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Immune tolerance

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576:), resulting in graft reaction. However, there are two general cases in which an allograft may be accepted. One is when cells or tissue are grafted to an immune-privileged site that is sequestered from immune surveillance (like in the eye or testes) or has strong molecular signals in place to prevent dangerous inflammation (like in the brain). The second is when a state of tolerance has been induced, either by previous exposure to the antigen of the donor in a manner that causes immune tolerance rather than sensitization in the recipient, or after chronic rejection. Long-term exposure to a foreign antigen from fetal development or birth may result in establishment of central tolerance, as was observed in Medawar's mouse-allograft experiments. In usual transplant cases, however, such early prior exposure is not possible. Nonetheless, a few patients can still develop allograft tolerance upon cessation of all exogenous immunosuppressive therapy, a condition referred to as operational tolerance. CD4+ Foxp3+ Treg cells, as well as CD8+ CD28- regulatory T cells that dampen cytotoxic responses to grafted organs, are thought to play a role. In addition, genes involved in 656:. Though in mammals a number of defenses exist to keep the microbiota at a safe distance, including a constant sampling and presentation of microbial antigens by local DCs, most organisms do not react against commensal microorganisms and tolerate their presence. Reactions are mounted, however, to pathogenic microbes and microbes that breach physiological barriers(epithelium barriers). Peripheral mucosal immune tolerance, in particular, mediated by iTreg cells and tolerogenic antigen-presenting cells, is thought to be responsible for this phenomenon. In particular, specialized gut CD103+ DCs that produce both 425:, in immune tolerance was recognized in 1995 when animal models showed that CD4+ CD25+ T cells were necessary and sufficient for the prevention of autoimmunity in mice and rats. Initial observations showed removal of the thymus of a newborn mouse resulted in autoimmunity, which could be rescued by transplantation of CD4+ T cells. A more specific depletion and reconstitution experiment established the phenotype of these cells as CD4+ and CD25+. Later in 2003, experiments showed that Treg cells were characterized by the expression of the 966: 208:
instead of rejection and elimination, and preventing attack of fetuses by the maternal immune system. Typically, a change in the host, not the antigen, is implied. Though some pathogens can evolve to become less virulent in host-pathogen coevolution, tolerance does not refer to the change in the pathogen but can be used to describe the changes in host physiology. Immune tolerance also does not usually refer to artificially induced
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strains of mice fall neatly along a spectrum of being more tolerant but less resistant or more resistant but less tolerant. Patients with autoimmune diseases also often have a unique gene signature and certain environmental risk factors that predispose them to disease. This may have implications for current efforts to identify why certain individuals may be disposed to or protected against
607:(MHC) proteins. However, the fetus usually is not rejected by the mother, making it essentially a physiologically tolerated allograft. It is thought that the placental tissues which interface with maternal tissues not only try to escape immunological recognition by downregulating identifying MHC proteins but also actively induce a marked peripheral tolerance. Placental 957:
general can be thought of as an alternative defense strategy that focuses on minimizing impact of an invader on host fitness, instead of on destroying and eliminating the invader. Such efforts may have a prohibitive cost on host fitness. In plants, where the concept was originally used, tolerance is defined as a
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hypersensitivity reactions have been mixed. The systemic effects of oral tolerance may be explained by the extensive recirculation of immune cells primed in one mucosal tissue in another mucosal tissue, allowing extension of mucosal immunity. The same probably occurs for cells mediating mucosal immune tolerance.
