Little is known about the ontogeny of naturally occurring CD4 ؉ CD25 ؉ regulatory/suppressor T cells that play a major role in maintaining self-tolerance in mice and humans. In rodents, thymectomy on day 3 of life leads to multiple organspecific autoimmune diseases that can be prevented by adoptive transfer of regulatory T cells, suggesting their neonatal development. We investigated regulatory T-cell ontogeny in 11 human fetuses. Together with the first mature T cells, thymic CD4 ؉ CD25 ؉ cells were detected as early as 13 weeks of gestation. Thymic CD25 ؉ cells appeared to be positively selected at the CD4 ؉ CD8 ؉ CD3 hi differentiation stage, as assessed by CD1a and CD69 expression. The proportion of thymic CD4 ؉ CD25 ؉ cells appeared quite stable with age, around 6% to 7%, similar to the proportion observed in infant thymi. Extrathymic CD4 ؉ CD25 ؉ T cells could hardly be detected at 13 weeks of gestation but were present from week 14 onwards. As adult regulatory T cells, purified CD4 ؉ CD25 ؉ fetal cells were anergic and suppressed T-cell proliferative responses; they expressed intracellular cytotoxic T-lymphocyte-associated antigen 4 (CTLA- 4
IntroductionT cells capable of suppressing immune responses have been hypothesized for a long time. 1 Functional assays have supported their existence 2,3 but the inability to phenotypically identify them has hampered their further study. However, there is now clear evidence that CD4 ϩ cells expressing the interleukin-2 receptor ␣ chain (CD25) contain a population of naturally and ubiquitously present cells endowed with suppressive activities. [4][5][6][7] The lack of a known specific surface marker makes it hard to distinguish CD4 ϩ CD25 ϩ regulatory T cells (Treg's) from CD4 ϩ activated effector T cells, which may transitorily express CD25. 8 As of today, Treg's are best identified by the expression of (1) high levels of CD25 (CD25 hi ), [8][9][10] (2) the forkhead/winged helix transcription factor Foxp3, 11 (3) high levels of intracytoplasmic cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), 12,13 and (4) the glucocorticoid-induced tumor necrosis factor receptor (GITR) surface marker. 14 Since these individual markers are neither specific nor always simultaneously expressed, the authentication of bona fide Treg's relies on the demonstration that (1) they are anergic in vitro in the absence of exogenous IL-2 and (2) they indeed suppress effector T-cell responses.It is now well established that Treg's play a major role in maintenance of self-tolerance and control of autoimmune diseases. 7,15 They are also involved in regulation of T-cell homeostasis [16][17][18] and modulation of immune responses to alloantigens, tumor cells, and various pathogens. [19][20][21][22][23][24][25][26] In the periphery, at steady-state, Treg's represent a stable proportion of the CD4 ϩ T cells, typically 5% to 12% in mice and humans. Although Treg's are anergic in vitro, in vivo studies have shown that some Treg's are quiescent with a long lifespan whereas others divide extensively du...