Gene therapy for the retina has been employed successfully in humans and animal models for the treatment of retinal dystrophies.1–3 The retina is attractive for gene therapy approaches because it is surgically approachable, isolated due to the presence of the blood-retina barrier and immunologically privileged. The requirements for successful gene therapy include efficient and sustained gene transfer and choice of a gene product that is capable of eliciting therapeutic efficacy.4 The potential value of cell-specific and regulated gene therapy for the eye has been proposed for models of AMD, photoreceptor degeneration, and retinal ischemia.5–8 Alterations in retinal oxygen availability can form a basis for disease-appropriate patterns of transgene expression either at early stages of oxygen deprivation due to tissue stress or damage and at later stages of disease associated with tissue ischemia and cell necrosis. Oxygen is critical for maintaining retinal function and reduction in oxygen levels serve as a trigger for pathologic effects underlying AMD and diabetic retinopathy.9 Hypoxia-induced changes in the retina can also serve as a trigger for activation of gene therapy vectors designed for regulating transgene expression in response to depleted oxygen levels.2,6 Such tight regulation of the expression from gene therapy vectors is likely to be particularly important in retinal tissue where there are numerous distinct cell types with differing abilities to tolerate stress from hypoxia or elevated reactive oxygen species. The sensing of cellular hypoxia depends on the action of a key oxygen-dependent sensing system involving the transcription factor hypoxia inducible factor (HIF)-1, a heterodimer formed between the constitutive and ubiquitously expressed monomers HIF-1-alpha and HIF-1-beta.10 In normoxia, transcription is prevented because HIF-1-alpha is modified by hydroxylation of a proline residue and then processed for ubiquitin-mediated proteasomal degradation.11 Under hypoxic conditions, however, HIF-1-alpha dimerizes with its partner HIF-1-beta and translocates to the nucleus for activation of gene transcription. Transcriptional activation by HIF-1 occurs through binding of the factor to hypoxia response elements (termed HREs) in regulatory domains of target genes.11,12 Therapeutic products synthesized by hypoxia-regulated vectors have included growth factors such as bFGF and VEGF, antioxidant components, antiangiogenic factors including angiostatin and proapoptotic components such as Bax.13–17 The promoters of such hypoxia-regulated therapeutic vectors are designed to include a regulatory domain which incorporates multiple hypoxia responsive elements (HREs) which are known to bind the transcription factor HIF-1. We and others have reported that multimers of the HRE drive enhanced levels of gene expression relative to a single HRE.6,18 For further control over basal levels of expression and of inducibility, we have previously incorporated a neuronal silencing element into the promoters to prevent “leaky” gene expression under normoxic conditions.6 HRE containing promoters which also contain silencer elements have been found to elicit inducibility in hypoxia of greater than 50-fold.6 The primary focus of this study is aimed at testing the hypothesis that a hypoxia-responsive domain can be employed for activating cell-specific expression in Muller cells under conditions of hypoxic stress in the pathologic retina. A promoter containing a hypoxia responsive domain together with a cell specific promoter would be expected to retain cell specificity while also being hypoxia-inducible. In responding to hypoxia, the promoter will have potential for activation during early phase hypoxia as well as later ischemic phases noted in the progression of such disease processes as AMD and diabetic retinopathy. For developing a retinal gene therapy approach, a variety of gene products may be especially appropriate for expression in this vector system including pro-survival kinases, antioxidant enzymes that enhance Muller cell viability, and secreted factors either for preventing angiogenesis or for eliciting neuroprotection. Our HRE-regulated, retinal glial cell–specific promoter could be incorporated to investigate new therapies to treat a range of animal models of eye diseases such as inherited photoreceptor degeneration, age related macular degeneration, diabetic retinopathy, and glaucoma. Glial fibrillary acidic protein (GFAP) is the major intermediate filament in astrocytes and other glial cells, including nonmyelinating Schwann cells and Muller cells (the major glial element in the retina).19–21 Expression of GFAP serves as a marker of developmental processes as well as an indicator of gliosis in response to injury.21–23 Elevated levels of GFAP expression in retinal glial cells have been observed in light-induced retinal damage and in a number of eye diseases including diabetic retinopathy and AMD. Identification of the upstream regulatory sequences of the GFAP gene has been valuable for achieving glial cell–specific transgene expression either in transgenic mice or when employing gene transfer vectors. The domain from bp −2163 to +47 of the human GFAP gene has been found to drive astrocyte-specific expression whereas an internally truncated −2163 GFAP promoter lacking bp −1488 to −132 loses its cell specificity. However a short gfaABC1D promoter consisting of enhancer domains plus a proximal promoter domain was found to retain astrocyte-specific expression in the brain, while demonstrating at least a twofold higher activity than −2163 GFAP.24 In transgenic mice, the astrocyte-specific GfaABC1D provides more regional specificity in the brain than other GFAP promoter domains.24 In this investigation, both in vitro and in vivo studies were used to confirm the applicability of these regulatory domains for gene therapy strategies. The complete promoter was incorporated into a recombinant self complementary AAV (scAAV) containing the HRE-GFAP promoter driving GFP. Primary cultures of Muller cells were transfected to demonstrate a lack of expression of the GFP transgene in normoxia and high level transgene expression in hypoxia. For in vivo studies, the murine model of oxygen-induced retinopathy (OIR) is widely used to study neovascularization.25 In this model, postnatal day 7 (P7) mouse pups are exposed to high oxygen until P12 then returned to room air for another 5 days. During the initial high oxygen phase, normal retinal blood vessels regress. During the regression phase, retinal cells produce several HIF-1–mediated proangiogenic factors. This leads to development of abnormal neovascularization in the retina by P17.26 The expression of HIF-1 in P17 hypoxic retina is 31-fold greater than in P17 normoxic retina.27 The OIR model is used to study hypoxia-regulated reporter gene expression in the mouse retina.5 As our promoter requires HIF-1 for its induction, we chose the OIR model to evaluate the activity of our regulated promoter for in vivo studies.