Hypoxia preconditioning and subsequent tolerance to hypoxia-ischemia damage is a well-known phenomenon and has significant implications in clinical medicine. In this investigation, we tested the hypothesis that the transcriptional activation of IGF-I is one of the underlying mechanisms for hypoxia-induced neuroprotection. In a rodent model of hypoxia-ischemia, hypoxia preconditioning improved neuronal survival as demonstrated by decreased hypoxia-ischemia-induced neuronal apoptosis. To study the role of IGF-I in hypoxia tolerance, we used in situ hybridization to examine IGF-I mRNA distribution on adjacent tissue sections. In cerebral cortex and hippocampus, hypoxia preconditioning resulted in an increase in neuronal IGF-I mRNA levels with or without hypoxia-ischemia. To test its direct effects, we added IGF-I to primary neuronal culture under varying oxygen concentrations. As oxygen concentration decreased, neuronal survival also decreased, which could be reversed by IGF-I, especially at the lowest oxygen concentration. Interestingly, IGF-I treatment resulted in an activation of hypoxia-inducible factor 1␣ (HIF-1␣), a master transcription factor for hypoxiainduced metabolic adaptation. To evaluate whether IGF-I transcriptional activation correlates with HIF-1␣ activity, we studied the time course of HIF-1␣ DNA binding activity in the same rat model of hypoxia-ischemia. After hypoxia-ischemia, there was an increase in HIF-1␣ DNA binding activity in cortical tissues, with the highest increase around 24 h. Like IGF-I mRNA levels, hypoxia preconditioning increased HIF-1␣ DNA binding activity alone or with subsequent hypoxia ischemia. Overall, our results suggest that IGF-I transcriptional activation is one of the metabolic adaptive responses to hypoxia, which is likely mediated by a direct activation of HIF-1␣. Abbreviations HIF-1, hypoxia-inducible factor 1 HIF-1␣, hypoxia-inducible factor 1␣ HIF-1, hypoxia-inducible factor 1 VEGF, vascular endothelial growth factor dNTP, nucleotides dGTP, 2'-deoxyguanosine 5'-triphosphate, sodium salt dCTP, 2'-deoxycytidine 5'-triphosphate, sodium salt dTTP, 2'-deoxythymidine 5'-triphosphate, sodium salt dATP, 2'-deoxyadenosine 5'-triphosphate, sodium salt SSC, sodium chloride and sodium citrate buffer EMSA, electrophoretic mobility shift assay W18, wild-type M18, mutant MTT, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide ϩϩϩ ] RT-PCR, reverse transcription PCR Hypoxia preconditioning is a process by which prior treatment of a sublethal dose of hypoxia renders cells tolerant to otherwise lethal hypoxia or hypoxia/ischemia insult. This phenomenon has been observed at cellular (1), tissue (2), and whole animal levels (3-6). Preconditioning and subsequent tolerance is not unique to hypoxia. In the brain, neurons can become tolerant to ischemia if exposed to a brief sublethal episode of ischemia (7,8), spreading depression (9), or exposure to metabolic inhibitors (10). To survive, cells seem to be armed with sophisticated adaptive mechanisms that enable them to sense t...