Summary: Qiu and colleagues describe how a structural component of lipid droplets is markedly induced in pseudohypoxic renal tumors, where it maintains endoplasmic reticulum (ER) homeostasis. This adaptation is indispensable in tumor cells-where growth demands and a fl uctuating blood supply place unnatural stresses on ER function-and is therefore an attractive therapeutic target. Cancer Discov; 5(6); 584-5. ©2015 AACR.See related article by Qiu and colleagues, p. 652 (2).With their lethal cocktail of high metabolic demands and poor vascularization, solid tumors are regularly assailed by hypoxia and endoplasmic reticulum (ER) stress. These insults compound each other-because protein folding consumes oxygen and energy, a hypoxic cell is particularly susceptible to ER stress. Healthy cells have evolved dedicated response pathways for each insult; these favor adaptation where possible, but lead to cell death when inappropriately activated. The unfolded protein response (UPR) alleviates ER stress by inhibiting translation, expediting protein processing, ERassociated degradation, and autophagy. The hypoxic response aims to match oxygen supply to demand and is primarily mediated by transcription factors known as hypoxia-inducible factors (HIF; the most important isoforms being HIF1α and HIF2α). When oxygen is low, HIF availability increases dramatically because it is no longer targeted for degradation by a complex that includes the von Hippel-Lindau protein (VHL).Clear-cell renal cell carcinomas (ccRCC) can arise from loss-of-function mutations of VHL -these tumors overexpress HIF, i.e., they are pseudohypoxic. The term "clear cell" alludes to the abundance of cytosolic lipid droplets in these tumors. Lipid accumulation is unsurprising, given that HIF suppresses lipolysis and β-oxidation of fatty acids while conserving energy stores in preparation for reoxygenation. However, lipid droplets have another less-recognized function-they can alleviate ER stress by sequestering toxic lipids in neutral forms and providing an ER-associated route to retrotranslocate soluble misfolded proteins ( 1 ). The current work by Qiu and colleagues ( 2 ) describes the novel convergence of HIF and ER stress response signals on lipid droplets in ccRCC.PLIN2 is a lipid droplet-associated structural protein with well-described metabolic functions. In the current study, Qiu and colleagues fi rst noted from ccRCC tissue samples that PLIN2 expression increases specifi cally with HIF2α expression. They went on to show that this relationship was causal, because PLIN2 levels declined as a result of HIF2α knockdown in the 786-O and RCC4 cell lines. Furthermore, this relationship was pathologically signifi cant. HIF2α knockdown in 786-O cells slowed xenograft growth and depleted lipid stores, but both neutral lipid staining and tumorigenicity were restored by PLIN2 overexpression. PLIN2 loss sensitizes ccRCC cultures to oleic acid treatment and pharmacologic agents that induce proteotoxicity. Conversely, inhibition of the UPR, mTORC1, and protein syn...