The 2019 Nobel Prize for Medicine has been shared between three scientists trying to answer this very question – and is an excellent example for collaborative working.

Peter Radcliffe and Gregg Semenza studied the regulation of the hormone erythropoietin (EPO) which stimulates the production of red blood cells in response to low levels of oxygen, thus increasing the overall carrying capacity of the blood for oxygen. They identified two genes that code for two proteins which complex together to form hypoxia-inducible factor, HIF, causing initiation of the transcription resulting in the production of EPO.

Concurrently, William Kaelin showed that a gene called VHL seemed influence how cells respond to oxygen. He was studying a syndrome involving mutations in VHL, and families with this mutation have an increased risk of certain cancers.

Ratcliffe and his team showed that the protein expressed by VHL interacts with a component of HIF under normal oxygen conditions and so suppresses the synthesis of EPO once oxygen levels are restored. When oxygen is present, VHL is chemically modified so that it binds to HIF, but when cells are starved of oxygen, the modification is blocked.

All organisms need oxygen to survive and this research has led to a better understanding of how the body responds to low levels of oxygen at a molecular level. This could be important in situations when oxygen must be quickly restored, as well as situations when inhibiting oxygen levels could slow or prevent cells from functioning – which has implications for growing tumours.

Most importantly, this Nobel Prize highlights the need for scientists to be open about their work and share ideas. It shows the importance of publication of scientific research and peer review so that the scientific community can act as a whole, rather than in isolated groups.