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Evolution works to optimize host fitness, so whether elimination or tolerance occurs depends on which would benefit the organism most in a given scenario. If the antigen is from a rare, dangerous invader, the costs of tolerating its presence are high and it is more beneficial to the host to eliminate
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The advantages of immune tolerance, in particular, may be seen in experiments with mice infected with malaria, in which more tolerant mice have higher fitness at greater pathogen burdens. In addition, development of immune tolerance would have allowed organisms to reap the benefits of having a robust
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is vulnerable to pathogenic penetration. The immune system must maintain its responsiveness to pathogenic antigens to prevent infections. The immune system has developed mechanisms in which orally ingested antigens can suppress following immune responses on a local and systemic level. Oral tolerance
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Dendritic cells play a crucial role in establishing oral tolerance for food antigens. The dendritic cells in the intestines cannot directly sample the antigens, as they are located behind the epithelial wall. There are different mechanisms in which the dendritic cells come in contact with the food
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Though it seems that the existence of tolerance is mostly adaptive, allowing an adjustment of the immune response to a level appropriate for the given stressor, it comes with important evolutionary disadvantages. Some infectious microbes take advantage of existing mechanisms of tolerance to avoid
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reactions in certain cases. Records from 1829 indicate that American Indians would reduce contact hypersensitivity from poison ivy by consuming leaves of related Rhus species; however, contemporary attempts to use oral tolerance to ameliorate autoimmune diseases like rheumatoid arthritis and other
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In their Nobel Lecture, Medawar and Burnet define immune tolerance as "a state of indifference or non-reactivity towards a substance that would normally be expected to excite an immunological response." Other more recent definitions have remained more or less the same. The 8th edition of Janeway's
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It was assumed that, since the presence of the Treg cells originally characterized was dependent on the neonatal thymus, these cells were thymically derived. By the mid-2000s, however, evidence was accruing of conversion of naïve CD4+ T cells to Treg cells outside of the thymus. These were later
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The deletion threshold is much more stringent for T cells than for B cells since T cells alone can cause direct tissue damage. Furthermore, it is more advantageous for the organism to let its B cells recognize a wider variety of antigen so it can produce antibodies against a greater diversity of
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twin cattle sharing a common placenta also shared a stable mixture of each other's red blood cells (though not necessarily 50/50), and retained that mixture throughout life. Although Owen did not use the term immune tolerance, his study showed the body could be tolerant of these foreign tissues.
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Though the exact evolutionary rationale behind the development of immunological tolerance is not completely known, it is thought to allow organisms to adapt to antigenic stimuli that will consistently be present instead of expending considerable resources fighting it off repeatedly. Tolerance in
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and α4β7 expression. The mesenteric lymph node stromal cells also release retinoic acid and are required for gut localisation of the mesenteric lymph node T cell population. The differentiated regulatory T cells subsequently migrate to the lamina propria, where they multiply. CX3CR1+ macrophages
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This process of negative selection ensures that T and B cells that could initiate a potent immune response to the host's own tissues are eliminated while preserving the ability to recognize foreign antigens. It is the step in lymphocyte education that is key for preventing autoimmunity (entire
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Immune tolerance is formally differentiated into central or peripheral; however, alternative terms such as "natural" or "acquired" tolerance have at times been used to refer to establishment of tolerance by physiological means or by artificial, experimental, or pharmacological means. These two
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Despite having mechanisms for both immune resistance and tolerance, any one organism may be overall more skewed toward a tolerant or resistant phenotype depending on individual variation in both traits due to genetic and environmental factors. In mice infected with malaria, different genetic
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Immune tolerance encompasses the range of physiological mechanisms by which the body reduces or eliminates an immune response to particular agents. It is used to describe the phenomenon underlying discrimination of self from non-self, suppressing allergic responses, allowing chronic infection
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develops after T and B cells mature and enter the peripheral tissues and lymph nodes. It is established by a number of partly overlapping mechanisms that mostly involve control at the level of T cells, especially CD4+ helper T cells, which orchestrate immune responses and give B cells the
