Molecular adaptation to hypoxia depends on the binding of hypoxia-inducible factor 1 (HIF-1) to cognate response elements in oxygen-regulated genes. In addition, adjacent sequences are required for hypoxiainducible transcription. To investigate the mechanism of interaction between these cis-acting sequences, the multiprotein complex binding to the lactate dehydrogenase A (LDH-A) promoter was characterized. The involvement of HIF-1, CREB-1/ATF-1, and p300/CREB binding protein (CBP) was demonstrated by techniques documenting in vitro binding, in combination with transient transfections that test the in vivo functional importance of each protein. In both the LDH-A promoter and the erythropoietin 3 enhancer, formation of multiprotein complexes was analyzed by using biotinylated probes encompassing functionally critical cis-acting sequences. Strong binding of p300/CBP required interactions with multiple DNA binding proteins. Thus, the necessity of transcription factor binding sites adjacent to a HIF-1 site for hypoxically inducible transcription may be due to the requirement of p300 to interact with multiple transcription factors for high-affinity binding and activation of transcription. Since it has been found to interact with a wide range of transcription factors, p300 is likely to play a similar role in other genes, mediating interactions between DNA binding proteins, thereby activating stimulus-specific and tissue-specific gene transcription.Tissue oxygen concentration is an important regulatory stimulus for many physiological and pathological processes (6). Adaptation to hypoxia depends in part on appropriate alterations in the expression of a number of physiologically relevant genes. Induction of the erythropoietin (Epo) gene by hypoxia is central to the regulation of the oxygen-carrying capacity of the blood (24); hypoxic induction of genes encoding angiogenic growth factors leads to new blood vessel formation in development, wound repair, and tumor growth (20, 21, 32); and hypoxic induction of genes encoding specific glycolytic isoenzymes and glucose transporters contributes to long-term adaptation of energy metabolism to decreased oxygen tension (12,13,16,42). In particular, increased expression of the lactate dehydrogenase A (LDH-A) gene in hypoxic cells plays a critical role in the switch from aerobic to anaerobic energy metabolism, resulting in increased production of lactate and regeneration of NAD ϩ (17).Most if not all mammalian cell types share a common mechanism of oxygen sensing and signal transduction (33), enabling hypoxia-induced activation of the transcription factor hypoxiainducible factor 1 (HIF-1) (45). HIF-1 is a heterodimer comprised of HIF-1␣ and ARNT, two basic helix-loop-helix proteins in the PAS family (46). While ARNT mRNA and protein and HIF-1␣ mRNA are unaffected by oxygen tension, the level of HIF-1␣ protein increases markedly in hypoxic cells (23,25,37). In normoxia, HIF-1␣ is rapidly degraded by the proteasome; in hypoxia, this degradation is blocked, and HIF-1␣ accumulates (22). ...