Obesity is thought to promote insulin resistance in part via activation of the innate immune system. Increases in proinflammatory cytokine production by M1 macrophages inhibit insulin signaling in white adipose tissue. In contrast, M2 macrophages have been found to enhance insulin sensitivity in part by reducing adipose tissue inflammation. The paracrine hormone prostaglandin E2 (PGE2) enhances M2 polarization in part through activation of the cAMP pathway, although the underlying mechanism is unclear. Here we show that PGE2 stimulates M2 polarization via the cyclic AMPresponsive element binding (CREB)-mediated induction of Krupplelike factor 4 (KLF4). Targeted disruption of CREB or the cAMP-regulated transcriptional coactivators 2 and 3 (CRTC2/3) in macrophages downregulated M2 marker gene expression and promoted insulin resistance in the context of high-fat diet feeding. As re-expression of KLF4 rescued M2 marker gene expression in CREB-depleted cells, our results demonstrate the importance of the CREB/CRTC pathway in maintaining insulin sensitivity in white adipose tissue via its effects on the innate immune system.U nder obese conditions, macrophage infiltration and activation in adipose tissue leads to a chronic inflammatory state with increased secretion of proinflammatory cytokines (1). The activation of IkB and Jun N-terminal kinases impairs insulin signaling in metabolic tissues and thereby contributes to insulin resistance (2-4). Classically activated M1 macrophages secrete proinflammatory cytokines, such as TNF-α and IL-12, which promote insulin resistance. Alternatively activated M2 macrophages are thought to protect adipocytes from the development of insulin resistance in response to IL-4 signaling (5, 6). Increases in STAT6 activity stimulate the expression of Krupplelike factor 4 (KLF4), which in turn promotes expression of the M2 program. Obesity causes an M2-to-M1 shift in adipose tissue that leads to insulin resistance (7).The eicosanoid prostaglandin E2 (PGE2) has been found to promote M2 macrophage polarization in part via induction of the cAMP pathway. Indeed, circulating catecholamines also exert potent anti-inflammatory effects on macrophage function via cAMP signaling (8). In this regard, a number of bacteria appear to evade the innate immune system by producing toxins that enhance cAMP production. cAMP stimulates the expression of cellular genes in part via the phosphorylation of CREB at Ser133 and via the dephosphorylation of the cAMP regulated transcriptional coactivators (CRTC) family of coactivators (9). Following its activation, the cyclic AMP-responsive element binding (CREB) pathway appears to block M1 macrophage function in part via the induction of the anti-inflammatory cytokine IL-10 (10, 11). Superimposed on these effects, cAMP also inhibits the expression of proinflammatory cytokines via the induction of class IIa histone deacetylases (HDACs) and subsequent deacetylation of NF-κB.Here we explore the potential roles of the class IIa HDAC and CREB/CRTC pathways in M2 macrophage...