Erythrocyte immune system: beyond the gas transporter

Accumulating research has revealed that erythrocytes play unique roles in the innate immune system. Once thought of as immunologically inert cells, erythrocytes are functional cells that exert diverse immunological effects. Although mature mammal erythrocytes lack internal organelles, they express various receptors, which provide an extraordinary ability for erythrocytes to clear or sequester circulating molecules that affect immune functions. In this review, we elucidate some crucial immunological molecules associated with erythrocytes, such as CR1, CD47, TLR9, and cytokines. CR1 acts as a bridge in clearing off immune complexes and an entrance gate for some pathogens. CD47, once bound to SIRPα, generates an inhibitory signal in macrophage phagocytosis. Reciprocally, erythrocyte CD47 undergoes a conformational change during oxidative stress-induced cellular senescence, subsequently activating phagocytic signals through binding to TSP-1. TLR9 recognizes unmethylated CpG-DNA present in viruses and bacteria. Erythrocyte TLR9 also binds to and eliminates mitochondrial DNA. Erythrocytes can recruit chemokines and modulate plasma chemokine levels through the Duffy antigen receptor for chemokines (DARC). Moreover, erythrocytes may exert immune functions by releasing danger-associated molecular patterns (DAMPs), i.e., heme, IL-33, ATP, and Hsp70. Heme bound with toll-like receptor 4 (TLR4) has the potential to trigger an inflammatory response. Similarly, IL-33, ATP, and Hsp70 from damaged erythrocytes may be involved in the innate immune response via diverse signaling mechanisms. This review provides novel insight into the immunological functions of erythrocytes, which play an irreplaceable role in innate immune responses. We argue that erythrocyte-involved immune function is a widespread area warranting intensive investigation.