Here, we demonstrate that troglitazone (Rezulin), a peroxisome proliferator-activated receptor agonist, acted in synergy with heregulin to induce massive cell death in breast cancer cells. Although the combination of heregulin and troglitazone (HRG/TGZ) induced both apoptosis and necrosis, the main mode of cell death was caspase-independent and occurred via necrosis. This combination increased generation of superoxide in mitochondria, which in turn destabilized mitochondria potential. Pretreatment with N-acetyl-L-cysteine and catalase expression ameliorated cell death induced by the combination treatment, indicating a role of oxidative stress in mediating HRG/TGZ-induced cell death. Notably, pretreatment with pyruvate significantly prevented the cell death, suggesting a potential mechanistic link between metabolic stress and HRG/ TGZ-induced cell death. The activation of the HRG signaling axis has been considered as a poor prognostic factor in breast cancer and confers resistance to gefitinib (Iressa) and tamoxifen. However, our data presented here paradoxically suggest that HRG expression can actually be beneficial when it comes to treating breast cancer with peroxisome proliferator-activated receptor-␥ ligands. Taken together, the combination of HRG and TGZ may provide a basis for the development of a novel strategy in the treatment of apoptosis-resistant and/or hormone-refractory breast cancer.Breast cancer is the second most common cause of cancer death, accounting for one in three of all cancer cases diagnosed in women. Although overall survival continues to improve for breast cancer, intrinsic or acquired therapy resistance has been an ongoing obstacle to reducing overall breast cancer mortality. Combining different drugs is now widely used to overcome the problem of therapy resistance. Combination therapy often increases the likelihood of response, and in ideal combination may even be synergistic rather than simply additive. In addition, by keeping each drug at low dose, there can be the potential advantages of longer duration of action and less side effects.Heregulin (HRG), 2 also known as neuregulin or neu differentiation factor, is a soluble secreted growth factor. The HRG gene family consists of four members, HRG-1, HRG-2, HRG-3, and HRG-4, of which a multitude of different isoforms are synthesized by alternative exon splicing (1). HRG binds to HER3 receptors or HER4 receptors, or both, resulting in the formation of receptor homo-and heterodimerization. In mammary epithelial cells, HRG predominantly uses HER2 and HER3 dimers. Upon engagement of HRG with the heregulin extracellular domain, multiple signaling pathways, such as the phosphatidylinositol 3-kinase (PI3K)/AKT, RAS/MAPK, and JNK pathways, are activated. To date, most studies have shown that HRG exhibits a growth-stimulatory effect in a variety of cancer cells, including breast cancer cells. Several lines of evidence implicated activation of human epidermal growth factor receptors by HRG as a primary driver of malignancy (2-4). Activation of H...