcome resistance[1][6][8][10].
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