The development of intratumoral hypoxia is a universal hallmark of rapidly growing solid tumors. Adaptation to the hypoxic environment, which is critical for tumor cell survival and growth, is mediated primarily through a hypoxia-inducible factor (HIF)-dependent transcriptional program. HIF activates genes that facilitate crucial adaptive mechanisms including increased glucose uptake and glycolysis and tumor angiogenesis, making it an important therapeutic target. However, the HIF-dependent transcriptional mechanism remains incompletely understood, and targeting HIF is a difficult endeavor. Here, we show that the orphan nuclear receptor estrogen-related receptors (ERRs) physically interact with HIF and stimulate HIF-induced transcription. Importantly, ERRs appear to be essential for HIF's function. Transcriptional activation of hypoxic genes in cells cultured under hypoxia is largely blocked by suppression of ERRs through expression of a dominant negative form of ERR or treatment with a pharmacological ERR inhibitor, diethylstilbestrol. Systematic administration of diethylstilbestrol severely diminished growth and angiogenesis of tumor xenografts in vivo. Because nuclear receptors are outstanding targets for drug discovery, the findings not only may offer mechanistic insights into HIF-mediated transcription but also may open new avenues for targeting the HIF pathway for cancer therapy.angiogenesis ͉ energy metabolism ͉ nuclear hormone receptor R apidly growing solid tumors tend to outstrip the supply of oxygen and nutrients provided by blood vessels, resulting in regions of low oxygen levels (hypoxia). Cancer cells undergo adaptation to persist in the hostile hypoxic environment. The adaptive response to hypoxia is controlled primarily by the hypoxia-inducible factor (HIF), a master regulator of hypoxic gene expression and oxygen homeostasis (1-3). HIF is a heterodimeric transcription factor comprising an oxygen-regulated ␣-subunit (HIF1␣ or -2␣) and a constitutively expressed and stable -subunit (HIF). Under normal oxygen tension, the HIF␣ subunit is subjected to prolyl hydroxylation catalyzed by a set of oxygen-and ferrous ion-dependent prolyl hydroxylases. Hydroxylated HIF␣ is recognized by the tumor-suppressor protein von Hippel-Lindau (VHL), a component of an E3 ubiquitin ligase complex. Subsequently, HIF␣ becomes polyubiquitinated and is targeted for rapid degradation by the proteasomal system. Oxygen deprivation, or administration of iron chelators or cobaltous ion (a classic hypoxia mimetic, which competes with ferrous ion), suppresses hydroxylase activity, allowing HIF␣ to escape the VHL-mediated destruction and to accumulate and dimerize with the constitutively present HIF. The binding of the HIF␣-HIF heterodimer along with the transcriptional coactivator p300/CBP to the cognate hypoxia-responsive element (HRE) augments the expression of a plethora of hypoxic genes that carry such elements within their promoters or enhancers (4). The HIF-orchestrated transcriptional program is directly responsible ...