is a key regulator that links cell cycle progression and cell death. E2F1 activity is controlled by Cdk2-cyclin complexes via several mechanisms, such as phosphorylation of retinoblastoma protein (pRb) to release E2F1, direct phosphorylation, and stable physical interaction. We have demonstrated that cisplatin cytotoxicity depends on Cdk2 activity, and Cdk2 inhibition protects kidney cells from cisplatin-induced cell death in vitro and in vivo. Now we show that E2F1 is an important downstream effector of Cdk2 that accumulates in mouse kidneys and in cultured mouse proximal tubular cells (TKPTS) after cisplatin exposure by a Cdk2-dependent mechanism. Direct inhibition of E2F1 by transduction with adenoviruses expressing an E2F1-binding protein (TopBP1) protected TKPTS cells from cisplatin-induced apoptosis, whereas overexpression of E2F1 caused cell death. Moreover, E2F1 knockout mice were markedly protected against cisplatin nephrotoxicity by both functional and histological criteria. Collectively, cisplatin-induced cell death is dependent on Cdk2 activity, which is at least partly through the Cdk2-E2F1 pathway both in vitro and in vivo.acute kidney injury; cell cycle; cell death CISPLATIN IS WIDELY USED to treat several types of solid tumors in cancer patients (9). Its clinical utility is limited by its nephrotoxicity, to which renal proximal tubule epithelial cells are especially sensitive (37,42). Multiple mechanisms are implicated in cisplatin-induced nephrotoxicity, which results in tubular cell death by both apoptosis and necrosis (16,30,32,53) and in acute loss of kidney function.We and other groups showed in vivo that many normally quiescent kidney cells enter the cell cycle after cisplatin administration, as indicated by an increase in nuclear proliferating cell nuclear antigen (PCNA) levels, as well as [ 3 H]thymidine and bromodeoxyuridine (BrdU) incorporation into nuclear DNA (30,31). Coincident with increased cell cycle activity, cisplatin administration induces upregulation of p21, a cyclindependent kinase (Cdk) inhibitor (31). This protein is a positive effector on the fate of cisplatin-exposed renal tubule cells in vivo and in vitro (30, 38), and we reported that the mechanism of p21 protection is by direct inhibition of Cdk2 activity (51). Recently, we demonstrated that cisplatin cytotoxicity depends on Cdk2 activity, and Cdk2 inhibition protected kidney cells from cisplatin-induced cell death in vitro and in vivo (39). The mechanism of Cdk2 involvement in cell death is the subject of this report. Cdk2 is a kinase participating in cell cycle progression and is an upstream regulator of E2F1. E2F1 plays an important role in coordinating events connected with both cell cycle progression and cell death. This led us to hypothesize that E2F1 may participate in the Cdk2-dependent cell death pathway(s) induced by cisplatin.We show here that E2F1 accumulation correlated with cisplatin exposure and required Cdk2 activity both in cultured mouse proximal tubular cells (TKPTS) and in mouse kidneys. Direct inh...