The mechanism behind the growthâpromoting effect of insulin is a subject of debate. Employing RT4 bladder cancer cells, we examined the crossâtalk between insulin and the epidermal growth factor system. We found that insulin induced a timeâ and doseâdependent (25â1000ânmol·Lâ1 insulin) increase in mRNA expression of three ligands from the epidermal growth factor system. Times for peak increase and fold increase after incubation with 250ânmol·Lâ1 insulin were as follows: heparinâbinding epidermal growth factorâlike growth factor, 0.5âh, 1.4âfold, Pâ<â0.05; epiregulin, 3âh, 14âfold, Pâ<â0.0001; and amphiregulin, 3âh, 12âfold, Pâ<â0.001. Induction of heparinâbinding epidermal growth factorâlike growth factor and amphiregulin was verified at the protein level. We demonstrate that incubation of RT4 bladder cancer cells for 24âh with 250ânmol·Lâ1 insulin increases proliferation by 43% (Pâ<â0.0001) as compared to untreated cells. At the same time, phosphorylation and thereby activation of the epidermal growth factor receptor (HER1) was observed. Both phosphorylation and insulinâinduced proliferation were almost completely inhibited by the HER1 inhibitor Iressa (Pâ<â0.0001). This shows that insulin leads to activation of HER1, and that HER1 plays an essential role in mediating the growthâpromoting effect of insulin. Iressa inhibited not only the activation of HER1 caused by insulin but also the insulinâinduced increase in the three ligands (heparinâbinding epidermal growth factorâlike growth factor, epiregulin and amphiregulin). As heparinâbinding epidermal growth factorâlike growth factor was induced before epiregulin and amphiregulin upon insulin stimulation, we speculated that the insulinâinduced heparinâbinding epidermal growth factorâlike growth factor initiated the activation of HER1, and that this in turn led to increased expression of epiregulin and amphiregulin and thereby to continued activation of HER1. Earlier reports have shown that insulinâlike growth factor receptor can activate HER1 via its ligand heparinâbinding epidermal growth factorâlike growth factor. In accord with this, we found that treatment of RT4 cells with recombinant heparinâbinding epidermal growth factorâlike growth factor mimicked the effect of insulin, with induction of mRNA for the three ligands. However, the insulinâinduced increase in mRNA expression of amphiregulin and epiregulin could not be prevented by the heparinâbinding epidermal growth factorâlike growth factor inhibitor CRM197, demonstrating that heparinâbinding epidermal growth factorâlike growth factor is not essential for the insulinâinduced increase in the expression of these ligands. In conclusion, we show that insulinâinduced growth in RT4 cells requires activated HER1. Furthermore, activation of HER1 is required for the insulinâinduced increase in expression of the HER1 ligands heparinâbinding epidermal growth factorâlike growth factor, amphiregulin and epiregulin.