IntroductionPeriods of low O 2 concentration or hypoxia occur during a broad range of biologic conditions from early development to tumorigenesis and heart disease. Under such situations, cells adapt to the low O 2 environment by increasing the expression of a number of genes including vascular endothelial growth factor, erythropoietin, glycolytic enzymes, 1 and genes involved in iron homeostasis, such as ceruloplasmin, transferrin (Tf), and transferrin receptor (TfR). [2][3][4][5] The expression of these genes requires activation by hypoxia-inducible factor-1 (HIF-1), a transcription factor consisting of hypoxia-inducible HIF-1␣ and constitutively expressed HIF-1 subunits. During normoxia, HIF-1␣ is destabilized by a mechanism involving prolyl hydroxylation and targeted for proteasomal degradation. 6 During hypoxia, prolyl hydroxylase activity is reduced and the nonhydroxylated form of HIF-1␣ is stabilized. HIF-1␣ then binds to the constitutively expressed HIF-1 subunit to activate transcription of genes that allow for adaptation to hypoxia.When the O 2 concentration returns to normal, the production of toxic reactive oxygen species (ROS), such as the hydroxyl radical ( ⅐ OH), superoxide, and hydrogen peroxide (H 2 O 2 ) increases. Iron contributes to ROS formation by catalyzing the generation of ⅐ OH from H 2 O 2 by Fenton chemistry. 7 ROS, especially ⅐ OH, can damage proteins, DNA, and lipids, and are thought to be responsible for much of the cellular and tissue injury associated with reperfusion disorders. 8,9 In both animal and cell culture models, iron chelation has been shown to decrease the damage caused during reperfusion. [10][11][12] Due to the dual nature of iron as essential for both cellular growth and survival, yet toxic when present in excess, cells have evolved a mechanism to maintain iron homeostasis via iron regulatory protein 1 (IRP1) and IRP2. [13][14][15] When the cellular-free iron pool is low, IRPs bind to specific RNA stem loop structures, called iron-responsive elements (IREs), located in the 5Ј-untranslated region (UTR) of mRNAs such as ferritin heavy chain (FtH) and ferritin light chain (FtL) subunits and mitochondrial aconitase (m-Aco), thereby preventing their translation. IRPs also bind to IREs located in the 3Ј-UTR of TfR mRNA, stabilizing the message from endonucleolytic cleavage and increasing the uptake of Tf-bound iron. Conversely, when the cellular free iron pool is high, IRP2 is degraded by the proteasome in an iron-dependent manner, and IRP1 is converted from an RNA-binding protein to a [4Fe-4S] cluster-containing protein that displays cytosolic aconitase (c-Aco) activity. These changes result in a decrease in TfR synthesis with a corresponding increase in Ft translation, leading to a decrease in the cellular-free iron pool. By constantly responding to changes in the cellular-free iron pool, IRPs maintain iron homeostasis by regulating iron uptake and sequestration.In addition to iron, IRP activities are influenced by other effectors, including ROS and reactive nitrogen s...