A vast number of epidemiological studies suggest that obesity is a pandemic condition that greatly influences risk, prognosis, and progression of various cancers such as colon, prostate, endometrium, hepatocellular, and breast. Investigating the relationship of obesity with mortality from breast cancer, many studies show that obese women in the highest quintile of body mass index have double the death rate from breast cancer when compared with women in the lowest quintile [
1–4], hence providing one of the few preventive interventions capable of making a significant effect on associated disease conditions. Obesity is associated with an increase in number and size of adipocytes that greatly alters the local and systemic secretion of biologically active polypeptides, adipocytokines such as leptin and adiponectin. Acting by endocrine, paracrine, and autocrine mechanisms, adipocytokines affect various biologic processes [
5,6].
Several epidemiological studies have linked high levels of plasma leptin with increased risk and poor prognosis for breast carcinogenesis [
7–11]. Circulating as a 16-kD protein, partially bound to plasma proteins, leptin exerts its biologic actions through specific cell surface receptors [leptin receptors (LRs)] present in a variety of tissues [
12]. Breast carcinoma cells express higher levels of leptin and LR in comparison to normal mammary epithelial cells. In fact, overexpression of leptin is observed in 92%of breast tumors and LRs are overexpressed in 83% breast tumors, whereas no or very low expression of leptin and LRs is found in normal mammary epithelial cells [
13]. Using loss-of-function mutants for leptin and LR,
in vivo studies show that leptin or LR-deficient mouse mammary tumor virus (MMTV)-transforming growth factor-α mice do not develop oncogene-induced mammary tumors [
14,15], hence providing direct evidence for the involvement of leptin in breast carcinogenesis. Hypothalamic LR-reconstituted db/db (LR-null) mice [
16] crossed with MMTV-PyMT mice exhibit that LR-mediated signaling promotes breast carcinogenesis [
17]. In addition, diet-induced obese MMTV-transforming growth factor-α mice show higher levels of leptin as well as increased breast tumor growth [
18]. Xenografts of MMTV-Wnt1 tumors grow faster in diet-induced obese mice in comparison with lean counterparts and exhibit stunted growth when transplanted in leptin-deficient (Ob/Ob) mice [
19]. In recent years, many laboratories including ours have shown that leptin increases proliferation of breast, endometrial, hepatocellular, and many other cancer cells through multiple signaling pathways including Stat3/extracellular signal-regulated kinase (ERK)/Akt signaling [
20–30]. Our recent research has shown the direct stimulatory effect of leptin on breast cancer cell migration, invasion, and epithelial-mesenchymal transition (EMT) [
20,21,24]. The therapeutic potential of inhibition of leptin has been evaluated to some extent in diseases associated with metabolic syndrome [
31,32], but the importance of inhibition of leptin signaling in carcinogenesis is still elusive and is an active area of research.
Adiponectin (also known as ACRP30, apM1, adipoQ, and GBP28) [
33–36], first identified in the mid-1990s, is an important adipocytokine that is known for its protective role against obesity-related disorders and the metabolic syndrome, particularly in the pathogenesis of type 2 diabetes and cardiovascular disease [
37–39]. Multiple functions of adiponectin include suppression of proliferation and activation of immune cells, down-regulation of vascular adhesion molecules in endothelial cells, and inhibition of smooth muscle migration [
40]. Adiponectin is reported to directly bind certain growth factors to control their bioavailability [
41]. Cellular functions of adiponectin are mainly mediated through two adiponectin receptors, AdipoR1 and AdipoR2 [
42]. Recently, T-cadherin has also been identified as AdipoR [
43]. Combination of interactions between adiponectin and its receptors mediate the cellular functions of adiponectin in a tissue-dependent manner. Several recent studies evaluated and established a role for adiponectin in carcinogenesis [
44–46]. Epidemiological evidences have put forth an inverse connection between obesity-associated low plasma levels of adiponectin with incidence as well as progression of many common forms of cancer [
47,48]. Low-serum adiponectin levels are associated with increased risk of breast cancer in both postmenopausal and premenopausal women, independent of age, menopause status, hormone receptor status, lymph node metastasis, and status of estrogen receptor (ER) and Her2/neu. It is also suggested that tumors arising in patients with low-serum adiponectin levels may have a more aggressive phenotype (large size of tumor, high histologic grade, and increased metastasis) [
47,48]. Providing molecular evidence, several recent studies show adiponectin-mediated antiproliferative response in breast cancer cells [
49–53]. Investigating upstream regulatory nodes capable of orchestrating the downstream signaling axes of adiponectin, we recently show that adiponectin inhibits metastatic properties of breast cancer through activation of master upstream kinase and tumor suppressor, LKB1 [
54].
In the present study, we specifically investigated if adiponectin can inhibit the oncogenic actions of leptin. Intriguingly, we found that adiponectin inhibits the effect of leptin on malignant properties of cancer cells including migration and invasion and also inhibits important downstream molecules of leptin signaling while activating physiological inhibitor of leptin signaling. In agreement with our in vitro data, we found that adiponectin treatment inhibits leptin-induced breast tumorigenesis in vivo. Thus, raising adiponectin might be an attractive goal for breast cancer prevention and therapy, particularly for patients with hyperleptinemic condition. Using thiazolidinedione drugs to raise adiponectin levels, we provide evidence that rosiglitazone treatment is capable of inhibiting leptin-induced migration and invasion of breast cancer cells.