Paclitaxel (Taxol) is one of the most effective treatment options for patients suffering from a variety of cancers. A major side effect seen in a high percentage of patients treated with paclitaxel is irreversible peripheral neuropathy. We previously reported that prolonged treatment with paclitaxel activates a calcium-dependent enzyme, calpain, which degrades neuronal calcium sensor 1 (NCS-1) and subsequent loss of intracellular calcium signaling. Because it appears that activation of calpain is an early step in this destructive cascade, we proposed that inhibition of calpain will protect against the unwanted side effects of paclitaxel treatment. First, NCS-1 levels and intracellular calcium signaling were found to be protected by the presence of lactacystin, a protesome inhibitor. To reinforce the role of calpain in this process, we showed that increased concentrations of calpastatin, a naturally occurring calpain inhibitor, were protective. Next, we tested two mutated versions of NCS-1 developed with point mutations at the P2 position of the calpain cleavage site of NCS-1 to decrease the likelihood of NCS-1 degradation. One mutant was cleaved more favorably by calpain compared with NCS-1 WT, whereas the other mutant was less favorably cleaved. Expression of either mutated version of NCS-1 in neuroblastoma cells protected intracellular calcium signals from paclitaxel-induced changes. These results support our hypothesis that it is possible to protect cells from paclitaxel-induced degradation of NCS-1 by inhibiting calpain activity.Paclitaxel (Taxol) is one of the most effective and commonly used treatment options for patients suffering from a variety of cancers, including breast and ovarian cancer (1, 2). Unfortunately, a major side effect seen in a high percentage of patients treated with this and several other chemotherapeutic drugs is an irreversible peripheral neuropathy (3, 4). Although the paclitaxel mechanism of action, polymerization of tubulin and the formation of stable microtubule polymers, was first discovered in 1979, the cellular mechanisms responsible for the development of peripheral pain are still unclear (5). Strategies are needed to prevent this unwanted effect of paclitaxel without altering its chemotherapeutic action.Recently, neuronal calcium sensor 1 (NCS-1) 2 was identified as a novel paclitaxel-binding partner (6). NCS-1 is a high affinity, low capacity calcium-binding protein containing four EF hand binding domains, three of which functionally bind calcium (7). NCS-1 was initially thought to be found solely in neuronal cells; however, more recently, it has been found in a variety of cell types where it enhances intracellular calcium signaling (8 -11). NCS-1 has a number of binding partners (12). Relevant to this study, NCS-1 binds to the inositol 1,4,5-trisphosphate receptor (InsP 3 R) and modulates its function in a calcium-dependent manner (11). Paclitaxel increases the interaction between NCS-1 and the InsP 3 R (11, 13). Prolonged treatment with paclitaxel activates calpain, a calc...