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Background Hyperinsulinemia,insulin-like growth factor (IGF)-Ⅰ and-Ⅱ (IGF-Ⅱ) are associated with increased risk of endometrial carcinoma.Insulin receptor isoform A (IR-A) is more frequently expressed in endometrial carcinoma than in normal endometrial tissues.To better understand their roles in endometrial carcinoma,we investigated the effects of insulin,IGF-Ⅰ,and IGF-Ⅱ in endometrial carcinomas cells with different IR-A expression levels.Methods To explore the role of IR-A in mediating the activity of IGF-Ⅰ,IGF-Ⅱ,and insulin,we investigate the cellular proliferation of endometrial carcinoma cell lines RL95-2 and RL95-2-IR-A by MTS assays.Then we examined the protein kinase Akt phosphorylation and extracellular signal-regulated kinase (ERK) 1/2 phosphorylation in both cell lines by West blotting.The effect of IGF-Ⅱ and AG1024 on cell cycle progression and apoptosis was assessed by flowcytometry.To examine whether the effects of IGFs were mediated by IR-A,we blocked IGF-Ⅰ receptor (IGF-IR) in both cell lines using AG1024,an IGF-IR-specific inhibitor.Results IGF-Ⅰ and IGF-Ⅱ significantly enhanced proliferation of both cell lines (P ＜0.05).By contrast,insulin significantly increased proliferation of RL95-2-IR-A cells only (P ＜0.05).IGF-Ⅰ and IGF-Ⅱ significantly increased pAkt levels in RL95-2 cells and pERK1/2 levels in RL95-2-IR-A cells (all,P ＜0.05).Insulin increased pERK1/2 levels in RL95-2-IR-A cells only (P ＜0.05).LY294002 and PD98059 inhibited the specific signaling activities and cellular proliferation.After AG1024 pretreatment,neither IGF-Ⅰ nor IGF-Ⅱ affected pAkt levels in RL95-2 cells.IGF-Ⅱ,but not IGF-Ⅰ,increased pERK1/2 levels in RL95-2-IR-A cells.After AG1024 pretreatment,the proliferation rate and DNA content corresponding to the S phase increased and apoptosis decreased significantly in IGF-Ⅱ-treated RL95-2-IR-A cells only (P ＜0.05).Conclusions The proliferation effect of insulin is mediated by IR-A.When IR-A dominates in a cell line,IGF-Ⅱ activated cell proliferation mainly through the ERK1/2 pathway.On the other hand,IGF-1 activated cell proliferation mainly through the Akt pathway.IR-A can at least partly mediate the proliferative and anti-apoptotic effects of IGF-1 through the ERK1/2 pathway.