While nonsense-mediated RNA decay (NMD) is an established mechanism to rapidly degrade select transcripts, the physiological regulation and biological significance of NMD are not well characterized. We previously demonstrated that NMD is inhibited in hypoxic cells. Here we show that the phosphorylation of the ␣ subunit of eukaryotic initiation factor 2 (eIF2␣) translation initiation factor by a variety of cellular stresses leads to the inhibition of NMD and that eIF2␣ phosphorylation and NMD inhibition occur in tumors. To explore the significance of this NMD regulation, we used an unbiased approach to identify approximately 750 NMD-targeted mRNAs and found that these mRNAs are overrepresented in stress response and tumorpromoting pathways. Consistent with these findings, the inhibition of NMD promotes cellular resistance to endoplasmic reticulum stress and encourages tumor formation. The transcriptional and translational regulations of gene expression by the microenvironment are established mechanisms by which tumor cells adapt to stress. These data indicate that NMD inhibition by the tumor microenvironment is also an important mechanism to dynamically regulate genes critical for the response to cellular stress and tumorigenesis.During tumorigenesis, a disorganized vasculature leads to amino acid and glucose deprivation, cellular hypoxia, the accumulation of reactive oxygen species (ROS), and various other stresses (5, 12). Cellular adaptation to the hostile tumor microenvironment requires the regulation of stress-induced genes (reviewed in reference 16). For example, the transcription factor ATF-4, upregulated in human tumors due to the stress-induced phosphorylation of the ␣ subunit of eukaryotic translation initiation factor 2 (eIF2␣), transactivates genes involved in amino acid metabolism, angiogenesis, and ROS attenuation (2,3,33). Cells that cannot phosphorylate eIF2␣ or that are deficient in ATF-4 and other stress-induced transcription factors do not form tumors in vivo (2, 13, 40), and therefore, a major goal in cancer biology has been to better understand and potentially target these adaptive mechanisms. However, while the translational and transcriptional responses that promote adaptation to the tumor microenvironment are well established, the role of mRNA stabilization in the cellular stress response has not been as thoroughly studied.Nonsense-mediated RNA decay (NMD) degrades up to 30% of all mutated protein-coding mRNAs, including those responsible for many genetic disorders, such as thalassemia, cystic fibrosis, and muscular dystrophy (11). During the processing of mammalian pre-mRNA, introns are excised and marked by an exon junction complex, which contains core NMD components. Newly synthesized mRNAs are thought to undergo a pioneering round of translation by a complex that includes eIF2␣ (6). When this translation complex pauses at a premature termination codon (PTC) upstream of an exon junction complex, the RNA helicase UPF1/Rent1, an essential component of the NMD process, is recruited and the...