Regulation by insulin signaling prompts the question whetherabnormal RDH expression associates with human disease. Forexample, impaired insulin secretion and insulin resistance duringdiabetes predicts elevated RDH expression and atRA synthesis(71). Conversely, enhancement of insulin signaling through PI3K/Akt from loss of phosphatase and tensin homolog deleted on chromosome10 in cancer implicates decreased RDH (72). ReducedRDH expression would decrease atRA biosynthesis, which could affect tumor differentiation and/or aggressiveness. Various cancersshow alterations in the atRA signaling pathway, such as loss ofatRA receptors (73, 74) and down-regulation of atRA chaperons(75, 76). atRA biosynthesis is impaired in breast cancer cell linesrelative to normal cells (77). Reduced atRA synthesis in the Rbp1-null mouse is consistent with increased mammary tumors, andsuggests consequences of the epigenetic silencing of Rbp1 in 25%of human breast cancers (62). In contrast, overexpression ofRDH10 in HepG2 cells reduces proliferation (70).