Insulin-like growth factor 1 receptor (IGF-1R) is critical for cancer cell proliferation; however, recent clinical anti-IGF-1R trials did not show clear clinical benefit in cancer therapy. We hypothesized that IGF-1R signaling-mediated proliferative response is heterogeneous in neuroblastoma (NB) cells, and analyzed the cell growth of 31 NB cell lines cultured in three different media, including Hybridoma-SFM medium (with insulin) and RPMI1640 with ⁄ without 10% FBS. Three growth patterns were found. In response to IGF and insulin, cell proliferation and Akt phosphorylation were upregulated in 13 cell lines, and suppressed by MK2206 (Akt inhibitor) and picropodophyllin (IGF-1R inhibitor). Interestingly, 3 of these 13 cell lines showed Akt self-phosphorylation and cell proliferation in RPMI1640; their proliferation was downregulated by anti-IGF-1 or anti-IGF-2 neutralizing antibody, suggesting the existence of an autocrine loop in the IGF-1R ⁄ Akt pathway. Eighteen NB cell lines did not proliferate in RPMI1640, even though Akt phosphorylation was upregulated by IGF and insulin. Based on the heterogeneous response of the IGF-1R ⁄ Akt pathway, the 31 NB cell lines could be classified into group 1 (autocrine IGF-mediated), group 2 (exogenous IGF-mediated) and group 3 (partially exogenous IGF-mediated) NB cell lines. In addition, group 3 NB cell lines were different from group 1 and 2, in terms of serum starvation-induced caspase 3 cleavage and picropodophyllin-induced G2 ⁄ M arrest. These results indicate that the response of the IGF-1R ⁄ Akt pathway is an important determinant of the sensitivity to IGF-1R antagonists in NB. To our knowledge, this is the first report describing heterogeneity in the IGF-1R ⁄ Aktmediated proliferation of NB cells. (Cancer Sci 2013; 104: 1162-1171 N euroblastoma (NB), a malignant tumor that originates from the sympathetic nervous system, is one of the most frequent pediatric solid tumors.(1) NB is characterized by heterogeneous clinical behaviors, tumor invasiveness being different according to age and anatomic stage at diagnosis. The tumor is sometimes completely curable and may even regress spontaneously, especially in younger children.(2) Heterogeneity of the tumors depends on the degree of morphological differentiation and on histopathology. Insulin and insulin-like growth factors (IGF, including IGF-1 and 2) belong to a family of mitogenic growth factors. IGF, insulin, and their receptors are involved in normal growth and differentiation of most tissues. The biological actions of both IGF and insulin can be mediated by the IGF-1 receptor (IGF-1R), a transmembrane heterotetramer, which is involved in mitogenic, anti-apoptotic and oncogenic transforming responses.(4,5) The functional IGF-1R contains two extracellular a-subunits and two intracellular b-subunits that form a heterotetrameric complex. The structural homology of IGF-1R and insulin receptor (IR) allows formation of hybrid receptors (hybrid-R) in which an IGF-1R chain is connected to an IR chain. Ligand interaction with a-...