Role of Intestinal HIF-2 alpha in Health and Disease

The intestine is supported by a complex vascular system that undergoes dynamic and transient daily shifts in blood perfusion, depending on the metabolic state. Moreover, the intestinal villi have a steep oxygen gradient from the hypoxic epithelium adjacent to the anoxic lumen to the relative higher tissue oxygenation at the base of villi. Due to the daily changes in tissue oxygen levels in the intestine, the hypoxic transcription factors hypoxiainducible factor (HIF)-1 alpha and HIF-2 alpha are essential in maintaining intestinal homeostasis. HIF-2 alpha is essential in maintaining proper micronutrient balance, the inflammatory response, and the regenerative and proliferative capacity of the intestine following an acute injury. However, chronic activation of HIF-2 alpha leads to enhanced proinflammatory response, intestinal injury, and colorectal cancer. In this review, we detail the major mechanisms by which HIF-2 alpha contributes to health and disease of the intestine and the therapeutic implications of targeting HIF-2 alpha in intestinal diseases.