These authors contributed equally to the review.
Gimme shelter: the immune system during pregnancy
Article first published online: 13 APR 2011
© 2011 John Wiley & Sons A/S
Special Issue: Mechanisms of Tolerance
Volume 241, Issue 1, pages 20–38, May 2011
How to Cite
Munoz-Suano, A., Hamilton, A. B. and Betz, A. G. (2011), Gimme shelter: the immune system during pregnancy. Immunological Reviews, 241: 20–38. doi: 10.1111/j.1600-065X.2011.01002.x
- Issue published online: 13 APR 2011
- Article first published online: 13 APR 2011
- regulatory T cells;
- mesenchymal stromal cells;
- immune evasion
Summary: Antigen-presenting molecules vary between individuals of the same species, making it more difficult for pathogens to evade immune recognition and spread through the whole population. As a result of this genetic diversity, transplants between individuals are recognized as foreign and are rejected. This alloreactivity turns placental viviparity into a major immunological challenge. The maternal immune system has to balance the opposing needs of maintaining robust immune reactivity to protect both mother and fetus from invading pathogens, while at the same time tolerating highly immunogenic paternal alloantigens in order to sustain fetal integrity. Regulatory T cells are responsible for the establishment of tolerance by modulating the immune response, and uterine natural killer cells direct placentation by controlling trophoblast invasion. A variety of other cell types, including decidual stromal cells, dendritic cells, and immunomodulatory multipotent mesenchymal stromal cells, are found at the fetal–maternal interface. These cells conspire to establish a suitable environment for fetal development without compromising systemic immunity. Defects in any of these components can lead to gestational failure despite successful fertilization.