This study examines the signaling mechanism by which cilostazol prevents neuronal cell death. Cilostazol (ϳ0.1-100 M) prevented tumor necrosis factor-␣ (TNF-␣)-induced decrease in viability of SK-N-SH and HCN-1A cells, which was antagonized by 1 M iberiotoxin, a maxi-K channel blocker. TNF-␣ did not suppress the viability of the U87-MG cell, a phosphatase and tensin homolog deleted from chromosome 10 (PTEN)-null glioblastoma cell, but it did decrease viability of U87-MG cells transfected with expression vectors for the sense PTEN, and this decrease was also prevented by cilostazol. Cilostazol as well as 1,3-dihydro-1-[2-hydroxy-5-(trifluoromethyl)phenyl]-5-(trifluoromethyl)-2H-benzimidazol-2-one (NS-1619) and (3S)-(ϩ)-(5-chloro-2-methoxyphenyl)-1,3-dihydro-3-fluoro-6-(trifluoromethyl)-2H-indole-2-one (BMS 204352), maxi-K channel openers, prevented increased DNA fragmentation evoked by TNF-␣, which were antagonizable by iberiotoxin. TNF-␣-induced increased PTEN phosphorylation and decreased Akt/ cyclic AMP response element-binding protein (CREB) phosphorylation were significantly prevented by cilostazol, those of which were antagonized by both iberiotoxin and paxilline, maxi-K channel blockers. The same results were evident in U87-MG cells transfected with expression vectors for sense PTEN. Cilostazol increases the K ϩ current in SK-N-SH cells by activating maxi-K channels without affecting the ATP-sensitive K ϩ channel. Thus, our results for the first time provide evidence that cilostazol prevents TNF-␣-induced cell death by suppression of PTEN phosphorylation and activation of Akt/CREB phosphorylation via mediation of the maxi-K channel opening.Recent research has shown that the phosphatase and tensin homolog deleted from chromosome 10 (PTEN) is implicated in the regulation of several cellular functions, including cell viability from apoptosis (Li et al., 1998;Stambolic et al., 1998;Cantley and Neel, 1999). PTEN is capable of dephosphorylating both phospho-tyrosine and phospho-serine/threonine-containing substrates (Myers et al., 1997) and also of dephosphorylating the phosphatidylinositol-3,4,5-triphosphate [PI(3,4,5)P 3 ], a direct product of phosphatidylinositol 3-kinase (PI3-K) activity, thereby converting the PI(3,4,5)P 3 to phosphatidylinositol 3,4-diphosphate [PI(3,4)P 2 ], an inactive state (Maehama and Dixon, 1998;Stambolic et al., 1998). Huang et al. (2001) have demonstrated that transient transfection of PTEN into the PTEN-null cells results in decrease in Bcl-2 mRNA and protein, and loss of PTEN leads to up-regulation of the Bcl-2 gene. Overexpression of PI3-K and its downstream effector Akt (serine/threonine kinase) have been documented to mediate growth factor-induced neuronal survival (Crowder and Freeman, 1998) and to up-regulate Bcl-2 promoter activity associated with increased Bcl-2