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The fetus has a different genetic makeup than the mother, as it also translates its father's genes, and is thus perceived as foreign by the maternal immune system. Women who have borne multiple children by the same father typically have antibodies against the father's red blood cell and
1004:. The injection of Treg cells specific for a tumor antigen also can reverse experimentally-mediated tumor rejection based on that same antigen. The prior existence of immune tolerance mechanisms due to selection for its fitness benefits facilitates its utilization in tumor growth. 178:"We did not set out with the idea in mind of studying the immunological consequences of the phenomenon described by Owen; on the contrary, we had been goaded by Dr. H.P. Donald into trying to devise a foolproof method of distinguishing monozygotic from dizygotic twins... ." 299:
confirmatory signals they need in order to produce antibodies. Inappropriate reactivity toward normal self-antigen that was not eliminated in the thymus can occur, since the T cells that leave the thymus are relatively but not completely safe. Some will have receptors (
267:, a state of non-activity. Weakly autoreactive B cells may also remain in a state of immunological ignorance where they simply do not respond to stimulation of their B cell receptor. Some weakly self-recognizing T cells are alternatively differentiated into natural 787:
After antigen interaction the CD103+ dendritic cells travel to the mesenteric lymph nodes where they interact with their T cell population. Within the mesenteric lymph nodes the CD103+ dendritic cells will induce differentiation of the naïve T cell population into
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in 1953, who showed by injecting foreign cells into fetal or neonatal mice, they could become accepting of future grafts from the same foreign donor. However, they were not thinking of the immunological consequences of their work at the time: as Medawar explains:
256:. Self-antigens are present due to endogenous expression, importation of antigen from peripheral sites via circulating blood, and in the case of thymic stromal cells, expression of proteins of other non-thymic tissues by the action of the transcription factor 212:
by corticosteroids, lymphotoxic chemotherapy agents, sublethal irradiation, etc. Nor does it refer to other types of non-reactivity such as immunological paralysis. In the latter two cases, the host's physiology is handicapped but not fundamentally changed.
888:. Attempts have been made to reduce hypersensitivity reactions by oral tolerance and other means of repeated exposure. Repeated administration of the allergen in slowly increasing doses, subcutaneously or sublingually appears to be effective for allergic 816:
In the lamina propria the regulatory T cell population creates a tolerogenic environment to food antigens. It is known that tolerance to food antigens is systemic. The mechanism that establishes this systemic tolerance is not yet fully understood.
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of host fitness over a range of parasite burdens, and can be measured from the slope of the line fitting these data. Immune tolerance may constitute one aspect of this defense strategy, though other types of tissue tolerance have been described.
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Immune tolerance contrasts with resistance. Upon exposure to a foreign antigen, either the antigen is eliminated by the standard immune response (resistance), or the immune system adapts to the pathogen, promoting immune tolerance instead.
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Resistance typically protects the host at the expense of the parasite, while tolerance reduces harm to the host without having any direct negative effects on the parasite. Each strategy has its unique costs and benefits for host fitness:
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Appropriate reactivity toward certain antigens can also be quieted by induction of tolerance after repeated exposure, or exposure in a certain context. In these cases, there is a differentiation of naïve CD4+ helper T cells into induced
693:. The intestine harbours many non-self-antigens that are able to induce an immune reaction. The immune system in the gut needs to restrain from responding to these antigens to prevent constant inflammation. On the other hand, the thin 908:, which have mutated proteins and altered antigen expression, prevent elimination by the host immune system. It is well recognized that tumors are a complex and dynamic population of cells composed of transformed cells as well as 433:
defined as induced or iTreg cells to contrast them with thymus-derived nTreg cells. Both types of Treg cells quieten autoreactive T cell signaling and proliferation by cell-contact-dependent and -independent mechanisms including:
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to reactive T cells These mechanisms altogether establish an immune-privileged state in the placenta that protects the fetus. A break in this peripheral tolerance results in miscarriage and fetal loss. (for more information, see
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efficiently promotes the differentiation of iTreg cells in the gut lymphoid tissue. Foxp3- TR1 cells that make IL-10 are also enriched in the intestinal lining. Break in this tolerance is thought to underlie the pathogenesis of
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Mallegol J, Van Niel G, Lebreton C, Lepelletier Y, Candalh C, Dugave C, et al. (May 2007). "T84-intestinal epithelial exosomes bear MHC class II/peptide complexes potentiating antigen presentation by dendritic cells".
287:). Lymphocyte development and education is most active in fetal development but continues throughout life as immature lymphocytes are generated, slowing as the thymus degenerates and the bone marrow shrinks in adult life. 1104:
it. Conversely, if experience (of the organism or its ancestors) has shown that the antigen is innocuous, then it would be more beneficial to tolerate the presence of the antigen rather than pay the costs of inflammation.
