Three-dimensional (3D) multicellular spheroid shows a biological complexity resembling native tissue in comparison to conventional monolayer cultures, making it a better model system to assess drug effcacy and cytotoxicity. The main aim of this study was to examine the usefulness of Caki-1, a human proximal tubule (PT) representative cell line, as a 3D model system for studying free fatty acid-induced PT lipotoxicity. Caki-1 spheroids were generated and maintained on ultra-low attachment plates and characterized regarding time-dependent changes in morphology and functionality. In optimal 3D culture conditions, Caki-1 cells formed well-defined large compact 3D spheroids with uniform morphology, good circularity, and increased diameter from days 2-10. There was no change when the spheroids were incubated with lipid-free bovine serum albumin (BSA, 0.5%) from day 6 to 10. Chronic exposure to palmitate (300 μM) resulted in dispersed and flattened spheroid morphology, with a larger number of dead cells in the peripheral layers and decreased spheroid core. Moreover, palmitate-treated spheroids showed a significant increase in caspase-3 activity at the external layers of the spheroids, suggesting that the detached cells underwent apoptosis. Simultaneous addition of oleate (200 μM) prevents palmitate-induced spheroid disintegration and cell death in Caki-1 3D culture. Mechanistically, palmitate triggered endoplasmic reticulum (ER) stress and autophagy dysfunction, as evidenced by significantly increased protein levels of ER stress markers AFT4 and CHOP, and autophagy substrate p62. Oleate upregulated adipose differentiation-related protein (ADRP, a lipid droplet-associated protein), and promoted lipid droplet formation in palmitate-treated Caki-1 cells. These results indicate that Caki-1 3D spheroids are a simple and reproducible in vitro system for lipotoxicity study. It can potentially be used for evaluating human renal proximal tubular toxicity and drug screening. NIH/NIGMS R16GM149499, NIH TL1DK136047. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.