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172

RAJIV R. RATAN AND MOSES V. CHAO

associated with cell cycle progression (e.g., E25, c-myc) are founding apoptotic neurons (Di Giovanni et al., 2003). Accordingly, a number of cell cycle inhibitors have been shown to protect neurons from cell death. One protein of particular interest is the cell cycle inhibitor, p21 waf1/cip1. Nuclear p21waf1/cip1 is classically known as a cyclin-dependent kinase inhibitor, but in its cytoplasmic form, it can negatively regulate proapoptotic proteins such as caspases and the upstream kinase, apoptosis signaling kinase-1 (ASK-1) (Coqueret, 2003). Another kinase that is inhibited by p21 that is of particular relevance to SCI and recovery is Rho kinase (Tanaka et al., 2002). The small GTPase RhoA, which has been shown to be upregulated 10-fold after SCI, activates this kinase. Indeed, RhoA inhibitors can reduce the number of TUNEL-labeled cells by 50% after SCI (Dubreuil et al., 2003). This protection is associated with decreased expression of the proneurotrophin receptor, p75. These results predict that agents that can upregulate nuclear p21 waf1/cip1 in the nucleus or cytoplasm should inhibit cell death after SCI through RhoA inhibition, cell cycle inhibition, and caspase inhibition. Agents are currently under development that enhance p21 activity. These agents could inhibit both intrinsic and extrinsic pathways to cell death.

8. CONCLUSION

Traumatic SCI triggers a host of secondary events, including ischemia, excitotoxicity, and inflammatory responses. Each of these processes can induce acute or delayed neuronal or oligodendroglial death. Cell death after SCI comes in many flavors, including classical apoptosis, classical necrosis, parthanatosis, and necroptosis. Autophagy may also contribute or mitigate death. The complexity of death signaling after SCI in neurons and oligodendrocyte underscores the complexity of interventions to reduce cell loss. Single agents that target both extrinsic and intrinsic pathways to death are attracting attention, as well as combinations that act on distinct pathways in distinct cell types. Ultimately, protection of neurons and oligodendrocytes that leads to recovery of function will be the metric by which single or combinatorial interventions can be determined to be successful.

ACKNOWLEDGMENTS

The authors would like to thank Wilfredo Milledo, Rachael Speer, and Renee Haskew-Layton for superb assistance in preparing the manuscript, including figures. R.R.R. is supported by the Richter Center for Research Excellence in Spinal Cord Injury, funded by the

SCIRP Board of the New York State Department of Health (#C019772), NIA PO1, and the Sheldon and Miriam Adelson Medical Research Foundation. M.V.C. is supported by National Institutes of Health Grants No. NS21072, AG025970, and HD23325.

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