Molecular Medicine

, Volume 21, Issue 1, pp 666–675 | Cite as

Upregulation and Mitochondrial Sequestration of Hemoglobin Occur in Circulating Leukocytes during Critical Illness, Conferring a Cytoprotective Phenotype

  • Attila Brunyanszki
  • Katalin Erdelyi
  • Bartosz Szczesny
  • Gabor Olah
  • Reinaldo Salomao
  • David N. Herndon
  • Csaba Szabo
Research Article


The classical role of hemoglobin in the erythrocytes is to carry oxygen from the lungs to the tissues via the circulation. However, hemoglobin also acts as a redox regulator and as a scavenger of the gaseous mediators nitric oxide (NO) and hydrogen sulfide (H2S). Here we show that upregulation of hemoglobin (α, β and δ variants of globin proteins) occurs in human peripheral blood mononuclear cells (PBMCs) in critical illness (patients with severe third-degree burn injury and patients with sepsis). The increase in intracellular hemoglobin concentration is a result of a combination of enhanced protein expression and uptake from the extracellular space via a CD163-dependent mechanism. Intracellular hemoglobin preferentially localizes to the mitochondria, where it interacts with complex I and, on the one hand, increases mitochondrial respiratory rate and mitochondrial membrane potential, and on the other hand, protects from H2O2-induced cytotoxicity and mitochondrial DNA damage. Both burn injury and sepsis were associated with increased plasma levels of H2S. Incubation of mononuclear cells with H2S induced hemoglobin mRNA upregulation in PBMCs in vitro. Intracellular hemoglobin upregulation conferred a protective effect against cell dysfunction elicited by H2S. Hemoglobin uptake also was associated with a protection from, and induced the upregulation of, HIF-1α and Nrf2 mRNA. In conclusion, PBMCs in critical illness upregulate their intracellular hemoglobin levels by a combination of active synthesis and uptake from the extracellular medium. We propose that this process serves as a defense mechanism protecting the cell against cytotoxic concentrations of H2S and other gaseous transmitters, oxidants and free radicals produced in critically ill patients.



This work was supported by the National Institutes of Health (P50GM060338 to DN Herndon and R01GM107846 to C Szabo) and by a grant from the Shriners of North America (#85800) to C Szabo.


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Authors and Affiliations

  • Attila Brunyanszki
    • 1
  • Katalin Erdelyi
    • 1
  • Bartosz Szczesny
    • 1
    • 2
  • Gabor Olah
    • 1
  • Reinaldo Salomao
    • 3
  • David N. Herndon
    • 2
    • 4
  • Csaba Szabo
    • 1
    • 2
  1. 1.Department of AnesthesiologyUniversity of Texas Medical Branch, Room 4.2.2HGalvestonUSA
  2. 2.Shriners Hospital for ChildrenGalvestonUSA
  3. 3.Division of Infectious Diseases, Department of Medicine, Hospital Sao Paulo, Escola Paulista de MedicinaUniversidade Federal de Sao PauloSao PauloBrazil
  4. 4.Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA

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