Red Blood Cells Exposed to Oxygen Deficiency Protect Against Myocardial Infarction

Red blood cells carry oxygen from the lungs to all of the body’s cells and carbon dioxide back to the lungs. A new study, conducted at Karolinska Institutet, now shows that red blood cells have an intrinsic function of protecting against heart injury caused by myocardial infarction.

The effect is enhanced by a diet containing nitrate-rich vegetables, such as arugula and other green leafy vegetables.

Part of the study was conducted through experiments with red blood cells from mice that were added to a myocardial infarction model with hearts from mice. Before the experiment, the red blood cells were exposed to low oxygen pressure, while nitrate was added to the drinking water.

In a clinical study, red blood cells were collected from patients with high blood pressure who were randomly assigned a nitrate-rich diet with green leafy vegetables or a diet with nitrate-poor vegetables. These red blood cells were given to the corresponding myocardial infarction model with hearts from rats.

“The results show both that the red blood cells convey protection against injury in the heart in the event of low oxygen levels, and how that protection can be enhanced through simple dietary advice. This may be of great importance for patients at risk of myocardial infarction,” says the study’s first author Jiangning Yang.

The next step in the research is to develop additional drugs that can activate the protective signaling mechanism in red blood cells to provide protection to the body’s tissues and cells in the event of oxygen deficiency.

“In addition, we need to map how the blood cells transmit their protective signal to the heart muscle cells,” says John Pernow.


Jiangning Yang, Michaela L. Sundqvist, Xiaowei Zheng, Tong Jiao, Aida Collado, Yahor Tratsiakovich, Ali Mahdi, John Tengbom, Evanthia Mergia, Sergiu-Bogdan Catrina, Zhichao Zhou, Mattias Carlström, Takaaki Akaike, Miriam M. Cortese-Krott, Eddie Weitzberg, Jon O. Lundberg, John Pernow. Hypoxic erythrocytes mediate cardioprotection through activation of soluble guanylate cyclase and release of cyclic GMP. Journal of Clinical Investigation, 2023; 133 (17) DOI: 10.1172/JCI167693

Karolinska Institutet. “Red blood cells exposed to oxygen deficiency protect against myocardial infarction.” ScienceDaily. ScienceDaily, 1 September 2023. <>.

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Photo by Robina Weermeijer