Abstract Cancer stem cells (CSCs) have been proposed to be responsible for tumor initiating, drug resistance, metastasis, and recurrence. Many novel therapeutic strategies have been designed to target and eliminate CSCs. According to our previous study, we have established a model of CSCs and cancer associated fibroblasts (CAFs) co-culture system for anti-CSCs drug screening. Here, we report one of the potential hits screened via this platform and the anti-CSCs activity was further investigated both in vitro and in vivo. Human lung CSCs and CAFs were primary cultured from patient with lung adenocarcinoma according to our previous study. Image-based high content screening system was used to analyze different parameters after drug treatment. Tumorogenicity and self-renew ability are examined by sphere forming ability. Aldehyde dehydrogenase (ALDH) activity was used to analyze stem cell population by flow cytometry. The expression level of stemness-related genes, Nanog, Oct3/4 and Sox2 were validated by real-time reverse transcriptase Q-PCR. The efficacy of the lead on tumor growth was examined by the xenograft model. Lung cancer stemness markers of the xenograft tumor tissues were also evaluated by immunohistochemistry. Using the image-based high content screening system to screen over one thousands of compounds, we have identified aloe-emodin (AE) shows higher potency targeting on lung cancer stem cells (under the concentration of 1 μM) and high specificity targeting on the cancer cell lines (IC50 < 20 μM); compared to normal human bronchial epithelium cells and human normal fibroblast represented by IC50 (26.77 μM v.s. 39.13 μM). The level of stemness markers, Nanog, Sox2 and Oct3/4 were significantly down regulated after AE treatment compared to cisplatin treatment. AE could suppress tumor initiating abilities and self-renew capacities represented by the ability to grow as tumors spheres in CL152 ALDH+ cells. Besides, AE could inhibit ALDH population in CL152 cells (40% reduced). Also, the AE can inhibit the cisplatin-induced ALDH population as well. Furthermore, we found that AE combine with cisplatin could inhibit tumor growth as comparing to cisplatin treatment in subcutaneous models in NOD/SCID mice, whereas, AE can inhibit the level of Nanog in mice tumor tissues. According to these results, AE is a potential lead targeting on lung cancer stem cells. To discover the pharmacological mechanism of AE on cancer stem cells will be helpful to develop new strategy for lung cancer therapy. Note: This abstract was not presented at the meeting. Citation Format: Pei-Jung Lee, Wan-Jiun Chen, Chao-Chi Ho, Pan-Chyr Yang, Huei-Wen Chen. Aloe-emodin as a potential lead targets lung cancer stem cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 133. doi:10.1158/1538-7445.AM2017-133