regulates the expression and enzyme activity of 11-hydroxysteroid dehydrogenase type 1 in murine adipose tissue and 3T3-L1 adipocytes. Am J Physiol Endocrinol Metab 292: E1213-E1222, 2007. First published December 26, 2006; doi:10.1152/ajpendo.00340.2006.-A clinically employed antihyperlipidemic drug, bezafibrate, has been characterized as a PPAR(␣, -␥, and -␦) pan-agonist in vitro. Recent extended trials have highlighted its antidiabetic properties in humans. However, the underlying molecular mechanism is not fully elucidated. The present study was designed to explore potential regulatory mechanisms of intracellular glucocorticoid reactivating enzyme, 11-HSD1 and anti-diabetic hormone, adiponectin by bezafibrate in murine adipose tissue, and cultured adipocytes. Treatment of db/db mice with bezafibrate significantly ameliorated hyperglycemia and insulin resistance, accompanied by a marked reduction of triglyceride and nonesterified fatty acids. Despite equipotent in lipid-lowering effects, another fibrate, fenofibrate, did not show such beneficial effects on glycemic control. Treatment of bezafibrate caused a marked decrease in the mRNA level of 11-HSD1 preferentially in adipose tissue of db/db mice (Ϫ47%, P Ͻ 0.05), concomitant with a significant increase in plasma adiponectin level (ϩ37%, P Ͻ 0.01). Notably, treatment of bezafibrate caused a marked decrease in the mRNA level (Ϫ34%, P Ͻ 0.01) and enzyme activity (Ϫ32%, P Ͻ 0.01) of 11-HSD1, whereas the treatment substantially augmented the expression (ϩ71%, P Ͻ 0.01) and secretion (ϩ27%, P Ͻ 0.01) of adiponectin in 3T3-L1 adipocytes. Knockdown of 11-HSD1 by siRNA confirmed that 11-HSD1 acts as a distinct oxoreductase in adipocytes and validated the enzyme activity assays in the present study. Effects of bezafibrate on regulation of 11-HSD1 and adiponectin in murine adipocytes were comparable with those in thiazolidinediones. This is the first demonstration that bezafibrate directly regulates 11-HSD1 and adiponectin in murine adipocytes, both of which may contribute to metabolicallybeneficial effects by bezafibrate. metabolic syndrome; adiponectin FAMILY GENES of peroxisome proliferator-activated receptors (PPARs) are profoundly relevant to fuel homeostasis (14, 41). Agonists for PPAR␣ and PPAR␥ have been widely used for the treatment of dyslipidemia and type 2 diabetes (46). Recent research progress (3) has highlighted the potential usefulness of PPAR␣/␥ dual agonists or PPAR(␣, -␥, and -␦) pan-agonists for metabolic diseases. However, some of these compounds are reported to cause adverse effects, including carcinogenesis, edema, hepatotoxicity, and increase in body weight in rodent experiments (45). Bezafibrate has been widely used for the treatment of dyslipidemia in human clinics (11). Recent in vitro experiments have shown that bezafibrate serves as a pan-agonist for PPAR␣, -␥, and -␦ (9, 48). Furthermore, recent extended clinical trials (15, 43) have highlighted its antidiabetic properties. However, the underlying mechanism is not fully clarified...