Although experiments in rodents and human population-based studies have demonstrated the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) such as sulindac in colorectal cancer (CRC) prevention, a detailed knowledge of the underlying mechanism of action of this drug is limited. To better understand the chemopreventitive effects of sulindac, especially early sulindac-induced apoptotic events, we used the CRC cell line LIM1215 as an experimental model, focusing on proteins secreted into the LIM1215 culture medium - i.e., the secretome. This subproteome comprises both soluble-secreted proteins and exosomes (30-100 nm diameter membrane vesicles released by several cell types). Selected secretome proteins whose expression levels were dysregulated by 1 mM sulindac treatment over 16 h were analyzed using 2-D DIGE, cytokine array, Western blotting, and MS. Overall, 150 secreted proteins were identified, many of which are implicated in molecular and cellular functions such as cell proliferation, differentiation, adhesion, invasion, angiogenesis, metastasis, and apoptosis. Our secretome-based proteomic studies have identified several secreted modulators of sulindac-induced apoptosis action (e.g., Mac-2 binding protein, Alix, 14-3-3 isoforms, profilin-1, calumenin/Cab45 precursors, and the angiogenic/tumor growth factors interleukin 8 (IL-8) and growth related oncogene (GRO-α)) that are likely to improve our understanding of the chemopreventitive action of this NSAID in CRC.