During the last century, it has been established that regions within solid tumors experience mild to severe oxygen deprivation, due to aberrant vascular function. These hypoxic regions are associated with altered cellular metabolism, as well as increased resistance to radiation and chemotherapy. As discussed in this Timeline, over the past decade, work from many laboratories has elucidated the mechanisms by which hypoxia-inducible factors (HIFs) modulate tumor cell metabolism, angiogenesis, growth, and metastasis. The central role played by intra-tumoral hypoxia and HTF in these processes has made them attractive therapeutic targets in the treatment of multiple human malignancies.Oxygen (O 2 ) is required for aerobic metabolism to maintain intracellular bioenergetics and serve as an electron acceptor in many organic and inorganic reactions. Hypoxia, defined as reduced O 2 levels, occurs in a variety of pathological conditions, including stroke, tissue ischemia, inflammation, and the growth of solid tumors. The beginnings of hypoxia research in tumor biology can be traced back to observations made in the early 20 th century by Otto Warburg who demonstrated that, unlike normal cells, tumor cells favor glycolysis, independent of cellular oxygenation levels. He postulated that tumor growth is caused by mitochondrial dysfunction in neoplastic cells, forcing them to generate energy through glycolysis (reviewed in 1 ). This hypothesis appears to be incorrect, but a number of other molecular mechanisms promoting "aerobic glycolysis" have been proposed including mutations and epigenetic changes in genes encoding tumor suppressors (e.g. p53), oncogene activation (e.g. c-Myc), and hypoxic adaptations {Denko, 2008 #6606; Gatenby, 2004 #6608; Deberardinis, 2008 #6609.

HIF-2alpha promotes von Hippel-Lindau (VHL)-deficient renal clear cell carcinoma (RCC) tumorigenesis, while HIF-1alpha inhibits RCC growth. As HIF-1alpha antagonizes c-Myc function, we hypothesized that HIF-2alpha might enhance c-Myc activity. We demonstrate here that HIF-2alpha promotes cell-cycle progression in hypoxic RCCs and multiple other cell lines. This correlates with enhanced c-Myc promoter binding, transcriptional effects on both activated and repressed target genes, and interactions with Sp1, Miz1, and Max. Finally, HIF-2alpha augments c-Myc transformation of primary mouse embryo fibroblasts (MEFs). Enhanced c-Myc activity likely contributes to HIF-2alpha-mediated neoplastic progression following loss of the VHL tumor suppressor and influences the behavior of hypoxic tumor cells.

Approximately 50% of cancer patients receive radiation treatment, either alone or in combination with other therapies. Tumor hypoxia has long been associated with resistance to radiation therapy. Moreover, the expression of hypoxia inducible factors HIF1␣ and/or HIF2␣ correlates with poor prognosis in many tumors. Recent evidence indicates that HIF1␣ expression can enhance radiation-induced apoptosis in cancer cells. We demonstrate here that HIF2␣ inhibition promotes tumor cell death and, in contrast to HIF1␣, enhances the response to radiation treatment. Specifically, inhibiting HIF2␣ expression augments p53 activity, increases apoptosis, and reduces clonogenic survival of irradiated and non-irradiated cells. Moreover, HIF2␣ inhibition promotes p53-mediated responses by disrupting cellular redox homeostasis, thereby permitting reactive oxygen species (ROS) accumulation and DNA damage. These results correlate with altered p53 phosphorylation and target gene expression in untreated human tumor samples and show that HIF2␣ likely contributes to tumor cell survival including during radiation therapy.M any cellular responses to hypoxia are mediated by the hypoxia inducible factors (HIFs). These transcription factors promote the expression of over 200 genes (1) and are heterodimers consisting of either HIF1␣ or HIF2␣ bound to the HIF␤/ARNT subunit. While ARNT is constitutively expressed, both HIF␣ subunits are regulated by O 2 availability. Under normoxia, the von Hippel-Lindau (VHL) E3 ligase complex targets HIF␣ subunits for proteasomal degradation (2). When O 2 levels decline, the HIF␣ subunits are stabilized, bind ARNT, and activate the expression of target genes providing hypoxic adaptations.Solid tumors are characterized by oncogenic signaling and hypoxic microenvironments that promote HIF␣ accumulation (3). Moreover, HIF1␣ and/or HIF2␣ expression has been associated with increased tumor vascularization and poor prognosis of numerous cancers such as breast, ovarian, and non-small cell lung cancer (2, 4). Of note, in mouse xenograft models, HIF2␣ (and not HIF1␣) expression is crucial for growth of clear cell renal cell carcinoma (ccRCC) (5, 6) and neuroblastoma (7) tumors.TP53 is a tumor suppressor that is mutated or silenced in a majority of human cancers (8). It coordinates many cellular stress responses by regulating genes involved in DNA repair, cell cycle arrest, and apoptosis. Following stress stimuli, p53 is activated through a variety of post-translational modifications, including phosphorylation on serine 15 (9). For example, the ataxia telangiectasia mutated (ATM) and checkpoint kinase 2 (Chk2) kinases directly phosphorylate p53 in response to DNA damage, resulting in its activation (9). Although many tumors select for TP53 mutations, p53 pathway inhibition can also contribute to tumor progression (10).With the emergence of HIF inhibitors (11,12) and their potential use in cancer therapy, it is important to accurately predict the response of HIF␣-expressing tumor cells to treatment. HIF1␣ appears to enh...