Oxidative stress has been implicated in the pathogenesis of a wide variety of neuronal diseases, including ischemic neuronal injury, Alzheimer's disease, and Parkinson's disease. Thioredoxin reduces exposed protein disulfides and couples with peroxiredoxin to scavenge reactive oxygen species. Nerve growth factor (NGF) has profound effects on neurons, including promotion of survival and differentiation via multiple signaling pathways. As for the NGF-induced neurite outgrowth, the CREB-cAMP responsive element (CRE) pathway is important to the activation of immediate-early genes such as c-fos. Thioredoxin is upregulated by NGF through ERK and the CREB-CRE pathway in PC12 cells. Thioredoxin is necessary for NGF signaling through CRE leading to c-fos expression and also plays a critical role in the NGF-mediated neurite outgrowth in PC12 cells. Therefore, thioredoxin appears to be a neurotrophic cofactor that augments the effect of NGF on neuronal differentiation and regeneration. NGF acts also as a neuronal survival factor. Previous reports showed that thioredoxin exerts a cytoprotective effect in the nervous system. The cytoprotective effect is mediated by enhancing the action of NGF, via the regulation of antiapoptotic signaling, or through its antioxidative stress activity.