dRetinol-binding protein 4 (RBP4), the sole retinol transporter in blood, is secreted from adipocytes and liver. Serum RBP4 levels correlate highly with insulin resistance, other metabolic syndrome factors, and cardiovascular disease. Elevated serum RBP4 causes insulin resistance, but the molecular mechanisms are unknown. Here we show that RBP4 induces expression of proinflammatory cytokines in mouse and human macrophages and thereby indirectly inhibits insulin signaling in cocultured adipocytes. This occurs through activation of c-Jun N-terminal protein kinase (JNK) and Toll-like receptor 4 (TLR4) pathways independent of the RBP4 receptor, STRA6. RBP4 effects are markedly attenuated in JNK1 ؊/؊ JNK2 ؊/؊ macrophages and TLR4؊/؊ macrophages. Because RBP4 is a retinol-binding protein, we investigated whether these effects are retinol dependent. Unexpectedly, retinol-free RBP4 (apo-RBP4) is as potent as retinol-bound RBP4 (holo-RBP4) in inducing proinflammatory cytokines in macrophages. Apo-RBP4 is likely to be physiologically significant since RBP4/retinol ratios are increased in serum of lean and obese insulin-resistant humans compared to ratios in insulin-sensitive humans, indicating that higher apo-RBP4 is associated with insulin resistance independent of obesity. Thus, RBP4 may cause insulin resistance by contributing to the development of an inflammatory state in adipose tissue through activation of proinflammatory cytokines in macrophages. This process reveals a novel JNK-and TLR4-dependent and retinol-and STRA6-independent mechanism of action for RBP4.O besity is a major risk factor for insulin resistance, which is a critical pathogenic factor in type 2 diabetes (50). Determination of the physiologic and cellular mechanisms linking obesity to type 2 diabetes could lead to development of new prevention and treatment approaches. Multiple mechanisms may contribute, including abnormal production of adipocyte-secreted proteins (adipokines) (1,15,29), infiltration of white adipose tissue (WAT) with proinflammatory macrophages (42), and aberrant lipid deposition in tissues such as muscle and liver (51). These mechanisms are not mutually exclusive. For example, adipokines can affect inflammation and lipid deposition in tissues (15).Serum retinol-binding protein 4 (RBP4) is an adipokine and is also secreted by liver. RBP4 levels are increased in obese and insulin-resistant humans and mouse models, and genetic or pharmacologic elevation of serum RBP4 causes insulin resistance in normal mice (19,31,65). Although many studies show strong correlations of serum RBP4 levels with obesity and the severity of insulin resistance (9,16,27,35), others do not (8,17,32,46), as reviewed in reference 32. This may result from the use of different populations of human subjects or from methodological issues with RBP4 assays (18,32,64). Many studies also show that serum RBP4 levels correlate with other components of the metabolic syndrome in humans, including hypertension (47, 54, 64), dyslipidemia (41, 47, 64, 67), waist/hip ratio (31...

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