iCliniq logo

Ask a Doctor Online Now

HomeHealth articlesred blood cellsWhat Are the Immunomodulatory Roles of Red Blood Cells?

Immunomodulatory Roles of Red Blood Cells - Functions and Recent Advancements

Verified dataVerified data

4 min read


Red blood cells (RBCs) play an important role in regulating the immune system through various immunomodulatory mechanisms. Read on to learn more.

Written by

Dr. Kinjal Shah

Medically reviewed by

Dr. Kaushal Bhavsar

Published At April 20, 2023
Reviewed AtApril 20, 2023


Red blood cells (RBCs) are typically recognized for their function in the transportation of oxygen, but new research has revealed that they also have a significant impact on immune system control. Several immunomodulatory roles for RBCs have been discovered, including cytokine level regulation, complement activation modulation, antigen presentation, T cell activation modulation, and dendritic cell function regulation. Recognizing the immunomodulatory functions of RBCs can shed light on the pathophysiology of several illnesses and pave the way for the creation of novel treatment approaches. The many ways that RBCs might control the immune response will be covered in-depth in this article.

What Are Red Blood Cells?

The most prevalent form of blood cell in the human body are red blood cells, or erythrocytes. They have a biconcave shape and no nucleus, which gives them greater room to transport oxygen and carbon dioxide. RBCs are largely in charge of bringing carbon dioxide back to the lungs for exhalation and transferring oxygen from the lungs to the body's tissues and organs. RBCs have a distinctive red hue because of hemoglobin, a protein that binds to oxygen and carbon dioxide. RBCs are created in the bone marrow and circulate for around 120 days before being eliminated through the spleen and liver.

What Are the Different Immunomodulatory Roles of Cytokines?

RBCs have a number of ways to control cytokine levels, including:

  • Cytokine Scavenging: Pro-inflammatory cytokines including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) have been found to be scavenged from the circulation by RBCs. Its scavenging function can lessen tissue damage and excessive cytokine production during inflammation.

  • Cytokine Production: RBCs can manufacture cytokines including erythropoietin (EPO) and transforming growth factor-beta (TGF-) on their own. Although TGF- has been proven to have immunosuppressive effects, EPO has been demonstrated to increase the synthesis of red blood cells and to have anti-inflammatory effects.

  • Adenosine Triphosphate (ATP) Release: RBCs respond to hypoxia by releasing adenosine triphosphate (ATP).

  • Heme Oxygenase-1 (HO-1) Production: RBCs generate heme oxygenase-1 (HO-1) in response to oxidative stress. HO-1 has anti-inflammatory properties and can decrease cytokine production.

Many illnesses, including sepsis and autoimmune disorders, have been linked to dysregulation of the cytokine system. Knowing the immunomodulatory functions of RBCs may offer fresh perspectives on the causes of various disorders and pave the way for the creation of novel treatment approaches.

  • Modulation of complementary systems.

  • The term "complementary system" refers to a group of blood proteins that cooperate to recognize and eliminate foreign substances like bacteria and viruses. Red blood cells (RBCs) lack this system but have a variety of ways to control the activity.

  • The expression of complement regulatory proteins on their surface is one method. These proteins (such as CD55 and CD59) prevent the activation of the complement system on the RBC surface, thereby protecting the cell from complement-mediated damage.

  • RBCs can also manufacture complement components themselves, notably complement component C3. This may play a role in the clearance of immune complexes and other debris from the blood.

  • Moreover, RBCs can interact with complement proteins in a number of ways. For example, RBCs can bind to complement proteins such as C1q and C3b, which can facilitate the clearance of immune complexes and other particles from the circulation.

Overall, while RBCs do not have a complementary system of their own, they can interact with and modulate the activity of this important component of the immune system in several ways.

  • Due to the lack of the machinery necessary for antigen presentation, such as the major histocompatibility complex (MHC) molecules, red blood cells (RBCs) typically do not present antigens to T cells. However, there are some circumstances in which RBCs can contribute to immunomodulation through antigen presentation.

  • One example is in the context of autoimmune hemolytic anemia (AIHA), a condition in which the immune system mistakenly attacks and destroys RBCs. In this case, the RBCs may be coated with autoantibodies, which can then be recognised by antigen-presenting cells (APCs) such as dendritic cells. These APCs can then present the RBC-derived autoantigens to T cells, leading to the activation of an autoimmune response.

  • Another example is in the context of transfusion reactions, where RBCs from a donor with a different blood type are transfused into a recipient. In this case, the recipient's immune system may recognise the donor RBCs as foreign and mount an immune response. This immune response may involve the presentation of antigens derived from donor RBCs by APCs, which causes T cells to become activated and produce antibodies against the donor RBCs.

In both of these scenarios, RBCs can indirectly contribute to antigen presentation and subsequent immunomodulation, although this is not a typical function of RBCs under normal circumstances.

Here are some possible ways that RBCs could modulate T cell activation:

  • Cytokine Secretion: RBCs can secrete cytokines such as TGF-β, which can inhibit T cell activation and proliferation. TGF-β can also promote the development of regulatory T cells (Tregs), which can further suppress T cell activation.

  • Antigen Presentation: While RBCs do not typically present antigens to T cells, they can present antigens in certain contexts such as autoimmune hemolytic anemia. In these cases, RBC-derived autoantigens could be presented to T cells by antigen-presenting cells, leading to T cell activation and potentially contributing to autoimmune responses.