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Those self-reactive T cells that escape intrathymic negative selection in the thymus can inflict cell injury unless they are deleted or effectively muzzled in the peripheral tissue chiefly by nTreg cells (see
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methods of categorization are sometimes confused, but are not equivalent—central or peripheral tolerance may be present naturally or induced experimentally. This difference is important to keep in mind.
948:(MDSCs), which also induce peripheral tolerance. In addition to promoting immune tolerance, other aspects of the microenvironment aid in immune evasion and induction of tumor-promoting inflammation. 916:, which the tumor largely manipulates to be immunotolerant so as to avoid elimination. There is an accumulation of metabolic enzymes that suppress T cell proliferation and activation, including 102: 2092:
Maher S, Toomey D, Condron C, Bouchier-Hayes D (April 2002). "Activation-induced cell death: the controversial role of Fas and Fas ligand in immune privilege and tumour counterattack".
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in general are traditionally thought of as misguided or excessive reactions by the immune system, possibly due to broken or underdeveloped mechanisms of peripheral tolerance. Usually,
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refers to the tolerance established by deleting autoreactive lymphocyte clones before they develop into fully immunocompetent cells. It occurs during lymphocyte development in the
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However, these discoveries, and the host of allograft experiments and observations of twin chimerism they inspired, were seminal for the theories of immune tolerance formulated by
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nTreg cells are specific, modestly, for self-antigen while iTreg cells recognize allergens, commensal bacteria, tumor antigens, alloantigens, and self-antigens in inflamed tissue.
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are not the only cells that mediate peripheral tolerance. Other regulatory immune cells include T cell subsets similar to but phenotypically distinct from Treg cells, including
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extend in between enterocytes and directly take up antigens form the intestinal lumen. These macrophages are not capable of traveling to the mesenteric lymph nodes. They form
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pathogens. Since the B cells can only be fully activated after confirmation by more self-restricted T cells that recognize the same antigen, autoreactivity is held in check.
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Kretschmer K, Apostolou I, Jaeckel E, Khazaie K, von Boehmer H (August 2006). "Making regulatory T cells with defined antigen specificity: role in autoimmunity and cancer".
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Ghiringhelli F, Ménard C, Martin F, Zitvogel L (December 2006). "The role of regulatory T cells in the control of natural killer cells: relevance during tumor progression".
1000:, and other worms and parasites. Another important disadvantage of the existence of tolerance may be susceptibility to cancer progression. Treg cells inhibit anti-tumor 796:
instead. The local microenvironment determines if CD103+ dendritic cells act tolerogenic or immunogenic. The differentiation into regulatory T cells is dependent on
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from the liver and mesenteric lymph node can induce anergy or deletion of antigen specific T cells. Anergic T cells are hyporesponsive to their specific antigen.
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Those lymphocytes that have receptors that bind strongly to self-antigens are removed by induction of apoptosis of the autoreactive cells, or by induction of
195:. Burnet and Medawar were ultimately credited for "the discovery of acquired immune tolerance" and shared the Nobel Prize in Physiology or Medicine in 1960. 147:
that manage to evade immune elimination. Additionally, the induction of peripheral tolerance within the local microenvironment is a strategy employed by many
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and contrasts the immune system's conventional role in eliminating foreign antigens. Depending on the site of induction, tolerance is categorized as either
3481: 623:, which represses maternal T cell responses by amino acid starvation. Maternal T cells specific for paternal antigens are also suppressed by tolerogenic 969:
Schematic of the reaction norm of tolerance (after). Organisms of genotype 2 are considered more tolerant to the pathogen than organisms of genotype 1.
