THE EFFECTS OF HYPOXIA on mammalian heart and muscle have fascinated physiologists for many a day. Myoglobin is expressed adaptively in muscle. In very young animals, and in the absence of muscle work, the myoglobin concentration in muscles remains very small. What factors lead to myoglobin genesis? Millikan (7) assembled a convincing body of observational and experimental evidence that sustained hard work is required for myoglobin expression. In 1962, Reynafarje (8) showed that life at high altitude favors high concentration of myoglobin in skeletal muscles of humans and small mammals. For a long time, the import of Reynafarje's findings was obscured by apparently contradictory studies showing that low oxygen pressure alone is not a sufficient stimulus for myoglobin expression. Now, Kanatous et al. (5), in the article under discussion, resolve this issue by showing that during hypoxia, myoglobin is elevated in the working heart, but not in the relatively idle skeletal musculature, of mice exposed to prolonged hypoxia. They conclude from their studies that hypoxia alone does not stimulate myoglobin expression, but that hypoxia in consort with repetitive contraction, exactly the conditions obtaining in the muscles of people residing at high altitude, does stimulate myoglobin genesis.Reversible oxygenation permits myoglobin to enhance oxygen flux from regions of high myoglobin oxygen saturation to regions of lower saturation in aqueous solution, a phenomenon named facilitated diffusion (12). This has encouraged physiologists to search for a role of intracellular myoglobin in enhancing oxygen supply to the heart and muscle mitochondria of whole animals to enhance oxidative ATP generation during hypoxia.Reversible oxygenation also permits myoglobin to function as an oxygen store, particularly in animals that work in low oxygen environments such as burrowers, animals living at high altitude, and mammals and birds performing prolonged deep sea dives (4, 6). The myoglobin content of muscles of diving animals often exceeds tenfold that apparently optimal (11) to facilitate oxygen diffusion. The myoglobin content of muscles of diving animals (4, 6) often accounts for ϳ50% of total body oxygen stores, and its concentration is directly correlated with dive duration (4). This raises the interesting question of whether the genetic mechanisms responsible for increased myoglobin expression in working muscles (5) are the same as those generating the massive myoglobin stores of diving animals. Adaptations in diving animals differ from those of the hypoxic, exercising mouse model described below. The diving animals display increased capillary density and mitochondrial volume density, adaptations that promote both diffusive and facilitated oxygen transport to the mitochondria and permit maintenance of aerobic lipid metabolism. These changes are coordinated in diving animals by increased hypoxia-inducible factor (HIF) activation. HIF, the hypoxia-inducible gene program, is a transcriptional activator of downstream target genes th...