  • Modulation of Dendritic Cells: RBCs can interact with dendritic cells, which are professional antigen-presenting cells that play a critical role in T cell activation. RBCs have been shown to modulate dendritic cell function and maturation, which can affect T cell activation.

  • Direct Interaction With T Cells: RBCs have been shown to interact directly with T cells, although the functional consequences of this interaction are not clear. Some studies have suggested that RBCs can suppress T cell activation, while others have found that RBCs can enhance T cell activation.

  • Regulation of Dendritic Cell Function: Dendritic cells are immune cells that play a crucial role in antigen presentation and the activation of the immune response. RBCs have been shown to regulate dendritic cell function by producing heme oxygenase-1 (HO-1) in response to oxidative stress. HO-1 can inhibit dendritic cell maturation and activation, leading to a decrease in the immune response.

What Are the Recent Findings?

Throughout the past century, research has shown that red blood cells have additional activities, such as immunological activity, in addition to carrying oxygen. According to recent research, the nucleic acid sensing receptor toll-like receptor 9 (TLR9) is expressed on the surface of red blood cells and is involved in the activation of the innate immune system and the removal of red blood cells during inflammatory situations. In addition to their function as DNA sensors, RBCs may also affect immune function by causing vascular dysfunction, according to mounting research.

With multiple studies revealing changes to RBC membrane structure and metabolism in response to severe acute respiratory syndrome and Coronavirus 2 infection, RBC proteomics and metabolomics have added to one’s understanding of how RBC immune function functions.

Lastly, evidence points to the possibility that RBCs regulate complement in a manner that affects host immunological responses. Taken together, these new data imply that RBCs contain immunological activity.


In conclusion, RBCs play a crucial role in modulating the immune response through various mechanisms that can help prevent excessive immune activation and tissue damage during inflammation. Future studies are needed to fully understand the complex interactions between RBCs and the immune system and how these interactions can be harnessed for therapeutic purposes.

Frequently Asked Questions


What Are the Immunological Functions of Red Blood Cells?

The immunological functions of red blood cells are to bind and scavenge chemokines, nucleic acid, and pathogens in circulation. Red blood cells are emerging as important modulators of the innate immune response.


What Are the Functions of Red Blood Cells?

The functions of red blood cells are:

- Delivers oxygen all through the body from the lungs and tissues.

- Facilitates transport of carbon dioxide.

- Acts as a buffer and regulates hydrogen ion concentration.

- Carries Rh factor and blood group antigen.


What Do RBCs Do to Promote Inflammation?

RBCs promote inflammation and auto-immune responses when hemoglobin and heme trigger the production of reactive oxygen species to destroy and eliminate hemolytic pathogens.


Which Blood Cells Deal With the Immune System?

The white blood cells deal with the immune system, and these cells are made in the bone marrow and a part of the lymphatic system. They move through blood and tissue throughout the body, looking for microbes such as viruses, bacteria, parasites, and fungi.


What Are the Types of Blood Cells?

Blood cells are stem cells that mature into three main types of cells: red blood cells, white blood cells, and platelets. White blood cells are of three types: lymphocytes, monocytes, and granulocytes. There are three main types of granulocytes: neutrophils, eosinophils, and basophils.


What Are the Mature Red Blood Cells Otherwise Called As?

The fully mature red blood cells are otherwise called erythrocytes. Red blood cells are the most common type of cell found in blood with each cubic millimeter of blood containing 4-6 million cells.


Which Disorder Destroys the Red Blood Cells?

The red blood cells are destroyed faster than they can be made by hemolytic anemia, and the destruction of these red blood cells is known as hemolysis. Hemolytic anemia is a blood condition that occurs when the red blood cells are destroyed faster than they can be replaced.


What Blood Cells Fight Against Inflammation?

White blood cells are a part of the immune system, and they participate in innate and humoral immune responses; while circulating in the blood, they mount inflammatory and cellular responses to injury or pathogens.


Do Red Blood Cells Fight Against Infection?

The red blood cells or erythrocytes are mechanical and biochemical barriers against infections, blood parasites and bacteria. Immune reactions are regulated to ensure harmony between the red and white blood cell populations.


What Is the Normal Range of RBCs in Adults?

In adults, the normal range of RBCs is 4.35 to 5.65 million red blood cells per microliter in men, and in women, the range is from 3.92 to 5.13 million red blood cells per microliter.


When Do Red Blood Cells Increase?

The red blood cells are increased in the body when there is low oxygen levels due to conditions such as congenital heart disease and chronic obstructive pulmonary disease.


What Are the Best Food Sources to Increase Red Blood Cells?

The red blood cells can be increased in the body by consuming food such as red meat, fish, poultry, shellfish, and other foods rich in iron, such as peas, beans, tofu, green leafy vegetables, and dried fruits.


What Happens When There Are Too Many Red Blood Cells?

When there are too many red blood cells in the body, it makes the blood thick and sluggish and increases the risk of blood clots and complications such as stroke and heart attack.

Source Article IclonSourcesSource Article Arrow
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


red blood cells
Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Source Article ArrowMost popular articles

Ask your health query to a doctor online

Internal Medicine

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy