# Hydrogen Sulfide Is a Regulator of Hemoglobin Oxygen-Carrying Capacity via Controlling 2,3-BPG Production in Erythrocytes

Authors: Gang Wang; Yan Huang; Ningning Zhang; Wenhu Liu; Changnan Wang; Xiaoyan Zhu; Xin Ni
Journal: Oxidative Medicine and Cellular Longevity
 (2021)

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## Abstract

Hydrogen sulfide (H2S) is naturally synthesized in a wide range of mammalian tissues. Whether H2S is involved in the regulation of erythrocyte functions remains unknown. Using mice with a genetic deficiency in a H2S natural synthesis enzyme cystathionine-γ-lyase (CSE) and high-throughput metabolomic profiling, we found that levels of erythrocyte 2,3-bisphosphoglycerate (2,3-BPG), an erythroid-specific metabolite negatively regulating hemoglobin- (Hb-) oxygen (O2) binding affinity, were increased in CSE knockout (Cse-/-) mice under normoxia. Consistently, the 50% oxygen saturation (P50) value was increased in erythrocytes of Cse-/- mice. These effects were reversed by treatment with H2S donor GYY4137. In the models of cultured mouse and human erythrocytes, we found that H2S directly acts on erythrocytes to decrease 2,3-BPG production, thereby enhancing Hb-O2 binding affinity. Mouse genetic studies showed that H2S produced by peripheral tissues has a tonic inhibitory effect on 2,3-BPG production and consequently maintains Hb-O2 binding affinity in erythrocytes. We further revealed that H2S promotes Hb release from the membrane to the cytosol and consequently enhances bisphosphoglycerate mutase (BPGM) anchoring to the membrane. These processes might be associated with S-sulfhydration of Hb. Moreover, hypoxia decreased the circulatory H2S level and increased the erythrocyte 2,3-BPG content in mice, which could be reversed by GYY4137 treatment. Altogether, our study revealed a novel signaling pathway that regulates oxygen-carrying capacity in erythrocytes and highlights a previously unrecognized role of H2S in erythrocyte 2,3-BPG production.


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## Body

## 1. Introduction

Red blood cells (RBCs), the most abundant type of blood cell, constitute approximately 75% of the human body’s total cell count [1]. The principal function of RBCs is the transport of oxygen between the respiratory system and the metabolizing tissues as RBCs have a high intracellular concentration of hemoglobin as oxygen carriers [2]. In the lungs, oxygen diffuses across the alveolar barrier from inspired air into the blood, where the majority is bound by hemoglobin (Hb) to form oxy-Hb. In the peripheral tissue, oxygen is released from oxy-Hb (deoxygenation) and diffuses into the cells. Classically, the ability of Hb to bind and release oxygen is based on the local oxygen partial pressure. The relationship between oxygen affinity of Hb and oxygen partial pressure can be described as the Hb-oxygen dissociation curve. Erythrocytes can functionally adjust O2 uptake, transport, and delivery through sophisticated regulation of Hb-O2 affinity by endogenous allosteric modulators, which include H+, CO2, 2,3-bisphosphoglycerate (2,3-BPG), Cl-, and lactate ions [3]. The concentrations of these factors in RBCs vary depending on cellular metabolism and changes in the extracellular milieu, leading to adjustments in Hb-O2 affinity that may be adaptive in optimizing tissue O2 supply.Hydrogen sulfide (H2S) is termed as “the third endogenous gaseous signaling transmitter” as it is identified after NO and CO. Its synthesis from L-cysteine occurs naturally in wide ranges of mammalian tissues, mainly through the activity of the enzymes including cystathionine-γ-lyase (CSE), cystathionine-β-synthase (CBS), and 3-mercaptopyruvate sulfurtransferase (3-MST) [4]. H2S is involved in many physiologic and pathologic processes such as vasodilation [5], angiogenesis [6], and inflammation [7]. Furthermore, H2S serves as an important protective factor in various tissues upon a number of injury insults, such as hypoxia and ischemia-reperfusion [8, 9]. A number of studies have implicated that erythrocytes are able to produce H2S because the H2S-producing enzyme activity is detected in RBCs [10–12]. Interestingly, D’Alessandro et al. [13] recently reported that H2S production is reduced in erythrocytes of the healthy volunteers exposed to high-altitude hypoxia. Thus, we hypothesized that H2S has a functional role in erythrocytes. To test it, we conducted metabolomic profiling, mouse genetic and bone marrow transplantation coupled with in vitro human and mouse erythrocyte culture and in vivo hypoxia challenging mouse studies. We demonstrated for the first time that H2S is an important regulator of erythrocyte Hb-O2 affinity through controlling 2,3-BPG production. Further, we elucidated that H2S promotes Hb release from the membrane to the cytosol and consequently enhances bisphosphoglycerate mutase (BPGM) anchoring to the membrane, leading to a reduction of 2,3-BPG production. In addition, we showed that H2S enhancement of Hb release from the membrane might be associated with S-sulfhydration of Hb. Together, our study provides new insight into RBC physiology by demonstrating a novel signaling pathway that regulates oxygen transport and revealing a previously unrecognized role of H2S in 2,3-BPG production in RBCs.


## 2. Materials and Methods

### 2.1. Animal Procedures

Adult C57BL/6J wild-type (WT) mice were obtained from Shanghai Laboratory Animal Co. (Shanghai, China). CSE-deficient (Cse-/-) mice with C57BL/6J background were provided by Shanghai Biomodel Organism Co., Ltd., and genotyped as described previously [14]. Mice were also housed in social groups of 3–5 in a cage with regular light-dark cycles (12 h) under controlled temperature (22±2°C) and humidity (50±10%) and were given a standard diet and water ad libitum. There were three sets of experiments. In the first set of experiments, both the adult male WT and Cse-/- mice (8 to 10 weeks old) were randomly divided into two groups. The mice were administrated (i.p.) with GYY4137 at a dose of 133 μmol/kg or received the same volume of saline as the vehicle control. The animals were sacrificed 24 h after treatment, and blood and tissues were collected. In the second set of experiments, both the adult male WT and Cse-/- mice were also randomly divided into two groups. WT and Cse-/- mice were administrated (i.p.) with pinacidil (2.8 μmol/kg) or received the same volume of saline as the vehicle control. The animals were sacrificed 24 h after treatment, and blood and tissues were collected. In the third experiment, WT mice were randomly divided into five groups, and two groups of mice were under normobaric hypoxia for 24 h and 72 h, respectively. One group of mice was under normoxia condition as the control. Two groups of mice underwent normobaric hypoxia condition for 1 day with the vehicle and GYY4137 (133 μmol/kg) treatment. For hypoxia treatment, the mice were placed in a hypoxia box (10% O2 and 90% N2) with a standard diet and water ad libitum. GYY4137 and pinacidil were purchased from Sigma-Aldrich and dissolved in saline. The dosage of GYY4137 and pinacidil was chosen based on the literature and our preliminary study [15–17]. All protocols involving animal studies were reviewed and approved by the Animal Care and Use Committee of the Second Military Medical University.


### 2.2. Irradiation and Bone Marrow Transplantation (BMT)

Reciprocal BMT between the WT andCse-/- mice was performed in the present study. Briefly, before irradiation, the recipient mice at 4 to 6 weeks old were treated with 100 μg/ml neomycin and 10 μg/ml polymyxin B sulfate in acidified drinking water (pH 2.7) for 1 week, as described previously with modification [18]. Then, mice were lethally irradiated with 9.0 Gy at a rate of 70 cGy/min using a cobalt-source gamma-irradiator (the irradiation center of the Second Military Medical University). Bone marrow cells (BMCs) were isolated from the femur of donor mice and transferred to irradiated recipient mice through intravenous tail injection (1×106 BMCs/mouse). After BMT, the mice were treated with 100 μg/ml neomycin and 10 μg/ml polymyxin B sulfate in drinking water for another 2 weeks. The mice were maintained for at least 8 weeks, and then the CSE mRNA level in white blood cells of recipient mice was detected as an indicator of chimerism.


### 2.3. Human Subjects

Blood sample collection of healthy human volunteers was performed with the approval of the Specialty Committee on Ethics of Biomedicine Research of the Second Military Medical University (SMMU). Written informed consent from each volunteer was obtained after explaining the study protocol. The participants (28-32 years old) were male, nonsmokers, and free from cardiovascular, respiratory, renal, and hepatic diseases. A volume of 2 ml venous blood was taken from each volunteer.


### 2.4. Blood Collection, Erythrocyte Preparation, andIn Vitro Treatment

Blood collection and RBC preparation were conducted as described previously [19]. Briefly, human and mouse blood samples were collected using heparin as an anticoagulant. Blood samples were centrifuged at 1500×g for 5 min at 4°C within 30 min after collection. Erythrocytes were then collected after aspiration of plasma and white interface. The collected RBCs were loaded on 70% Percoll (GE Healthcare, Uppsala, Sweden) and then centrifuged at 1500×g for 20 min. The RBC pellets were washed with 10x volume of ice-cold PBS 3 times. After determination of RBC protein concentration, the RBC samples were aliquoted and then stored at -80°C.Fresh isolated RBCs were washed with F-10 nutrient mixture (Life Technologies) three times and then resuspended to 4% hematocrit using F-10 media. The cells were plated in six-well culture plates and added with GYY4137 (250-500μM) and subsequently incubated under 5% CO2 and 95% air with gentle shaking for indicating time.


### 2.5. Metabolomic Profiling

The purified RBC samples were collected from 10 male WT mice and 10 maleCse-/- mice as described above. Metabolomic profiling of erythrocytes was conducted by Shanghai Applied Protein Technology, Ltd. (Shanghai, China), via liquid chromatography-tandem mass spectrometry (LC-MS/MS). Briefly, erythrocyte samples were thawed on the ice and exacted in ice-cold lysis/extraction buffer (methanol : acetonitrile : water: 2 : 2 : 1). The samples were sonicated at 4°C for 30 min and incubated at -20°C for 1 h and then centrifuged at 14,000×g for 15 min at 4°C. The supernatants were collected and then dried by speed vacuum. The samples were then reconstituted by analysis buffer (acetonitrile : water: 1 : 1). Analyses were performed using an UHPLC (1290 Infinity LC, Agilent Technologies) coupled to a quadrupole time-of-flight (AB Sciex TripleTOF 6600). RBC extracts were analyzed using a 2.1mm×100mm ACQUITY UPLC BEH 1.7 μm column (Waters, Ireland). In auto MS/MS acquisition, the instrument was set to acquire over the m/z range 25-1000 Da, and the accumulation time for the product ion scan was set at 0.05 s/spectra. The product ion scan is acquired using information-dependent acquisition (IDA) with the high-sensitivity mode selected. The raw MS data (wiff.scan files) were converted to mzXML files using ProteoWizard msConvert before importing into freely available XCMS software. Compound identification of metabolites by MS/MS spectra with an in-house database established with available authentic standards. Subsequently, functional enrichment analyses were performed against the KEGG pathway database (http://www.genome.jp/kegg/pathway.html).


### 2.6. Determination of the Oxygen Dissociation Curve

The oxygen dissociation curve of erythrocytes and Hb was measured using the Hemox Analyzer (TCS Scientific Corporation, New Hope, PA) following the method described previously [14]. Briefly, 10 μl of whole blood aliquot or 10 μl of a 107/μl suspension of erythrocytes was mixed with 4.5 ml of Hemox buffer (TCS Scientific Corporation, New Hope, PA), 10 μl of antifoaming reagent (TCS Scientific Corporation, PA), and 20 μl of 22% BSA in PBS. The mixture was then injected into the Hemox Analyzer for measuring the oxygen equilibrium curve at the temperature of 37°C following the manufacturer’s manual. The oxygen dissociation curve of human and mouse Hb was measured in a similar manner.


### 2.7. Preparation of Hb

Human Hb was obtained from Sigma-Aldrich. Mouse Hb was purified from fresh mouse blood. After isolation of RBCs from whole blood, mouse RBCs were hemolyzed in a solution of (pH 8.0) 5 mM sodium phosphate,1 mM EDTA, and 30μg/ml PMSF (Thermo Fisher Scientific, Rockford, IL) and centrifuged at 40,000×g for 20 min at 4°C. Supernatants were harvested and then purified on a Sephadex G-100 gel filtration column in 0.1 M NaCl. The elutes were then dialyzed overnight in >40-fold excess of 0.01 M HEPES buffer (pH 7.7) to remove 2,3-BPG and other modulating ligands from Hb.Both the human and mouse Hb were reduced with 100 mM tetrasodium pyrophosphate buffer (pH 8.3) containing 10 mM hydrosulfite (Sigma-Aldrich). Reduced Hb was applied to an Econo-Pac 10DG Desalting column (Bio-Rad, Hercules, CA) that was preequilibrated with aerobic HEPES buffer to remove excess sodium hydrosulfite and to form oxyhemoglobin (oxy-Hb) [20, 21].


### 2.8. Measurement of Blood Pressure

Arterial blood pressure measurement was performed as described previously [22]. Briefly, the pregnant rats were anesthetized (urethane 800 mg/kg and alpha-chloralose 40 mg/kg, i.p.), and then the right carotid artery was catheterized. The systolic blood pressure (SBP) was determined by the PowerLab system (ADInstruments, Australia).


### 2.9. Western Blot Analysis

The western blot analysis of the targeted proteins in tissues and erythrocytes was conducted as described by prior studies [7, 19, 23]. For erythrocyte samples, after washing three times with cold PBS, the RBC samples were lysed by freeze/thaw 5 times and then centrifuged at 12,000×g for 15 min at 4°C. The supernatants were harvested for following western blot analysis. The protein concentration was determined by measuring the absorbance at 280 nm. Tissue samples were lysed with cold RIPA lysis buffer (Beyotime, Jiangsu, China), followed by centrifuging at 12,000×g for 15 min at 4°C. The supernatants were then collected. The protein concentration was determined by the Pierce™ BCA Protein Assay Kit (Thermo Fisher Scientific, MA, USA). Then, tissue or cell extracts were mixed with 4x loading buffer containing 250 mmol/l Tris-HCl, 10%SDS, 0.5% bromophenol blue, 50% glycerol, and 7.5% DTT at pH 6.8. Prior to loading on a gel, samples were heated to 99°C for 10 minutes. The samples were separated by 10% SDS-PAGE and subsequently transferred to nitrocellulose membranes (Millipore Corp., Bedford, MA). The membranes were incubated with blocking buffer (Tris-buffered saline containing 0.1% Tween-20 and 5% skimmed milk powder) for 2 h at room temperature and then incubated with primary antibodies against BPGM (Santa Cruz Biotechnology; Cat# sc-373819), hemoglobin (Abcam; Cat# ab-191183), band 4.2 (Aviva Systems Biology; Cat# ABIN214102), or β-actin (Abcam; Cat# ab-8226) at 4°C overnight. After incubation with a secondary horseradish peroxidase-conjugated IgG (Santa Cruz Biotechnology) for 1 h at room temperature, immunoblots were visualized using the enhanced chemiluminescence western blot detection system (Millipore). The chemiluminescent signal from the membranes was quantified by a GeneGnome HR scanner using GeneTools software (SynGene).


### 2.10. Measurement of 2,3-BPG

2,3-BPG in erythrocytes was extracted, and its concentration was determined by using a commercially available kit (Roche, Nutley, NJ) as described by prior studies [24, 25]. Briefly, RBC pellets were added with 0.6 M ice-cold perchloric acid on ice, vortexed, and subsequently sonicated for 10 s. Then, the homogenates were centrifuged at 20,000×g for 10 min at 4°C. The supernatants were collected and neutralized with 10 ml 2.5 M K2CO3, then centrifuged at 20,000×g for 5 min at 4°C. The supernatants were harvested and then used to quantify 2,3-BPG concentration using a 2,3-BPG kit following the manufacturer’s manual.


### 2.11. Measurement of the H2S Level in Circulation and H2S Generation in RBCs

The level of H2S in plasma was measured following the method described by prior studies [26, 27]. Briefly, a volume of 40 μl plasma was mixed with 62.5 μl Zn acetate (1%, w/v) and 100 μl distilled water. The mixture was incubated for 10 min at room temperature and then added with 62.5 μl trichloroacetic acid (10%) and centrifuged at 14,000×g for 10 min at 4°C. The supernatant was collected and mixed with the 30 μl buffer containing N,N-dimethyl-p-phenylenediamine sulfate (2 M) and FeCl3 (3 M) in 1.2 M HCl for 20 min. Absorbance at 650 nm was measured by the Cytation 3 Imaging Reader (BioTek).To determine the real-time kinetics of H2S production by RBCs, a miniaturized H2S microrespiration sensor (Model H2S-MRCh, Unisense, Aarhus, Denmark) coupled to a Unisense PA2000 amplifier was used as previously described [7]. Briefly, The RBC samples were lysed by freeze/thaw in ice-cold PBS containing protease inhibitor (Roche), followed by centrifuging at 12,000 rpm for 15 min at 4°C. 1 ml analysis buffer (1 mM L-cysteine and 2 mM pyridoxal-5′-phosphate in PBS) at 37°C was added into a temperature-controlled microrespiration chamber (Unisense) inside a well-grounded Faraday cage. In order to avoid the spontaneous H2S oxidation, nitrogen was used to deoxygenate the analysis buffer in the respiratory chamber. After the sensor signals were stabilized, 50 μl RBC protein solution (10-20 mg) was injected into the chamber, and real-time H2S production trace was recorded. H2S production rates were determined at the initial steepest slopes of each trace.


### 2.12. Isolation of RBC Membrane and Cytosolic Proteins and Measurement of Heme Concentration

The membrane and cytosolic proteins of RBCs for determination of BPGM and heme levels were separated by using the Mem-PER Plus Membrane Protein Extraction Kit (Cat# 89842, Thermo Fisher Scientific) following the manufacturer’s instruction. Briefly, RBCs were freshly isolated from 200μl mouse or human blood. After washing the RBC samples with Cell Wash Solution, the cells were resuspended in Cell Wash Solution and centrifuged at 300×g for 5 min. The cell pellets were added with Permeabilization Buffer, vortexed, and incubated for 10 min at 4°C with constant mixing. Then, permeabilized cells were centrifuged at 20,000×g for 15 min at 4°C. The supernatants (containing cytosolic proteins) were harvested and transferred to a new tube. The pellets were mixed with Solubilization Buffer, vortexed, and incubated for 30 min at 4°C with constant mixing and then centrifuged at 20,000×g for 15 minutes at 4°C. The supernatants (containing membrane proteins) were harvested and transferred to a new tube. The levels of BPGM in cytosolic and membrane extracts were determined by western blot.The heme concentration in the membrane fraction was measured as described previously [28]. Briefly, a volume of 20 μl membrane protein solution was mixed with 1 ml formic acid and vortexed for 1 min and centrifuged at 14,000×g. The supernatant was collected and mixed with 100 μl 5 M NaOH. The heme content in the membrane protein solution was determined by measuring its absorbance at 398 nm within 1 h, which was compared with that of a standard curve derived from human hemoglobin dissolved in an identical concentration of formic acid.


### 2.13. Determination of BPGM Activity in the Cytoplasm

Isolation of the cytoplasm was performed following the methods with modification [19]. Briefly, fresh isolated RBCs were washed three times in cold wash buffer: 5 mM Na2HPO4, pH 8.0, containing NaCl (0.9%). The cells were treated with 5 mM Na2HPO4 buffer (pH 8.0) and centrifuged at 20,000×g for 20 min at 4°C. The supernatants were harvested for measuring BPGM activity immediately.BPGM activity was measured following the method described previously [29]. The cytoplasmic extract of erythrocytes was incubated in a 100 μl reaction mixture containing 100 mM triethanolamine (pH 7.6), 1 mM MgSO4, 4 mM ATP, 3 mM 3-phosphoglycerate, and 10 U phosphoglycerate kinase at 30°C for 20 min. The reaction was then terminated by the addition of 25 μl of trichloroacetic acid and centrifuged at 10,000×g for 5 min. 100 μl of the supernatant was mixed with 17 μl of 1.8 M Tris base, and the 2,3-BPG level was determined by using a 2,3-BPG kit.


### 2.14. Coimmunoprecipitation

RBCs were lysed in RIPA lysis buffer (Beyotime) with protease inhibitor cocktail and protease inhibitor (Roche) and then incubated on ice for 2 h. After centrifugation, the supernatants were incubated with antibodies against BPGM or band 4.2 antibody (Aviva Systems Biology) at 4°C overnight with gentle rotation and then added with protein A and G sepharose beads (Santa Cruz Biotechnology) and incubated at 4°C for an additional 3 h. The immune complexes were washed four times. The final precipitates were collected for western blot analysis. A rabbit IgG antibody was used as a negative control. The precipitates by BPGM were also collected for LC-MS/MS analysis for identification of the potential proteins that interacted with BPGM.


### 2.15. Immunofluorescent Staining of BPGM in Erythrocytes

Mouse and human erythrocytes were fixed with ice-cold methanol for 10 min. After washing the cells with PBS two times, the cells were then blocked with 1% BSA in PBS (pH 7.4) for 1 h at room temperature. Cells were incubated with an anti-BPGM monoclonal antibody (1 : 100; Santa Cruz Biotechnology) at 4°C overnight. After washing with PBS three times, the cells were incubated with Alexa Fluor 488 donkey anti-mouse IgG (1 : 1000; Life Technologies) for 1 h at room temperature in the dark. The cells were then washed with PBS three times and resuspended in PBS. The cells were smeared on the slides and then dried in the dark. The slides were mounted with cover glass and observed under a confocal microscope (Zeiss LSM 780, Zeiss Inc., Jena, Germany).


### 2.16. Preparation of Erythrocyte Ghost Cells and Ghost Membrane Assay

Erythrocyte ghost cells were prepared from human or mouse fresh blood as described previously [30, 31]. Briefly, erythrocytes were isolated and washed with PBS at 4°C three times. The cells were then lysed in 5 mM phosphate buffer (pH 8.0) containing protease inhibitor cocktail (Roche) and 1 mM EDTA. The lysed cells were centrifuged at 20,000×g for 20 min at 4°C. The pellets were collected and washed in phosphate buffer seven times to obtain ghost cells.Ghost membrane assay was performed as described previously [30, 32]. Nonporous silica (SiO2) microspheres with a diameter of 3.17 μm were purchased from Bangs Laboratories (Fishers, USA). The silica beads were prepared as follows: beads were treated with 6 ml of the buffer (30% H2O2/30% NH4OH/H2O: 1/1/5) and sonicated for 5 min, then were incubated at 60°C for 30 min. Then, the beads were washed with Millipore water (pH 5.5) 5 times, followed by washing with phosphate buffer (5 mM, pH 8.0) 3 times. The beads were then coated by ghost cells, and the inside-out membrane (IOM) was therefore produced. The IOM was washed gently with phosphate buffer (5 mM, pH 8.0) 6 times. Packed 5×109 IOM beads were added in 100 μl 5 mM phosphate buffer (pH 7.4) with 100 μM human or mouse hemoglobin, different concentrations of GYY4137, and/or iodoacetamide (Sigma-Aldrich). Beads were incubated at 37°C for 30 min and then centrifuged at 500×g for 1 min. The supernatant was collected for BPGM activity assay, while the pelleted beads were washed with phosphate buffer (pH 7.4) 6 times. These beads were added into 100 μl of concentrated formic acid (Sigma-Aldrich) and vortexed for 5 min. The beads were centrifuged at 500×g for 2 min. The supernatants were collected for the determination of heme concentration.


### 2.17. Determination of the Proteins with S-Sulfhydration

S-Sulfhydrated proteins were examined by using two methods. For the identification of potential S-sulfhydrated proteins, maleimide assay was performed as described previously [33]. Briefly, RBCs were lysed in RIPA-A buffer with rotation at 4°C for 30 min. The lysates were centrifuged at 20,000×g for 10 min. The supernatants were collected and then incubated with 2 mM of Alexa Fluor 680-conjugated C2 maleimide for 2 h at 4°C with occasional gentle mixing, followed by incubation with or without DTT (1 mM) for 1 h at 4°C. The lysates were used for SDS-PAGE gel electrophoresis. The protein bands with S-sulfhydration were collected from the gel for analysis by LC-MS/MS in order to identify the potential proteins that might be S-sulfhydrated.For determination of S-sulfhydration of Hb and BPGM, biotin-switch assay was conducted as described previously [27, 34]. Briefly, RBCs were homogenized in HEN buffer, which consists of 250 mM HEPES-NaOH (pH 7.7), 1 mM EDTA, and 0.1 mM neocuproine supplemented with 100 μM deferoxamine. After centrifugation at 13,000×g for 30 min at 4°C, the supernatants were incubated with HEN buffer (2.5% SDS and 20 mM methyl methanethiosulfonate) at 50°C for 20 min with frequent vortexing. Acetone was then added in order to remove methyl methanethiosulfonate, and the mixture was allowed to be precipitated at –20°C for 20 min. After centrifugation, the proteins were resuspended in HEN buffer containing 1% SDS (i.e., HENS buffer). The suspension was added with biotin-HPDP in dimethyl sulfoxide without ascorbic acid and incubated for 3 h at 25°C. Biotinylated proteins were precipitated by streptavidin agarose beads. The proteins were then washed with the HENS buffer and then subjected for western blot analysis using antibodies against Hb or BPGM.Identification of the proteins with S-sulfhydration and the proteins that interacted with BPGM was performed by BioCloud Ltd. (Shanghai, China) via LC-MS/MS. Briefly, digestion of the samples was incubated with trypsin buffer at 37°C for 12 hours and then added with formic acid (0.1% (v/v) final) in order to acidify the tryptic peptides. Then, peptide samples were separated with the nanoACQUITY UPLC (Waters Corporation, Milford) and detected with the Q Exactive mass spectrometer (Thermo Fisher Scientific). The MS/MS spectra were preprocessed with PEAKS Studio version 8.5 (Bioinformatics Inc., CA). The PEAKS DB was searched against the Rattus database (UniProtKB/Swiss-Prot), assuming the digestion enzyme trypsin. The following search parameters were used: fixed modifications: Carbamidomethyl (C), Acetylation (Protein N-term), and Deamidation (NQ); variable modifications: Oxidation (M); missed cleavages: 2; MS mass tolerance: ±10.0 ppm; and MS/MS mass tolerance: ±0.02 Da.Identification of the S-sulfhydration site of Hb was performed by Shanghai Applied Protein Technology, Ltd. (Shanghai, China), using LC-MS/MS. Briefly, RBC samples were lysed in UA buffer (8 M urea, 150 mM Tris-HCl, pH 8.0) with ultrasonication. After centrifugation, the samples were digested by trypsin buffer overnight. The peptide samples were collected and then desalted on C18 Cartridges. After concentration, the samples were reconstituted in 0.1% (v/v) formic acid. The peptide mixture was loaded onto a reversed phase trap column (Thermo Scientific Acclaim PepMap100) connected to the C18 reversed phase analytical column (Thermo Scientific EASY Column) and detected by the Q Exactive mass spectrometer (Thermo Fisher Scientific). The MS/MS spectra were searched using MASCOT engine (Matrix Science, London, UK; version 2.2) against the National Center for Biotechnology Information (https://www.ncbi.nlm.nih.gov/), assuming the digestion enzyme trypsin. For protein identification, the following options were used: peptide mass tolerance=20ppm, MS/MS tolerance=0.1Da, missed cleavage=2, and variable modification: Oxidation (M), Acetylation (Protein N-term), S (modified sulfhydration) of cysteine.


### 2.18. Statistical Analysis

Statistical analyses were performed using SPSS 20. All data are expressed asmean±SEM. Normal distribution was assessed by the Shapiro-Wilk test. Statistical significance was determined according to sample distribution and homogeneity of variance. Statistical comparisons between two groups were determined by a two-tailed Student’s t-test. One-way ANOVA with Bonferroni’s post hoc test and the Kruskal-Wallis test with Dunn’s post hoc test were performed for multigroup analysis. p<0.05 was considered statistically significant.


## 2.1. Animal Procedures

Adult C57BL/6J wild-type (WT) mice were obtained from Shanghai Laboratory Animal Co. (Shanghai, China). CSE-deficient (Cse-/-) mice with C57BL/6J background were provided by Shanghai Biomodel Organism Co., Ltd., and genotyped as described previously [14]. Mice were also housed in social groups of 3–5 in a cage with regular light-dark cycles (12 h) under controlled temperature (22±2°C) and humidity (50±10%) and were given a standard diet and water ad libitum. There were three sets of experiments. In the first set of experiments, both the adult male WT and Cse-/- mice (8 to 10 weeks old) were randomly divided into two groups. The mice were administrated (i.p.) with GYY4137 at a dose of 133 μmol/kg or received the same volume of saline as the vehicle control. The animals were sacrificed 24 h after treatment, and blood and tissues were collected. In the second set of experiments, both the adult male WT and Cse-/- mice were also randomly divided into two groups. WT and Cse-/- mice were administrated (i.p.) with pinacidil (2.8 μmol/kg) or received the same volume of saline as the vehicle control. The animals were sacrificed 24 h after treatment, and blood and tissues were collected. In the third experiment, WT mice were randomly divided into five groups, and two groups of mice were under normobaric hypoxia for 24 h and 72 h, respectively. One group of mice was under normoxia condition as the control. Two groups of mice underwent normobaric hypoxia condition for 1 day with the vehicle and GYY4137 (133 μmol/kg) treatment. For hypoxia treatment, the mice were placed in a hypoxia box (10% O2 and 90% N2) with a standard diet and water ad libitum. GYY4137 and pinacidil were purchased from Sigma-Aldrich and dissolved in saline. The dosage of GYY4137 and pinacidil was chosen based on the literature and our preliminary study [15–17]. All protocols involving animal studies were reviewed and approved by the Animal Care and Use Committee of the Second Military Medical University.


## 2.2. Irradiation and Bone Marrow Transplantation (BMT)

Reciprocal BMT between the WT andCse-/- mice was performed in the present study. Briefly, before irradiation, the recipient mice at 4 to 6 weeks old were treated with 100 μg/ml neomycin and 10 μg/ml polymyxin B sulfate in acidified drinking water (pH 2.7) for 1 week, as described previously with modification [18]. Then, mice were lethally irradiated with 9.0 Gy at a rate of 70 cGy/min using a cobalt-source gamma-irradiator (the irradiation center of the Second Military Medical University). Bone marrow cells (BMCs) were isolated from the femur of donor mice and transferred to irradiated recipient mice through intravenous tail injection (1×106 BMCs/mouse). After BMT, the mice were treated with 100 μg/ml neomycin and 10 μg/ml polymyxin B sulfate in drinking water for another 2 weeks. The mice were maintained for at least 8 weeks, and then the CSE mRNA level in white blood cells of recipient mice was detected as an indicator of chimerism.


## 2.3. Human Subjects

Blood sample collection of healthy human volunteers was performed with the approval of the Specialty Committee on Ethics of Biomedicine Research of the Second Military Medical University (SMMU). Written informed consent from each volunteer was obtained after explaining the study protocol. The participants (28-32 years old) were male, nonsmokers, and free from cardiovascular, respiratory, renal, and hepatic diseases. A volume of 2 ml venous blood was taken from each volunteer.


## 2.4. Blood Collection, Erythrocyte Preparation, andIn Vitro Treatment

Blood collection and RBC preparation were conducted as described previously [19]. Briefly, human and mouse blood samples were collected using heparin as an anticoagulant. Blood samples were centrifuged at 1500×g for 5 min at 4°C within 30 min after collection. Erythrocytes were then collected after aspiration of plasma and white interface. The collected RBCs were loaded on 70% Percoll (GE Healthcare, Uppsala, Sweden) and then centrifuged at 1500×g for 20 min. The RBC pellets were washed with 10x volume of ice-cold PBS 3 times. After determination of RBC protein concentration, the RBC samples were aliquoted and then stored at -80°C.Fresh isolated RBCs were washed with F-10 nutrient mixture (Life Technologies) three times and then resuspended to 4% hematocrit using F-10 media. The cells were plated in six-well culture plates and added with GYY4137 (250-500μM) and subsequently incubated under 5% CO2 and 95% air with gentle shaking for indicating time.


## 2.5. Metabolomic Profiling

The purified RBC samples were collected from 10 male WT mice and 10 maleCse-/- mice as described above. Metabolomic profiling of erythrocytes was conducted by Shanghai Applied Protein Technology, Ltd. (Shanghai, China), via liquid chromatography-tandem mass spectrometry (LC-MS/MS). Briefly, erythrocyte samples were thawed on the ice and exacted in ice-cold lysis/extraction buffer (methanol : acetonitrile : water: 2 : 2 : 1). The samples were sonicated at 4°C for 30 min and incubated at -20°C for 1 h and then centrifuged at 14,000×g for 15 min at 4°C. The supernatants were collected and then dried by speed vacuum. The samples were then reconstituted by analysis buffer (acetonitrile : water: 1 : 1). Analyses were performed using an UHPLC (1290 Infinity LC, Agilent Technologies) coupled to a quadrupole time-of-flight (AB Sciex TripleTOF 6600). RBC extracts were analyzed using a 2.1mm×100mm ACQUITY UPLC BEH 1.7 μm column (Waters, Ireland). In auto MS/MS acquisition, the instrument was set to acquire over the m/z range 25-1000 Da, and the accumulation time for the product ion scan was set at 0.05 s/spectra. The product ion scan is acquired using information-dependent acquisition (IDA) with the high-sensitivity mode selected. The raw MS data (wiff.scan files) were converted to mzXML files using ProteoWizard msConvert before importing into freely available XCMS software. Compound identification of metabolites by MS/MS spectra with an in-house database established with available authentic standards. Subsequently, functional enrichment analyses were performed against the KEGG pathway database (http://www.genome.jp/kegg/pathway.html).


## 2.6. Determination of the Oxygen Dissociation Curve

The oxygen dissociation curve of erythrocytes and Hb was measured using the Hemox Analyzer (TCS Scientific Corporation, New Hope, PA) following the method described previously [14]. Briefly, 10 μl of whole blood aliquot or 10 μl of a 107/μl suspension of erythrocytes was mixed with 4.5 ml of Hemox buffer (TCS Scientific Corporation, New Hope, PA), 10 μl of antifoaming reagent (TCS Scientific Corporation, PA), and 20 μl of 22% BSA in PBS. The mixture was then injected into the Hemox Analyzer for measuring the oxygen equilibrium curve at the temperature of 37°C following the manufacturer’s manual. The oxygen dissociation curve of human and mouse Hb was measured in a similar manner.


## 2.7. Preparation of Hb

Human Hb was obtained from Sigma-Aldrich. Mouse Hb was purified from fresh mouse blood. After isolation of RBCs from whole blood, mouse RBCs were hemolyzed in a solution of (pH 8.0) 5 mM sodium phosphate,1 mM EDTA, and 30μg/ml PMSF (Thermo Fisher Scientific, Rockford, IL) and centrifuged at 40,000×g for 20 min at 4°C. Supernatants were harvested and then purified on a Sephadex G-100 gel filtration column in 0.1 M NaCl. The elutes were then dialyzed overnight in >40-fold excess of 0.01 M HEPES buffer (pH 7.7) to remove 2,3-BPG and other modulating ligands from Hb.Both the human and mouse Hb were reduced with 100 mM tetrasodium pyrophosphate buffer (pH 8.3) containing 10 mM hydrosulfite (Sigma-Aldrich). Reduced Hb was applied to an Econo-Pac 10DG Desalting column (Bio-Rad, Hercules, CA) that was preequilibrated with aerobic HEPES buffer to remove excess sodium hydrosulfite and to form oxyhemoglobin (oxy-Hb) [20, 21].


## 2.8. Measurement of Blood Pressure

Arterial blood pressure measurement was performed as described previously [22]. Briefly, the pregnant rats were anesthetized (urethane 800 mg/kg and alpha-chloralose 40 mg/kg, i.p.), and then the right carotid artery was catheterized. The systolic blood pressure (SBP) was determined by the PowerLab system (ADInstruments, Australia).


## 2.9. Western Blot Analysis

The western blot analysis of the targeted proteins in tissues and erythrocytes was conducted as described by prior studies [7, 19, 23]. For erythrocyte samples, after washing three times with cold PBS, the RBC samples were lysed by freeze/thaw 5 times and then centrifuged at 12,000×g for 15 min at 4°C. The supernatants were harvested for following western blot analysis. The protein concentration was determined by measuring the absorbance at 280 nm. Tissue samples were lysed with cold RIPA lysis buffer (Beyotime, Jiangsu, China), followed by centrifuging at 12,000×g for 15 min at 4°C. The supernatants were then collected. The protein concentration was determined by the Pierce™ BCA Protein Assay Kit (Thermo Fisher Scientific, MA, USA). Then, tissue or cell extracts were mixed with 4x loading buffer containing 250 mmol/l Tris-HCl, 10%SDS, 0.5% bromophenol blue, 50% glycerol, and 7.5% DTT at pH 6.8. Prior to loading on a gel, samples were heated to 99°C for 10 minutes. The samples were separated by 10% SDS-PAGE and subsequently transferred to nitrocellulose membranes (Millipore Corp., Bedford, MA). The membranes were incubated with blocking buffer (Tris-buffered saline containing 0.1% Tween-20 and 5% skimmed milk powder) for 2 h at room temperature and then incubated with primary antibodies against BPGM (Santa Cruz Biotechnology; Cat# sc-373819), hemoglobin (Abcam; Cat# ab-191183), band 4.2 (Aviva Systems Biology; Cat# ABIN214102), or β-actin (Abcam; Cat# ab-8226) at 4°C overnight. After incubation with a secondary horseradish peroxidase-conjugated IgG (Santa Cruz Biotechnology) for 1 h at room temperature, immunoblots were visualized using the enhanced chemiluminescence western blot detection system (Millipore). The chemiluminescent signal from the membranes was quantified by a GeneGnome HR scanner using GeneTools software (SynGene).


## 2.10. Measurement of 2,3-BPG

2,3-BPG in erythrocytes was extracted, and its concentration was determined by using a commercially available kit (Roche, Nutley, NJ) as described by prior studies [24, 25]. Briefly, RBC pellets were added with 0.6 M ice-cold perchloric acid on ice, vortexed, and subsequently sonicated for 10 s. Then, the homogenates were centrifuged at 20,000×g for 10 min at 4°C. The supernatants were collected and neutralized with 10 ml 2.5 M K2CO3, then centrifuged at 20,000×g for 5 min at 4°C. The supernatants were harvested and then used to quantify 2,3-BPG concentration using a 2,3-BPG kit following the manufacturer’s manual.


## 2.11. Measurement of the H2S Level in Circulation and H2S Generation in RBCs

The level of H2S in plasma was measured following the method described by prior studies [26, 27]. Briefly, a volume of 40 μl plasma was mixed with 62.5 μl Zn acetate (1%, w/v) and 100 μl distilled water. The mixture was incubated for 10 min at room temperature and then added with 62.5 μl trichloroacetic acid (10%) and centrifuged at 14,000×g for 10 min at 4°C. The supernatant was collected and mixed with the 30 μl buffer containing N,N-dimethyl-p-phenylenediamine sulfate (2 M) and FeCl3 (3 M) in 1.2 M HCl for 20 min. Absorbance at 650 nm was measured by the Cytation 3 Imaging Reader (BioTek).To determine the real-time kinetics of H2S production by RBCs, a miniaturized H2S microrespiration sensor (Model H2S-MRCh, Unisense, Aarhus, Denmark) coupled to a Unisense PA2000 amplifier was used as previously described [7]. Briefly, The RBC samples were lysed by freeze/thaw in ice-cold PBS containing protease inhibitor (Roche), followed by centrifuging at 12,000 rpm for 15 min at 4°C. 1 ml analysis buffer (1 mM L-cysteine and 2 mM pyridoxal-5′-phosphate in PBS) at 37°C was added into a temperature-controlled microrespiration chamber (Unisense) inside a well-grounded Faraday cage. In order to avoid the spontaneous H2S oxidation, nitrogen was used to deoxygenate the analysis buffer in the respiratory chamber. After the sensor signals were stabilized, 50 μl RBC protein solution (10-20 mg) was injected into the chamber, and real-time H2S production trace was recorded. H2S production rates were determined at the initial steepest slopes of each trace.


## 2.12. Isolation of RBC Membrane and Cytosolic Proteins and Measurement of Heme Concentration

The membrane and cytosolic proteins of RBCs for determination of BPGM and heme levels were separated by using the Mem-PER Plus Membrane Protein Extraction Kit (Cat# 89842, Thermo Fisher Scientific) following the manufacturer’s instruction. Briefly, RBCs were freshly isolated from 200μl mouse or human blood. After washing the RBC samples with Cell Wash Solution, the cells were resuspended in Cell Wash Solution and centrifuged at 300×g for 5 min. The cell pellets were added with Permeabilization Buffer, vortexed, and incubated for 10 min at 4°C with constant mixing. Then, permeabilized cells were centrifuged at 20,000×g for 15 min at 4°C. The supernatants (containing cytosolic proteins) were harvested and transferred to a new tube. The pellets were mixed with Solubilization Buffer, vortexed, and incubated for 30 min at 4°C with constant mixing and then centrifuged at 20,000×g for 15 minutes at 4°C. The supernatants (containing membrane proteins) were harvested and transferred to a new tube. The levels of BPGM in cytosolic and membrane extracts were determined by western blot.The heme concentration in the membrane fraction was measured as described previously [28]. Briefly, a volume of 20 μl membrane protein solution was mixed with 1 ml formic acid and vortexed for 1 min and centrifuged at 14,000×g. The supernatant was collected and mixed with 100 μl 5 M NaOH. The heme content in the membrane protein solution was determined by measuring its absorbance at 398 nm within 1 h, which was compared with that of a standard curve derived from human hemoglobin dissolved in an identical concentration of formic acid.


## 2.13. Determination of BPGM Activity in the Cytoplasm

Isolation of the cytoplasm was performed following the methods with modification [19]. Briefly, fresh isolated RBCs were washed three times in cold wash buffer: 5 mM Na2HPO4, pH 8.0, containing NaCl (0.9%). The cells were treated with 5 mM Na2HPO4 buffer (pH 8.0) and centrifuged at 20,000×g for 20 min at 4°C. The supernatants were harvested for measuring BPGM activity immediately.BPGM activity was measured following the method described previously [29]. The cytoplasmic extract of erythrocytes was incubated in a 100 μl reaction mixture containing 100 mM triethanolamine (pH 7.6), 1 mM MgSO4, 4 mM ATP, 3 mM 3-phosphoglycerate, and 10 U phosphoglycerate kinase at 30°C for 20 min. The reaction was then terminated by the addition of 25 μl of trichloroacetic acid and centrifuged at 10,000×g for 5 min. 100 μl of the supernatant was mixed with 17 μl of 1.8 M Tris base, and the 2,3-BPG level was determined by using a 2,3-BPG kit.


## 2.14. Coimmunoprecipitation

RBCs were lysed in RIPA lysis buffer (Beyotime) with protease inhibitor cocktail and protease inhibitor (Roche) and then incubated on ice for 2 h. After centrifugation, the supernatants were incubated with antibodies against BPGM or band 4.2 antibody (Aviva Systems Biology) at 4°C overnight with gentle rotation and then added with protein A and G sepharose beads (Santa Cruz Biotechnology) and incubated at 4°C for an additional 3 h. The immune complexes were washed four times. The final precipitates were collected for western blot analysis. A rabbit IgG antibody was used as a negative control. The precipitates by BPGM were also collected for LC-MS/MS analysis for identification of the potential proteins that interacted with BPGM.


## 2.15. Immunofluorescent Staining of BPGM in Erythrocytes

Mouse and human erythrocytes were fixed with ice-cold methanol for 10 min. After washing the cells with PBS two times, the cells were then blocked with 1% BSA in PBS (pH 7.4) for 1 h at room temperature. Cells were incubated with an anti-BPGM monoclonal antibody (1 : 100; Santa Cruz Biotechnology) at 4°C overnight. After washing with PBS three times, the cells were incubated with Alexa Fluor 488 donkey anti-mouse IgG (1 : 1000; Life Technologies) for 1 h at room temperature in the dark. The cells were then washed with PBS three times and resuspended in PBS. The cells were smeared on the slides and then dried in the dark. The slides were mounted with cover glass and observed under a confocal microscope (Zeiss LSM 780, Zeiss Inc., Jena, Germany).


## 2.16. Preparation of Erythrocyte Ghost Cells and Ghost Membrane Assay

Erythrocyte ghost cells were prepared from human or mouse fresh blood as described previously [30, 31]. Briefly, erythrocytes were isolated and washed with PBS at 4°C three times. The cells were then lysed in 5 mM phosphate buffer (pH 8.0) containing protease inhibitor cocktail (Roche) and 1 mM EDTA. The lysed cells were centrifuged at 20,000×g for 20 min at 4°C. The pellets were collected and washed in phosphate buffer seven times to obtain ghost cells.Ghost membrane assay was performed as described previously [30, 32]. Nonporous silica (SiO2) microspheres with a diameter of 3.17 μm were purchased from Bangs Laboratories (Fishers, USA). The silica beads were prepared as follows: beads were treated with 6 ml of the buffer (30% H2O2/30% NH4OH/H2O: 1/1/5) and sonicated for 5 min, then were incubated at 60°C for 30 min. Then, the beads were washed with Millipore water (pH 5.5) 5 times, followed by washing with phosphate buffer (5 mM, pH 8.0) 3 times. The beads were then coated by ghost cells, and the inside-out membrane (IOM) was therefore produced. The IOM was washed gently with phosphate buffer (5 mM, pH 8.0) 6 times. Packed 5×109 IOM beads were added in 100 μl 5 mM phosphate buffer (pH 7.4) with 100 μM human or mouse hemoglobin, different concentrations of GYY4137, and/or iodoacetamide (Sigma-Aldrich). Beads were incubated at 37°C for 30 min and then centrifuged at 500×g for 1 min. The supernatant was collected for BPGM activity assay, while the pelleted beads were washed with phosphate buffer (pH 7.4) 6 times. These beads were added into 100 μl of concentrated formic acid (Sigma-Aldrich) and vortexed for 5 min. The beads were centrifuged at 500×g for 2 min. The supernatants were collected for the determination of heme concentration.


## 2.17. Determination of the Proteins with S-Sulfhydration

S-Sulfhydrated proteins were examined by using two methods. For the identification of potential S-sulfhydrated proteins, maleimide assay was performed as described previously [33]. Briefly, RBCs were lysed in RIPA-A buffer with rotation at 4°C for 30 min. The lysates were centrifuged at 20,000×g for 10 min. The supernatants were collected and then incubated with 2 mM of Alexa Fluor 680-conjugated C2 maleimide for 2 h at 4°C with occasional gentle mixing, followed by incubation with or without DTT (1 mM) for 1 h at 4°C. The lysates were used for SDS-PAGE gel electrophoresis. The protein bands with S-sulfhydration were collected from the gel for analysis by LC-MS/MS in order to identify the potential proteins that might be S-sulfhydrated.For determination of S-sulfhydration of Hb and BPGM, biotin-switch assay was conducted as described previously [27, 34]. Briefly, RBCs were homogenized in HEN buffer, which consists of 250 mM HEPES-NaOH (pH 7.7), 1 mM EDTA, and 0.1 mM neocuproine supplemented with 100 μM deferoxamine. After centrifugation at 13,000×g for 30 min at 4°C, the supernatants were incubated with HEN buffer (2.5% SDS and 20 mM methyl methanethiosulfonate) at 50°C for 20 min with frequent vortexing. Acetone was then added in order to remove methyl methanethiosulfonate, and the mixture was allowed to be precipitated at –20°C for 20 min. After centrifugation, the proteins were resuspended in HEN buffer containing 1% SDS (i.e., HENS buffer). The suspension was added with biotin-HPDP in dimethyl sulfoxide without ascorbic acid and incubated for 3 h at 25°C. Biotinylated proteins were precipitated by streptavidin agarose beads. The proteins were then washed with the HENS buffer and then subjected for western blot analysis using antibodies against Hb or BPGM.Identification of the proteins with S-sulfhydration and the proteins that interacted with BPGM was performed by BioCloud Ltd. (Shanghai, China) via LC-MS/MS. Briefly, digestion of the samples was incubated with trypsin buffer at 37°C for 12 hours and then added with formic acid (0.1% (v/v) final) in order to acidify the tryptic peptides. Then, peptide samples were separated with the nanoACQUITY UPLC (Waters Corporation, Milford) and detected with the Q Exactive mass spectrometer (Thermo Fisher Scientific). The MS/MS spectra were preprocessed with PEAKS Studio version 8.5 (Bioinformatics Inc., CA). The PEAKS DB was searched against the Rattus database (UniProtKB/Swiss-Prot), assuming the digestion enzyme trypsin. The following search parameters were used: fixed modifications: Carbamidomethyl (C), Acetylation (Protein N-term), and Deamidation (NQ); variable modifications: Oxidation (M); missed cleavages: 2; MS mass tolerance: ±10.0 ppm; and MS/MS mass tolerance: ±0.02 Da.Identification of the S-sulfhydration site of Hb was performed by Shanghai Applied Protein Technology, Ltd. (Shanghai, China), using LC-MS/MS. Briefly, RBC samples were lysed in UA buffer (8 M urea, 150 mM Tris-HCl, pH 8.0) with ultrasonication. After centrifugation, the samples were digested by trypsin buffer overnight. The peptide samples were collected and then desalted on C18 Cartridges. After concentration, the samples were reconstituted in 0.1% (v/v) formic acid. The peptide mixture was loaded onto a reversed phase trap column (Thermo Scientific Acclaim PepMap100) connected to the C18 reversed phase analytical column (Thermo Scientific EASY Column) and detected by the Q Exactive mass spectrometer (Thermo Fisher Scientific). The MS/MS spectra were searched using MASCOT engine (Matrix Science, London, UK; version 2.2) against the National Center for Biotechnology Information (https://www.ncbi.nlm.nih.gov/), assuming the digestion enzyme trypsin. For protein identification, the following options were used: peptide mass tolerance=20ppm, MS/MS tolerance=0.1Da, missed cleavage=2, and variable modification: Oxidation (M), Acetylation (Protein N-term), S (modified sulfhydration) of cysteine.


## 2.18. Statistical Analysis

Statistical analyses were performed using SPSS 20. All data are expressed asmean±SEM. Normal distribution was assessed by the Shapiro-Wilk test. Statistical significance was determined according to sample distribution and homogeneity of variance. Statistical comparisons between two groups were determined by a two-tailed Student’s t-test. One-way ANOVA with Bonferroni’s post hoc test and the Kruskal-Wallis test with Dunn’s post hoc test were performed for multigroup analysis. p<0.05 was considered statistically significant.


## 3. Results

### 3.1. H2S Is Essential for Normal Erythrocyte 2,3-BPG Production and Hb-O2 Binding Affinity

We explored the functional role of H2S in erythrocytes using Cse-/- mice as Cse-/- mice show a remarkably decreased H2S level [26, 35]. Using the metabolomic technique, we identified 98 metabolites in erythrocytes and revealed that several metabolic pathways, such as pyruvate metabolism and glycolysis or gluconeogenesis, were significantly changed in Cse-/- mice compared with WT mice (supplemental Tab. S1-S3). Of note, 2,3-BPG was significantly elevated among the metabolites in the erythrocytes of Cse-/- mice compared to WT mice (supplemental Tab. S2). An elevated erythrocyte 2,3-BPG level in Cse-/- mice was then confirmed by spectrophotometric assay (Figure 1(a)). As 2,3-BPG is a specific allosteric modulator that regulates Hb-O2 affinity [2], we examined the oxygen dissociation curve of Cse-/- mice. As expected, the 50% oxygen saturation (P50) value was significantly increased in Cse-/- mice by 4 to 6 mmHg compared with WT mice (Figures 1(b) and 1(c)).Figure 1
Reduced H2S level contributes to increased 2,3-BPG production and decreased Hb-O2 affinity in erythrocytes of Cse-/-mice. WT and Cse-/- mice were administered with saline or GYY4137 (133 μmol/kg). (a–c) Erythrocytes were isolated for determination of the 2,3-BPG level (a) and oxygen dissociation curve ((b) P50 value; (c) representative trace of the oxygen dissociation curve) 24 h after injection. Data are expressed as mean±SEM (n=10). ∗∗∗p<0.001, ∗∗∗∗p<0.0001.
(a)(b)(c)To ensure increased 2,3-BPG and P50 levels inCse-/- mice due to decreased H2S production, we treated the Cse-/- mice with a slow-releasing hydrogen sulfide donor GYY4137. As shown in Figures 1(a)–1(c), GYY4137 (133 μmol/kg) treatment led to a reduction in 2,3-BPG and P50 levels. Of note, GYY4137 per se decreased erythrocyte 2,3-BPG and P50 levels in WT mice. Since pH is one of the major determinants of Hb-O2 affinity and 2,3-BPG formation, the pH value in RBCs was also examined. No significant difference in pH between the WT and Cse-/- mice was found (supplemental Fig. S1), suggesting that increased levels of 2,3-BPG and P50 are independent of pH in the erythrocytes of Cse-/- mice.It is known that CSE is widely expressed in tissues. Some studies have shown that CSE activity is identified in RBCs [12]. As shown in supplemental Fig. S2, mouse erythrocytes could produce H2S and express CSE protein. The H2S production rate was significantly reduced in CSE-/- mice. In fact, H2S produced by peripheral tissues and serum could diffuse into erythrocytes. Thus, we performed reciprocal bone marrow transplantation (BMT) between the WT and Cse-/- mice. Three groups of mice were generated by BMT: (1) the “WT-to-Cse-/-” group was designed by transplanting BM of WT mice to Cse-/- mice to determine if CSE deficiency in peripheral tissues except BM-derived cells could have effects on Hb-O2 affinity in WT erythrocytes; (2) the “Cse-/--to-WT” group was generated by transplanting BM of Cse-/- mice to WT mice to examine if CSE deficiency only in BM-derived cells was sufficient to affect Hb-O2 affinity; and (3) “WT-to-WT” group is WT mouse BM to WT mice (supplement Fig. S3). As expected, the “WT-to-Cse-/-” mice showed significantly lower circulatory H2S levels compared with “WT-to-WT” and “Cse-/--to-WT” mice (Figure 2(a)). Accordingly, erythrocyte 2,3-BPG and P50 levels in the “WT-to-Cse-/-” mice were significantly higher than those in the “WT-to-WT” and “Cse-/--to-WT” mice (Figures 2(b) and 2(c)). GYY4137 treatment could increase the H2S level in the circulation of “WT-to-Cse-/-” mice (Figure 2(a)). The elevated erythrocyte 2,3-BPG and P50 levels in the “WT-to-Cse-/-” mice were reversed by GYY4137 (Figures 2(b) and 2(c)). These data suggest that H2S produced by peripheral tissues and serum except BM-derived cells has an inhibitory effect on 2,3-BPG production and consequently maintains Hb-O2 affinity in RBCs.Figure 2
Levels of 2,3-BPG and P50 are dependent on H2S produced by peripheral tissues but not related to the blood pressure in Cse-/- mice. (a–c) BMT was performed between the WT and Cse-/- mice. Eight weeks after BMT, the “WT-to-WT” and “Cse-/--to-WT” mice were administered with saline, while the “WT-to-Cse-/-” mice were administered with saline or GYY4137 (133 μmol/kg). Circulatory H2S levels (a), erythrocyte 2,3-BPG levels (b), and P50 (c) were examined 24 h after treatment. (d–f) WT and Cse-/- were treated with pinacidil (2.8 μmol/kg) or saline. The blood pressure (d), erythrocyte 2,3-BPG levels (e), and P50 (f) were examined 24 h after treatment. Data are expressed as mean±SEM (n=8). ∗∗∗p<0.001, ∗∗∗∗p<0.0001.
(a)(b)(c)(d)(e)(f)Cse-/- mice display hypertension as H2S is an important vasodilator via controlling KATP channel activity [35]. It has been shown that KATP channel openers, such as pinacidil, can reduce blood pressure in Cse-/- mice. In order to define whether the changes in 2,3-BPG production and Hb-O2 affinity in Cse-/- mice are attributed to hypertension, we examined the effect of pinacidil treatment on 2,3-BPG production and P50 in erythrocytes of Cse-/- mice. As shown in Figures 2(d)–2(f), pinacidil treatment significantly reduced the blood pressure but did not affect 2,3-BPG production and Hb-O2 affinity in RBCs of Cse-/- mice. The above data suggest that increased 2,3-BPG and P50 levels are not associated with hypertension in Cse-/- mice.Next, we tested the direct effects of H2S on 2,3-BPG production and oxygen affinity of Hb in erythrocytes isolated from WT mice and humans. As shown in Figures 3(a)–3(c), treatment of isolated mouse erythrocytes with H2S donor GYY4137 (500 μM) decreased 2,3-BPG concentration in the cells, shifted the oxygen dissociation curve to the left, and reduced P50 levels. Similar effects of GYY4137 on 2,3-BPG production and P50 levels were obtained in isolated human erythrocytes (Figures 3(d)–3(f)). Further, we showed that GYY4137 treatment did not significantly affect P50 levels of mouse and human Hb (supplemental Fig. S4). The above data suggest that H2S acts on erythrocytes rather than on Hb to decrease 2,3-BPG production, thereby enhancing Hb-O2 affinity.Figure 3
The effects of H2S on 2,3-BPG concentration and Hb-O2 affinity in cultured erythrocytes. (a–c) Isolated mouse erythrocytes were treated with the indicated doses of GYY4137 for 6 h and then harvested and used for determination of the 2,3-BPG level (a) and oxygen dissociation curve ((b) P50 value; (c) representative trace of the oxygen dissociation curve). Data are expressed as mean±SEM (n=6 cultures). (d–f) After 6 h treatment of human erythrocytes with GYY4137, the cells were harvested for determination of the 2,3-BPG level (d) and oxygen dissociation curve ((e) P50 value; (f) representative trace of the oxygen dissociation curve). Data are expressed as mean±SEM (n=6 cultures). ∗∗p<0.01, ∗∗∗p<0.001, and ∗∗∗∗p<0.0001.
(a)(b)(c)(d)(e)(f)


### 3.2. H2S Suppresses Erythrocyte 2,3-BPG Production via Inhibiting Membrane Anchored BPGM Release from the Membrane to the Cytosol

BPGM is the key limiting enzyme for 2,3-BPG production in erythrocytes [36]. In erythrocytes, translocation of glycolytic enzymes between the membrane and the cytosol is the key mechanism involved in the regulation of cytosolic glycolytic enzyme activity [19, 37, 38]. We found that cytosolic BPGM activity in erythrocytes was increased in Cse-/- mice compared with WT mice (Figure 4(a)). Consistently, the cytosolic BPGM protein level was also significantly increased in Cse-/- mice, while the membrane BPGM protein level was significantly decreased in Cse-/- mice (Figure 4(b)). Immunofluorescent analysis also revealed the translocation of BPGM from the membrane to the cytosol of Cse-/- mouse erythrocytes (Figure 4(c)). GYY4137 treatment reduced the cytosolic BPGM activity and protein level, increased the membrane BPGM level in Cse-/- mice (Figures 4(a) and 4(b)), and induced BPGM anchoring to the membrane in erythrocytes of Cse-/- mice (Figure 4(c)). In the model of cultured mouse (Figures 5(a) and 5(b)) and human (Figures 5(c) and 5(d)) erythrocytes, GYY4137 inhibited the cytosolic BPGM activity, increased the membrane BPGM level, and decreased the cytosolic BPGM level. Image analysis confirmed that GYY4137 induced translocation of BPGM from the cytosol to the membrane (Figure 5(e)).Figure 4
The effects of H2S on BPGM trafficking between the membrane and the cytoplasm in erythrocytes in vivo. WT and Cse-/- mice were administered with saline or GYY4137 (50 mg/kg). Blood samples were collected 24 h after treatment. RBCs were isolated for determination of cytosolic BPGM activity and membrane and cytosolic BPGM levels, as well as immunofluorescent staining of BPGM. (a) Cytosolic BPGM activity in RBCs of WT and Cse-/- mice with and without GYY4137 treatment. Data are expressed as mean±SEM (n=10). (b) Erythrocyte membrane and cytosolic BPGM levels in WT and Cse-/- mice with and without GYY4137 treatment. Data are expressed as mean±SEM (n=6). (c) Representative images of BPGM staining in erythrocytes of WT and Cse-/- mice with and without GYY4137 treatment. ∗∗∗p<0.001, ∗∗∗∗p<0.0001.
(a)(b)(c)Figure 5
The effects of H2S on BPGM trafficking between the membrane and the cytoplasm in cultured erythrocytes. Erythrocytes were isolated from WT mice (a, b, e) and healthy volunteers (c, d, e) and then incubated with the indicated doses of GYY4137 for 6 h. The cells were harvested for measurement of cytosolic BPGM activity, determination of membrane and cytosolic BPGM levels, and immunofluorescent staining of BPGM. (a, c) Cytosolic BPGM activity in mouse (a) and human (c) RBCs with and without GYY4137 treatment. (b, d) Membrane and cytosolic BPGM levels in mouse (b) and human (d) erythrocytes with and without GYY4137 treatment. (e) Representative images of staining in mouse and human erythrocytes with and without GYY4137 treatment. Data are expressed as mean±SEM (n=6 cultures). ∗p<0.05, ∗∗p<0.01, ∗∗∗p<0.001, and ∗∗∗∗p<0.0001.
(a)(b)(c)(d)(e)


### 3.3. H2S Decreases Hb Anchoring to the Membrane, Thereby Reducing BPGM Release from the Membrane

It has been demonstrated that translocation of glycolytic enzymes between the membrane and the cytosol is attributed to Hb trafficking between the membrane and the cytoplasm [19, 37, 38]. Hb can bind to the cytosolic domain of band 3 at the membrane and replace glycolytic enzymes, and these molecules in turn relocate to the cytosol. We therefore hypothesized that H2S-induced BPGM anchoring to the membrane is attributed to a decrease in membrane-anchored Hb. To test it, we firstly explored whether BPGM interacted with the membrane proteins of erythrocytes. MS revealed that α- and β-spectrin, ankyrin, and band 4.2 proteins were the potential proteins that interact with BPGM (supplemental Tab. S4). Interestingly, in the RBC membrane, band 3 protein can interact with a number of proteins, including band 4.2, ankyrin, and spectrin, which thereby constitutes a single complex termed as band 3 macrocomplex [39, 40]. Using the Co-IP approach, we validated that BPGM could interact with band 4.2 and also confirmed that Hb interacted with band 4.2 (Figure 6(a)). Thus, it may suggest that Hb as well as BPGM anchors to the membrane by interacting with band 3 macrocomplex. Secondly, we determined membrane-anchored Hb by measuring heme content in the erythrocyte membrane. In accordance with BPGM release from the membrane in Cse-/- mice, membrane heme content was significantly increased in the erythrocytes of Cse-/-mice, which was reversed by GYY4137 treatment (Figure 6(b)). In cultured mouse and human erythrocytes, GYY4137 treatment also decreased membrane heme content (Figures 6(c) and 6(d)).Figure 6
The effects of H2S on the interaction of Hb and BPGM with membrane proteins and Hb trafficking in erythrocytes. (a) Interaction of Hb and BPGM with band 4.2 protein. Coimmunoprecipitation with band 4.2 antibody was performed in mouse RBC lysates. BPGM and Hb in the immunoprecipitate were detected by western blot analysis. (b) The effects of H2S on Hb trafficking between the membrane and the cytoplasm in vivo. WT and Cse-/- mice were administered with saline or GYY4137 (50 mg/kg). Erythrocytes were obtained for the measurement of membrane heme concentrations 24 h after treatment. Data are expressed as mean±SEM (n=10). (c, d) The effects of H2S on Hb trafficking between the membrane and the cytoplasm in cultured erythrocytes. Isolated mouse (c) or human (d) erythrocytes were treated with the indicated doses of GYY4137 for 6 h and then were harvested for the measurement of membrane heme concentrations. Data are expressed as mean±SEM (n=6 cultures). (e) Representative images showing the effects of H2S on the interaction of Hb and BPGM with band 4.2 protein. WT and Cse-/- mice were injected with saline or GYY4137 (50 mg/kg). Blood samples were collected 24 h after treatment. Erythrocytes were isolated for the coimmunoprecipitation analysis. ∗p<0.05, ∗∗p<0.01, and ∗∗∗p<0.001.
(a)(b)(c)(d)(e)Further, we showed that band 4.2 binding with Hb was increased, whereas band 4.2 binding with BPGM was decreased in erythrocytes ofCse-/- mice. GYY4137 treatment decreased band 4.2 binding with Hb while increased band 4.2 binding with BPGM in erythrocytes of Cse-/- mice (Figure 6(e)), indicating that band 4.2 binding with BPGM and band 4.2 binding with Hb are interrelated and H2S has an impact on Hb and BPGM binding to band 3 macrocomplex. Ghost membrane assay showed that GYY4137 reduced heme content in the membrane and BPGM activity in the supernatant in the preparation of mouse (Figures 7(a) and 7(b)) and human (Figures 7(c) and 7(d)) erythrocyte ghost membranes. Thus, we provide evidence that the release of BPGM from the membrane is associated with Hb anchoring to the membrane and that H2S negatively modulates this process.Figure 7
H2S modulation of Hb and BPGM translocation and the role of S-sulfhydration in these processes. (a–d) The effects of H2S and iodoacetamide on Hb binding to the membrane and BPGM release from the membrane in mouse and human erythrocyte ghost membranes. Hb binding to the membrane (a) and BPGM release from the membrane to the cytosol (b) in the mouse erythrocyte membrane ghost, which was treated with Hb and different concentrations of GYY4137 in the presence or absence of iodoacetamide (IAM). Hb binding to the membrane (c) and BPGM release from the membrane to the cytosol (d) in the human erythrocyte membrane ghost, which was treated with Hb and different concentrations of GYY4137 in the presence or absence of iodoacetamide (IAM). Data are expressed as mean±SEM (n=8). ∗p<0.05, ∗∗p<0.01, ∗∗∗p<0.001, and ∗∗∗∗p<0.0001. (e, f) Representative images of Hb and BPGM S-sulfhydration in erythrocytes of WT and Cse-/- mice. WT and Cse-/- mice were administered with saline or GYY4137 (50 mg/kg). Blood samples were collected 24 h after treatment. Erythrocytes were isolated for the determination of S-sulfhydration of Hb (e) and BPGM (f) using the biotin-switch technique. (g, h) Representative images of S-sulfhydration of Hb and BPGM in cultured human erythrocytes. Isolated human erythrocytes were treated with GYY4137 (500 μM) for 6 h and then were harvested for determination of S-sulfhydration of Hb (g) and BPGM (h) using the biotin-switch technique.
(a)(b)(c)(d)(e)(f)(g)(h)


### 3.4. H2S Suppression of Hb Anchoring to the Membrane Might Be Associated with S-Sulfhydration of Hb

S-Sulfhydration has been recognized as a novel posttranslational modification by H2S in eukaryotic cells [15, 27, 33, 34, 41]. Idoacetamine (IAM), an inhibitor of S-sulfhydration [41], reversed the GYY4137-induced reduction in heme content in the membrane and BPGM activity in the cytoplasm (Figures 7(a)–7(d)), indicating that S-sulfhydration may underlie H2S-mediated translocation of Hb and BPGM between the membrane and the cytosol. Next, we intended to identify the proteins which were sulfhydrated by H2S in erythrocytes by using maleimide assay coupled with MS analysis. We identified that Hb was the most abundant protein among S-sulfhydrated proteins in mouse RBCs (supplemental Tab. S5). As shown in Figure 7(e), less S-sulfhydration of Hb in RBCs was found in Cse-/- mice compared with WT mice. Administration of GYY4137 could increase S-sulfhydration of Hb in both the Cse-/- and WT mice. In the cultured human erythrocytes, GYY4137 treatment also enhanced S-sulfhydration of Hb (Figure 7(g)). However, no obvious S-sulfhydration of BPGM was found in erythrocytes of WT and Cse-/- mice with or without GYY4137 treatment (Figure 7(f)). In cultured human erythrocytes, no obvious S-sulfhydration of BPGM occurred in the absence and presence of GYY4137 (Figure 7(h)).We then sought to determine the S-sulfhydrated site in Hb. MS revealed that a single site of Hb at cysteine 104 of theα-chain was S-sulfhydrated in mouse RBCs (supplemental Fig. S5A and Tab. S6). In human RBCs, cysteine 105 of the α-chain in Hb was S-sulfhydrated (supplemental Fig. S5B and Tab. S7).


### 3.5. Reduced Circulatory H2S Level Contributes to Increased 2,3-BPG and P50 Levels in Erythrocytes of Mice with Hypoxia Insults

Consistent with the previous hypoxia studies [19], we showed that the erythrocyte 2,3-BPG level was increased in response to one-day hypoxia and maintained at a high level until 3 days under hypoxia in mice (Figure 8(a)). Moreover, P50 was increased by ~15% after one-day hypoxia and continued increasing on the 3rd day under hypoxia (Figure 8(b)). We also examined the circulatory level of H2S in the mice in response to hypoxia insults. As shown in Figure 8(c), the H2S level in circulation was significantly reduced on the 1st day and further reduced on the 3rd day during hypoxia. The CSE expression level in the erythrocytes, liver, and kidney was also significantly reduced during hypoxia (supplemental Fig. S6). Intriguingly, GYY4137 treatment reversed hypoxia-induced elevation of erythrocyte 2,3-BPG and P50 (Figures 8(d) and 8(e)).Figure 8
Reduced H2S production contributes to hypoxia-induced increased 2,3-BPG and P50 levels and translocation of BPGM and Hb between the membrane and the cytosol in mouse RBCs. (a–c) The effects of hypoxia on 2,3-BPG, P50, and H2S levels. WT mice were exposed to hypoxia (10% oxygen) for the indicated time. Blood samples were collected for the determination of erythrocyte 2,3-BPG (a) and P50 (b) levels, as well as the H2S level in plasma (c). Data are expressed as mean±SEM (n=10). ∗∗p<0.01, ∗∗∗∗p<0.0001. (d–h) The effects of GYY4137 on hypoxia-induced elevated 2,3-BPG and P50 levels and translocation of BPGM and Hb from the membrane to the cytosol. WT mice were exposed to hypoxia (10% oxygen) with the administration of GYY4137 or saline. After hypoxia and treatment of GYY413 for 24 h, the blood samples were collected for determination of erythrocyte 2,3-BPG (d), P50 (e), membrane heme concentration (f), cytosolic BPGM activity (g), and membrane and cytosolic BPGM levels (h). Data are expressed as mean±SEM (n=10). ∗∗∗∗p<0.0001. (h) Representative images of S-sulfhydration of Hb in erythrocytes of the mice. WT mice were exposed to hypoxia (10% oxygen) with the administration of GYY4137 (50 mg/kg) or saline. After hypoxia and treatment of GYY413 for 24 h, the blood samples were collected for determination of S-sulfhydration of Hb using the biotin-switch technique.
(a)(b)(c)(d)(e)(f)(g)(h)(i)We then tested the effects of hypoxia on membrane Hb content, cytosolic BPGM activity, and BPGM trafficking from the membrane to the cytosol in RBCs and the effects of H2S intervention during hypoxia. As expected, membrane heme content was significantly increased in the erythrocytes of the mice exposed to hypoxia compared with control mice (Figure 8(f)). Consistently, cytosolic BPGM activity was significantly increased (Figure 8(g)), and membrane BPGM levels were significantly decreased while cytosolic BPGM levels were significantly increased (Figure 8(h)) in the erythrocytes of the mice exposed to hypoxia compared with the mice under normoxia. Under hypoxia, GYY4137 treatment reduced the membrane heme content, increased the cytosolic BPGM activity and membrane BPGM level, decreased the cytosolic BPGM level in RBCs (Figures 8(f)–8(h)). Furthermore, the level of Hb sulfhydration was decreased in the mice under hypoxia, which was reversed by GYY4137 treatment (Figure 8(i)).


## 3.1. H2S Is Essential for Normal Erythrocyte 2,3-BPG Production and Hb-O2 Binding Affinity

We explored the functional role of H2S in erythrocytes using Cse-/- mice as Cse-/- mice show a remarkably decreased H2S level [26, 35]. Using the metabolomic technique, we identified 98 metabolites in erythrocytes and revealed that several metabolic pathways, such as pyruvate metabolism and glycolysis or gluconeogenesis, were significantly changed in Cse-/- mice compared with WT mice (supplemental Tab. S1-S3). Of note, 2,3-BPG was significantly elevated among the metabolites in the erythrocytes of Cse-/- mice compared to WT mice (supplemental Tab. S2). An elevated erythrocyte 2,3-BPG level in Cse-/- mice was then confirmed by spectrophotometric assay (Figure 1(a)). As 2,3-BPG is a specific allosteric modulator that regulates Hb-O2 affinity [2], we examined the oxygen dissociation curve of Cse-/- mice. As expected, the 50% oxygen saturation (P50) value was significantly increased in Cse-/- mice by 4 to 6 mmHg compared with WT mice (Figures 1(b) and 1(c)).Figure 1
Reduced H2S level contributes to increased 2,3-BPG production and decreased Hb-O2 affinity in erythrocytes of Cse-/-mice. WT and Cse-/- mice were administered with saline or GYY4137 (133 μmol/kg). (a–c) Erythrocytes were isolated for determination of the 2,3-BPG level (a) and oxygen dissociation curve ((b) P50 value; (c) representative trace of the oxygen dissociation curve) 24 h after injection. Data are expressed as mean±SEM (n=10). ∗∗∗p<0.001, ∗∗∗∗p<0.0001.
(a)(b)(c)To ensure increased 2,3-BPG and P50 levels inCse-/- mice due to decreased H2S production, we treated the Cse-/- mice with a slow-releasing hydrogen sulfide donor GYY4137. As shown in Figures 1(a)–1(c), GYY4137 (133 μmol/kg) treatment led to a reduction in 2,3-BPG and P50 levels. Of note, GYY4137 per se decreased erythrocyte 2,3-BPG and P50 levels in WT mice. Since pH is one of the major determinants of Hb-O2 affinity and 2,3-BPG formation, the pH value in RBCs was also examined. No significant difference in pH between the WT and Cse-/- mice was found (supplemental Fig. S1), suggesting that increased levels of 2,3-BPG and P50 are independent of pH in the erythrocytes of Cse-/- mice.It is known that CSE is widely expressed in tissues. Some studies have shown that CSE activity is identified in RBCs [12]. As shown in supplemental Fig. S2, mouse erythrocytes could produce H2S and express CSE protein. The H2S production rate was significantly reduced in CSE-/- mice. In fact, H2S produced by peripheral tissues and serum could diffuse into erythrocytes. Thus, we performed reciprocal bone marrow transplantation (BMT) between the WT and Cse-/- mice. Three groups of mice were generated by BMT: (1) the “WT-to-Cse-/-” group was designed by transplanting BM of WT mice to Cse-/- mice to determine if CSE deficiency in peripheral tissues except BM-derived cells could have effects on Hb-O2 affinity in WT erythrocytes; (2) the “Cse-/--to-WT” group was generated by transplanting BM of Cse-/- mice to WT mice to examine if CSE deficiency only in BM-derived cells was sufficient to affect Hb-O2 affinity; and (3) “WT-to-WT” group is WT mouse BM to WT mice (supplement Fig. S3). As expected, the “WT-to-Cse-/-” mice showed significantly lower circulatory H2S levels compared with “WT-to-WT” and “Cse-/--to-WT” mice (Figure 2(a)). Accordingly, erythrocyte 2,3-BPG and P50 levels in the “WT-to-Cse-/-” mice were significantly higher than those in the “WT-to-WT” and “Cse-/--to-WT” mice (Figures 2(b) and 2(c)). GYY4137 treatment could increase the H2S level in the circulation of “WT-to-Cse-/-” mice (Figure 2(a)). The elevated erythrocyte 2,3-BPG and P50 levels in the “WT-to-Cse-/-” mice were reversed by GYY4137 (Figures 2(b) and 2(c)). These data suggest that H2S produced by peripheral tissues and serum except BM-derived cells has an inhibitory effect on 2,3-BPG production and consequently maintains Hb-O2 affinity in RBCs.Figure 2
Levels of 2,3-BPG and P50 are dependent on H2S produced by peripheral tissues but not related to the blood pressure in Cse-/- mice. (a–c) BMT was performed between the WT and Cse-/- mice. Eight weeks after BMT, the “WT-to-WT” and “Cse-/--to-WT” mice were administered with saline, while the “WT-to-Cse-/-” mice were administered with saline or GYY4137 (133 μmol/kg). Circulatory H2S levels (a), erythrocyte 2,3-BPG levels (b), and P50 (c) were examined 24 h after treatment. (d–f) WT and Cse-/- were treated with pinacidil (2.8 μmol/kg) or saline. The blood pressure (d), erythrocyte 2,3-BPG levels (e), and P50 (f) were examined 24 h after treatment. Data are expressed as mean±SEM (n=8). ∗∗∗p<0.001, ∗∗∗∗p<0.0001.
(a)(b)(c)(d)(e)(f)Cse-/- mice display hypertension as H2S is an important vasodilator via controlling KATP channel activity [35]. It has been shown that KATP channel openers, such as pinacidil, can reduce blood pressure in Cse-/- mice. In order to define whether the changes in 2,3-BPG production and Hb-O2 affinity in Cse-/- mice are attributed to hypertension, we examined the effect of pinacidil treatment on 2,3-BPG production and P50 in erythrocytes of Cse-/- mice. As shown in Figures 2(d)–2(f), pinacidil treatment significantly reduced the blood pressure but did not affect 2,3-BPG production and Hb-O2 affinity in RBCs of Cse-/- mice. The above data suggest that increased 2,3-BPG and P50 levels are not associated with hypertension in Cse-/- mice.Next, we tested the direct effects of H2S on 2,3-BPG production and oxygen affinity of Hb in erythrocytes isolated from WT mice and humans. As shown in Figures 3(a)–3(c), treatment of isolated mouse erythrocytes with H2S donor GYY4137 (500 μM) decreased 2,3-BPG concentration in the cells, shifted the oxygen dissociation curve to the left, and reduced P50 levels. Similar effects of GYY4137 on 2,3-BPG production and P50 levels were obtained in isolated human erythrocytes (Figures 3(d)–3(f)). Further, we showed that GYY4137 treatment did not significantly affect P50 levels of mouse and human Hb (supplemental Fig. S4). The above data suggest that H2S acts on erythrocytes rather than on Hb to decrease 2,3-BPG production, thereby enhancing Hb-O2 affinity.Figure 3
The effects of H2S on 2,3-BPG concentration and Hb-O2 affinity in cultured erythrocytes. (a–c) Isolated mouse erythrocytes were treated with the indicated doses of GYY4137 for 6 h and then harvested and used for determination of the 2,3-BPG level (a) and oxygen dissociation curve ((b) P50 value; (c) representative trace of the oxygen dissociation curve). Data are expressed as mean±SEM (n=6 cultures). (d–f) After 6 h treatment of human erythrocytes with GYY4137, the cells were harvested for determination of the 2,3-BPG level (d) and oxygen dissociation curve ((e) P50 value; (f) representative trace of the oxygen dissociation curve). Data are expressed as mean±SEM (n=6 cultures). ∗∗p<0.01, ∗∗∗p<0.001, and ∗∗∗∗p<0.0001.
(a)(b)(c)(d)(e)(f)


## 3.2. H2S Suppresses Erythrocyte 2,3-BPG Production via Inhibiting Membrane Anchored BPGM Release from the Membrane to the Cytosol

BPGM is the key limiting enzyme for 2,3-BPG production in erythrocytes [36]. In erythrocytes, translocation of glycolytic enzymes between the membrane and the cytosol is the key mechanism involved in the regulation of cytosolic glycolytic enzyme activity [19, 37, 38]. We found that cytosolic BPGM activity in erythrocytes was increased in Cse-/- mice compared with WT mice (Figure 4(a)). Consistently, the cytosolic BPGM protein level was also significantly increased in Cse-/- mice, while the membrane BPGM protein level was significantly decreased in Cse-/- mice (Figure 4(b)). Immunofluorescent analysis also revealed the translocation of BPGM from the membrane to the cytosol of Cse-/- mouse erythrocytes (Figure 4(c)). GYY4137 treatment reduced the cytosolic BPGM activity and protein level, increased the membrane BPGM level in Cse-/- mice (Figures 4(a) and 4(b)), and induced BPGM anchoring to the membrane in erythrocytes of Cse-/- mice (Figure 4(c)). In the model of cultured mouse (Figures 5(a) and 5(b)) and human (Figures 5(c) and 5(d)) erythrocytes, GYY4137 inhibited the cytosolic BPGM activity, increased the membrane BPGM level, and decreased the cytosolic BPGM level. Image analysis confirmed that GYY4137 induced translocation of BPGM from the cytosol to the membrane (Figure 5(e)).Figure 4
The effects of H2S on BPGM trafficking between the membrane and the cytoplasm in erythrocytes in vivo. WT and Cse-/- mice were administered with saline or GYY4137 (50 mg/kg). Blood samples were collected 24 h after treatment. RBCs were isolated for determination of cytosolic BPGM activity and membrane and cytosolic BPGM levels, as well as immunofluorescent staining of BPGM. (a) Cytosolic BPGM activity in RBCs of WT and Cse-/- mice with and without GYY4137 treatment. Data are expressed as mean±SEM (n=10). (b) Erythrocyte membrane and cytosolic BPGM levels in WT and Cse-/- mice with and without GYY4137 treatment. Data are expressed as mean±SEM (n=6). (c) Representative images of BPGM staining in erythrocytes of WT and Cse-/- mice with and without GYY4137 treatment. ∗∗∗p<0.001, ∗∗∗∗p<0.0001.
(a)(b)(c)Figure 5
The effects of H2S on BPGM trafficking between the membrane and the cytoplasm in cultured erythrocytes. Erythrocytes were isolated from WT mice (a, b, e) and healthy volunteers (c, d, e) and then incubated with the indicated doses of GYY4137 for 6 h. The cells were harvested for measurement of cytosolic BPGM activity, determination of membrane and cytosolic BPGM levels, and immunofluorescent staining of BPGM. (a, c) Cytosolic BPGM activity in mouse (a) and human (c) RBCs with and without GYY4137 treatment. (b, d) Membrane and cytosolic BPGM levels in mouse (b) and human (d) erythrocytes with and without GYY4137 treatment. (e) Representative images of staining in mouse and human erythrocytes with and without GYY4137 treatment. Data are expressed as mean±SEM (n=6 cultures). ∗p<0.05, ∗∗p<0.01, ∗∗∗p<0.001, and ∗∗∗∗p<0.0001.
(a)(b)(c)(d)(e)


## 3.3. H2S Decreases Hb Anchoring to the Membrane, Thereby Reducing BPGM Release from the Membrane

It has been demonstrated that translocation of glycolytic enzymes between the membrane and the cytosol is attributed to Hb trafficking between the membrane and the cytoplasm [19, 37, 38]. Hb can bind to the cytosolic domain of band 3 at the membrane and replace glycolytic enzymes, and these molecules in turn relocate to the cytosol. We therefore hypothesized that H2S-induced BPGM anchoring to the membrane is attributed to a decrease in membrane-anchored Hb. To test it, we firstly explored whether BPGM interacted with the membrane proteins of erythrocytes. MS revealed that α- and β-spectrin, ankyrin, and band 4.2 proteins were the potential proteins that interact with BPGM (supplemental Tab. S4). Interestingly, in the RBC membrane, band 3 protein can interact with a number of proteins, including band 4.2, ankyrin, and spectrin, which thereby constitutes a single complex termed as band 3 macrocomplex [39, 40]. Using the Co-IP approach, we validated that BPGM could interact with band 4.2 and also confirmed that Hb interacted with band 4.2 (Figure 6(a)). Thus, it may suggest that Hb as well as BPGM anchors to the membrane by interacting with band 3 macrocomplex. Secondly, we determined membrane-anchored Hb by measuring heme content in the erythrocyte membrane. In accordance with BPGM release from the membrane in Cse-/- mice, membrane heme content was significantly increased in the erythrocytes of Cse-/-mice, which was reversed by GYY4137 treatment (Figure 6(b)). In cultured mouse and human erythrocytes, GYY4137 treatment also decreased membrane heme content (Figures 6(c) and 6(d)).Figure 6
The effects of H2S on the interaction of Hb and BPGM with membrane proteins and Hb trafficking in erythrocytes. (a) Interaction of Hb and BPGM with band 4.2 protein. Coimmunoprecipitation with band 4.2 antibody was performed in mouse RBC lysates. BPGM and Hb in the immunoprecipitate were detected by western blot analysis. (b) The effects of H2S on Hb trafficking between the membrane and the cytoplasm in vivo. WT and Cse-/- mice were administered with saline or GYY4137 (50 mg/kg). Erythrocytes were obtained for the measurement of membrane heme concentrations 24 h after treatment. Data are expressed as mean±SEM (n=10). (c, d) The effects of H2S on Hb trafficking between the membrane and the cytoplasm in cultured erythrocytes. Isolated mouse (c) or human (d) erythrocytes were treated with the indicated doses of GYY4137 for 6 h and then were harvested for the measurement of membrane heme concentrations. Data are expressed as mean±SEM (n=6 cultures). (e) Representative images showing the effects of H2S on the interaction of Hb and BPGM with band 4.2 protein. WT and Cse-/- mice were injected with saline or GYY4137 (50 mg/kg). Blood samples were collected 24 h after treatment. Erythrocytes were isolated for the coimmunoprecipitation analysis. ∗p<0.05, ∗∗p<0.01, and ∗∗∗p<0.001.
(a)(b)(c)(d)(e)Further, we showed that band 4.2 binding with Hb was increased, whereas band 4.2 binding with BPGM was decreased in erythrocytes ofCse-/- mice. GYY4137 treatment decreased band 4.2 binding with Hb while increased band 4.2 binding with BPGM in erythrocytes of Cse-/- mice (Figure 6(e)), indicating that band 4.2 binding with BPGM and band 4.2 binding with Hb are interrelated and H2S has an impact on Hb and BPGM binding to band 3 macrocomplex. Ghost membrane assay showed that GYY4137 reduced heme content in the membrane and BPGM activity in the supernatant in the preparation of mouse (Figures 7(a) and 7(b)) and human (Figures 7(c) and 7(d)) erythrocyte ghost membranes. Thus, we provide evidence that the release of BPGM from the membrane is associated with Hb anchoring to the membrane and that H2S negatively modulates this process.Figure 7
H2S modulation of Hb and BPGM translocation and the role of S-sulfhydration in these processes. (a–d) The effects of H2S and iodoacetamide on Hb binding to the membrane and BPGM release from the membrane in mouse and human erythrocyte ghost membranes. Hb binding to the membrane (a) and BPGM release from the membrane to the cytosol (b) in the mouse erythrocyte membrane ghost, which was treated with Hb and different concentrations of GYY4137 in the presence or absence of iodoacetamide (IAM). Hb binding to the membrane (c) and BPGM release from the membrane to the cytosol (d) in the human erythrocyte membrane ghost, which was treated with Hb and different concentrations of GYY4137 in the presence or absence of iodoacetamide (IAM). Data are expressed as mean±SEM (n=8). ∗p<0.05, ∗∗p<0.01, ∗∗∗p<0.001, and ∗∗∗∗p<0.0001. (e, f) Representative images of Hb and BPGM S-sulfhydration in erythrocytes of WT and Cse-/- mice. WT and Cse-/- mice were administered with saline or GYY4137 (50 mg/kg). Blood samples were collected 24 h after treatment. Erythrocytes were isolated for the determination of S-sulfhydration of Hb (e) and BPGM (f) using the biotin-switch technique. (g, h) Representative images of S-sulfhydration of Hb and BPGM in cultured human erythrocytes. Isolated human erythrocytes were treated with GYY4137 (500 μM) for 6 h and then were harvested for determination of S-sulfhydration of Hb (g) and BPGM (h) using the biotin-switch technique.
(a)(b)(c)(d)(e)(f)(g)(h)


## 3.4. H2S Suppression of Hb Anchoring to the Membrane Might Be Associated with S-Sulfhydration of Hb

S-Sulfhydration has been recognized as a novel posttranslational modification by H2S in eukaryotic cells [15, 27, 33, 34, 41]. Idoacetamine (IAM), an inhibitor of S-sulfhydration [41], reversed the GYY4137-induced reduction in heme content in the membrane and BPGM activity in the cytoplasm (Figures 7(a)–7(d)), indicating that S-sulfhydration may underlie H2S-mediated translocation of Hb and BPGM between the membrane and the cytosol. Next, we intended to identify the proteins which were sulfhydrated by H2S in erythrocytes by using maleimide assay coupled with MS analysis. We identified that Hb was the most abundant protein among S-sulfhydrated proteins in mouse RBCs (supplemental Tab. S5). As shown in Figure 7(e), less S-sulfhydration of Hb in RBCs was found in Cse-/- mice compared with WT mice. Administration of GYY4137 could increase S-sulfhydration of Hb in both the Cse-/- and WT mice. In the cultured human erythrocytes, GYY4137 treatment also enhanced S-sulfhydration of Hb (Figure 7(g)). However, no obvious S-sulfhydration of BPGM was found in erythrocytes of WT and Cse-/- mice with or without GYY4137 treatment (Figure 7(f)). In cultured human erythrocytes, no obvious S-sulfhydration of BPGM occurred in the absence and presence of GYY4137 (Figure 7(h)).We then sought to determine the S-sulfhydrated site in Hb. MS revealed that a single site of Hb at cysteine 104 of theα-chain was S-sulfhydrated in mouse RBCs (supplemental Fig. S5A and Tab. S6). In human RBCs, cysteine 105 of the α-chain in Hb was S-sulfhydrated (supplemental Fig. S5B and Tab. S7).


## 3.5. Reduced Circulatory H2S Level Contributes to Increased 2,3-BPG and P50 Levels in Erythrocytes of Mice with Hypoxia Insults

Consistent with the previous hypoxia studies [19], we showed that the erythrocyte 2,3-BPG level was increased in response to one-day hypoxia and maintained at a high level until 3 days under hypoxia in mice (Figure 8(a)). Moreover, P50 was increased by ~15% after one-day hypoxia and continued increasing on the 3rd day under hypoxia (Figure 8(b)). We also examined the circulatory level of H2S in the mice in response to hypoxia insults. As shown in Figure 8(c), the H2S level in circulation was significantly reduced on the 1st day and further reduced on the 3rd day during hypoxia. The CSE expression level in the erythrocytes, liver, and kidney was also significantly reduced during hypoxia (supplemental Fig. S6). Intriguingly, GYY4137 treatment reversed hypoxia-induced elevation of erythrocyte 2,3-BPG and P50 (Figures 8(d) and 8(e)).Figure 8
Reduced H2S production contributes to hypoxia-induced increased 2,3-BPG and P50 levels and translocation of BPGM and Hb between the membrane and the cytosol in mouse RBCs. (a–c) The effects of hypoxia on 2,3-BPG, P50, and H2S levels. WT mice were exposed to hypoxia (10% oxygen) for the indicated time. Blood samples were collected for the determination of erythrocyte 2,3-BPG (a) and P50 (b) levels, as well as the H2S level in plasma (c). Data are expressed as mean±SEM (n=10). ∗∗p<0.01, ∗∗∗∗p<0.0001. (d–h) The effects of GYY4137 on hypoxia-induced elevated 2,3-BPG and P50 levels and translocation of BPGM and Hb from the membrane to the cytosol. WT mice were exposed to hypoxia (10% oxygen) with the administration of GYY4137 or saline. After hypoxia and treatment of GYY413 for 24 h, the blood samples were collected for determination of erythrocyte 2,3-BPG (d), P50 (e), membrane heme concentration (f), cytosolic BPGM activity (g), and membrane and cytosolic BPGM levels (h). Data are expressed as mean±SEM (n=10). ∗∗∗∗p<0.0001. (h) Representative images of S-sulfhydration of Hb in erythrocytes of the mice. WT mice were exposed to hypoxia (10% oxygen) with the administration of GYY4137 (50 mg/kg) or saline. After hypoxia and treatment of GYY413 for 24 h, the blood samples were collected for determination of S-sulfhydration of Hb using the biotin-switch technique.
(a)(b)(c)(d)(e)(f)(g)(h)(i)We then tested the effects of hypoxia on membrane Hb content, cytosolic BPGM activity, and BPGM trafficking from the membrane to the cytosol in RBCs and the effects of H2S intervention during hypoxia. As expected, membrane heme content was significantly increased in the erythrocytes of the mice exposed to hypoxia compared with control mice (Figure 8(f)). Consistently, cytosolic BPGM activity was significantly increased (Figure 8(g)), and membrane BPGM levels were significantly decreased while cytosolic BPGM levels were significantly increased (Figure 8(h)) in the erythrocytes of the mice exposed to hypoxia compared with the mice under normoxia. Under hypoxia, GYY4137 treatment reduced the membrane heme content, increased the cytosolic BPGM activity and membrane BPGM level, decreased the cytosolic BPGM level in RBCs (Figures 8(f)–8(h)). Furthermore, the level of Hb sulfhydration was decreased in the mice under hypoxia, which was reversed by GYY4137 treatment (Figure 8(i)).


## 4. Discussion

Although H2S plays an important role in numerous cells and tissues, its function in erythrocytes remains unknown. In the present study, functionally, we revealed that H2S plays a critical role in controlling 2,3-BPG production and consequently maintains Hb-O2 affinity in a normal range under normoxia. Mechanistically, we revealed that endogenous H2S suppresses the translocation of Hb to the membrane and therefore maintains BPGM largely anchoring to the membrane, normal 2,3-BPG levels, and Hb-O2 binding affinity under normoxia. These studies led us to further discover that the hypoxia-induced reduction of H2S production by peripheral tissues contributes to the hypoxia-mediated elevation of erythrocyte 2,3-BPG levels and reduced Hb-O2 binding affinity in mice. Taken together, our findings demonstrate a previously unrecognized role of endogenous H2S in erythrocytes and reveal molecular mechanisms underlying H2S modulating 2,3-BPG and Hb-O2 binding affinity under normoxia and hypoxia (Figure 9).Figure 9
Integrated scheme of the potential mechanisms underlying H2S modulating 2,3-BPG and Hb-O2 binding affinity under normoxia and hypoxia. H2S suppresses translocation of Hb from the cytosol to the membrane and in turn promotes BPGM anchoring to the membrane and thereby prevents an increase in 2,3-BPG levels in normoxia. During hypoxia, the decreased H2S level promotes Hb anchoring to the membrane and BPGM release to the cytosol from the membrane, eventually resulting in an increase in 2,3-BPG production in erythrocytes.H2S has been considered an important gaseous signaling molecule that contributes to numerous cellular and tissue functions in health and diseases [42]. There may be controversy regarding the changes in H2S production in response to hypoxia insults. Some studies have shown that hypoxia promotes H2S generation in some tissues such as the gastrointestinal tissues and carotid body, and the PO2 value and H2S concentration are routinely encountered in these tissues; it has therefore been implicated that H2S can act as an oxygen sensor [43, 44]. In contrast, many other studies have reported that hypoxia suppresses H2S generation in various tissues and leads to decreased H2S levels in circulation [45–47]. D’Alessandro et al. [13] recently reported that high altitude results in immediate decreases in H2S in healthy volunteers. Consistently, we validated that H2S levels are significantly reduced in mice exposed to hypoxia as humans under high altitude. Using the mouse model with CSE gene modification, we identified that endogenous H2S by CSE has a tonic inhibitory effect on 2,3-BPG production and subsequently maintains Hb-O2 binding affinity under normoxia. Although both 2,3-BPG and H2S are reported to be altered under high altitude in human studies [17, 20, 40], whether H2S modulates 2,3-BPG levels under hypoxia is still unknown. Similar to CSE-deficient mice, we found that hypoxia-mediated reduction of H2S leads to induction of 2,3-BPG and reduction of Hb-O2 binding affinity. Thus, our findings add significant new insight to erythrocyte physiology and pathology by demonstrating an important role of H2S in erythrocytes under normoxia to maintain a normal range of 2,3-BPG levels and Hb-O2 binding affinity and a critical role of reduced H2S levels in promoting 2,3-BPG production and thereby reducing Hb-O2 binding affinity that may be adaptive in optimizing tissue O2 supply during hypoxia.The formation of erythrocyte 2,3-BPG is modulated by various signaling pathways, and its levels are known to be induced under hypoxia [19, 48]. It can be stimulated by a high activity of glycolytic enzymes, which increases the glucose shunted into the BPGM reaction [49, 50]. Recently, Sun et al. [19] have shown that sphingosine-1-phosphate (S1P) can increase GAPDH activity, thereby promoting 2,3-BPG production in RBCs. BPGM is the key limiting enzyme for 2,3-BPG production. Recent studies showed that BPGM is activated by AMPK downstream of adenosine signaling under hypoxia [48]. However, how H2S regulates 2,3-BPG production remains unknown until we demonstrated the importance of H2S in 2,3-BPG production and Hb-O2 binding under both normoxia and hypoxia. Notably, Hb binds to the cytosolic domain of band 3 on the membrane to cause the release of glycolytic enzymes, including phosphofructokinase, aldolase, and GAPDH, from the membrane to the cytosol to enhance glycolysis and subsequently increases 2,3-BPG production under hypoxia [38, 51]. Besides Hb and glycolytic enzymes, a number of proteins, including band 4.2, ankyrin, and spectrin, interact with band 3 in the RBC membrane, which thereby constitutes a single complex termed as band 3 macrocomplex [39, 40]. To our knowledge, whether BPGM is trafficked between the membrane and the cytosol in erythrocytes has not been reported. Using multidisciplinary biochemical and genetic approaches, we provided new insight into regulatory mechanisms of BPGM activity and 2,3-BPG production, which is mediated by H2S in erythrocytes. Specifically, using the MS approach, we identified band 4.2, ankyrin, spectrin, and band 3 proteins from the proteins that interacted with BPGM, indicating that BPGM is associated with band 3 macrocomplex in the RBC membrane. Using the model of erythrocyte ghost membranes, we revealed that BPGM is trafficked between the membrane and the cytosol, and BPGM and Hb trafficking are interrelated. Moreover, we provided both solid genetic evidence and pharmacological evidence that H2S is an important factor for suppressing Hb anchoring to the membrane and BPGM release from the membrane, thereby maintaining the normal range of 2,3-BPG levels and Hb-O2 binding affinity.RBCs play a critical role in adaptations to hypoxia, in line with their vital role in oxygen transport and delivery. Improved oxygen release is one of the most important adaptations of mature RBCs to hypoxia. However, the mechanistic understanding ofin vivo adaptations of RBCs to hypoxia is still incomplete. Recent studies demonstrate that the elevated erythrocyte sphingosine kinase 1 activity-mediated increase in S1P is responsible for hypoxia adaptation by inducing oxygen release [19]. Liu et al. [48] show that 5′AMP-activated protein kinase (AMPK) underlies hypoxia-induced 2,3-BPG production by phosphorylation and activation of 2,3-BPG mutase. In the present study, we demonstrated that downregulation of H2S contributed to the reduced Hb-O2 binding affinity in hypoxia, thus providing a novel molecular mechanism underlying RBC adaptation to hypoxia.The limitation of the present study is that mechanisms by which H2S modulates Hb and BPGM trafficking between the membrane and the cytosol in RBCs remain to be further elucidated. H2S-induced posttranslational S-sulfhydration modification has been highlighted in regulating the functions of many proteins such as the potassium channels and NF-κB [15, 26, 27, 33, 52]. More recently, Zhao et al. [27] have demonstrated that S-sulfhydrated Kelch-like ECH-associated protein 1 (Keap1) and nuclear factor erythroid 2-related factor (Nrf2) are critical for H2S protection of the liver tissue in response to various injury insults. Using mouse genetic studies combined with various molecular biology manipulations, they provided evidence that Cys 151 of Keap1 is sulfhydrated after H2S treatment. Although we found that Cys 104 in α-chain of Hb is sulfhydrated, whether it is critical for H2S regulation of Hb-O2 affinity requires to be further confirmed. Of note, Vitvitsky et al. [10] reported that hemoglobin binds H2S and oxidizes it to a mixture of thiosulfate and hydropolysulfides. Whether this reaction is involved in Hb-O2 affinity remains unknown. Nevertheless, the mechanisms underlying H2S regulating the translocation of Hb and BPGM in erythrocytes require to be defined in future studies.


## 5. Conclusion

In conclusion, the present study has demonstrated the novel findings that H2S is essential to maintain the normal range of 2,3-BPG levels and Hb-O2 binding affinity under normoxia and that downregulation of H2S is a key signaling molecule promoting 2,3-BPG production under hypoxia. Given that all living cells require O2 for survival, proliferation, and differentiation to adapt to physiological and pathological stress conditions, the change in Hb-O2 binding affinity mediated by H2S is likely an important functional response to various stimuli.



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*Source: 8877691-2021-02-13.xml*