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Maternal Acceptance of the Fetus: True Human Tolerance

Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, Boston, MA 02115

Induction and maintenance of immunologic tolerance in humans remains a desirable but elusive goal. Therefore, understanding the physiologic mechanisms of regulation of immune responses is highly clinically relevant for immune-mediated diseases (e.g., autoimmunity and asthma/allergy) and for cell and organ transplantation. Acceptance of the fetus, which expresses paternally inherited alloantigens, by the mother during pregnancy is a unique example of how the immune system reshapes a destructive alloimmune response to a state of tolerance. Understanding the complex mechanisms of fetomaternal tolerance has important implications for developing novel strategies to induce immunologic tolerance in humans in general and for prevention of spontaneous abortion in at-risk populations in particular.

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¹ Address correspondence and reprint requests to Dr. Indira Guleria, Transplantation Research Center, 300 Longwood Avenue, Boston, MA 02115. E-mail address: indira.guleria{at}tch.harvard.edu

² Abbreviations used in this paper: FasL, Fas ligand; DC, dendritic cell; ILT, Ig-like transcript; KIR, killer Ig-like receptor; PDL, programmed death ligand; Treg, regulatory T cell; uNK, uterine NK.