1412:"Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) and IPEX-related disorders: an evolving web of heritable autoimmune diseases" 726:. The newly differentiated regulatory T cells travel to the lamina propria, where they suppress the immune reaction against the recognized antigens. 572:
Immune recognition of non-self-antigens typically complicates transplantation and engrafting of foreign tissue from an organism of the same species (
940:. Pharmacologic monoclonal antibodies targeted against some of these ligands has been effective in treating cancer. Tumor-derived vesicles known as 62:. Although the mechanisms establishing central and peripheral tolerance differ, their outcomes are analogous, ensuring immune system modulation. 525:
nTreg cells and iTreg cells, however, have a few important distinguishing characteristics that suggest they have different physiological roles:
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Råberg L, Sim D, Read AF (November 2007). "Disentangling genetic variation for resistance and tolerance to infectious diseases in animals".
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The skin and digestive tract of humans and many other organisms is colonized with an ecosystem of microorganisms that is referred to as the
2671:"All-trans retinoic acid mediates enhanced T reg cell growth, differentiation, and gut homing in the face of high levels of co-stimulation" 829:
or deletion of antigen specific T cells. This process can take place in the liver. The liver is exposed to many food antigens through the
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nTreg cells develop from Foxp3- CD25+ CD4+ cells while iTreg cells develop from Foxp3+ CD25- CD4- cells (both become Foxp3+ CD25+CD4+).
912:, blood vessels, tissue macrophages, and other immune infiltrates. These cells and their interactions all contribute to the changing 69:. Central tolerance is crucial for enabling the immune system to differentiate between self and non-self antigens, thereby preventing 489: 98: 377:
cells, as well as other less well-characterized cells that help establish a local tolerogenic environment. B cells also express
3474: 2581:"Oral tolerance can be established via gap junction transfer of fed antigens from CX3CR1⁺ macrophages to CD103⁺ dendritic cells" 1657:
Fenner F (June 1983). "The Florey lecture, 1983. Biological control, as exemplified by smallpox eradication and myxomatosis".
2874: 1925: 1641: 1240: 362: 73:. Peripheral tolerance plays a significant role in preventing excessive immune reactions to environmental agents, including 869: 685:
Oral tolerance refers to a specific type of peripheral tolerance induced by antigens given by mouth and exposed to the gut
410: 3467: 3117:"The immunosuppressive tumour network: myeloid-derived suppressor cells, regulatory T cells and natural killer T cells" 1989:
Vadasz Z, Haj T, Kessel A, Toubi E (June 2013). "B-regulatory cells in autoimmunity and immune mediated inflammation".
1183: 381:, a non-specific inhibitor receptor that dampens B cell receptor activation. A subset of B regulatory cells that makes 3440: 271:(nTreg cells), which act as sentinels in the periphery to calm down potential instances of T cell autoreactivity (see 1946:
Sakaguchi S, Miyara M, Costantino CM, Hafler DA (July 2010). "FOXP3+ regulatory T cells in the human immune system".
1361:"Expression of the autoimmune regulator gene and its relevance to the mechanisms of central and peripheral tolerance" 284: 245: 401:
in T cells that recognize antigen expressed at high levels and thus presented at steady-state by DCs. In addition,
3813: 604: 880:, which mediate allergic response. Deficits in Treg cells or their localization to mucosa have been implicated in 945: 797: 769: 657: 507: 386: 370: 344: 397:
needed by T cells to proliferate and thus reduce responsiveness. DCs also have the capacity to directly induce
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commensal microbiome, such as increased nutrient absorption and decreased colonization by pathogenic bacteria.
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Hogquist KA, Baldwin TA, Jameson SC (October 2005). "Central tolerance: learning self-control in the thymus".
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Ramsay AG (August 2013). "Immune checkpoint blockade immunotherapy to activate anti-tumour T-cell immunity".
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Braza F, Soulillou JP, Brouard S (September 2012). "Gene expression signature in transplantation tolerance".
641: 597: 191:, who were the first to propose the deletion of self-reactive lymphocytes to establish tolerance, now termed 143:
However, immune tolerance is not without its drawbacks. It can permit the successful infection of a host by
2769:"Intestinal tolerance requires gut homing and expansion of FoxP3+ regulatory T cells in the lamina propria" 1149: 86: 2808:
Goubier A, Dubois B, Gheit H, Joubert G, Villard-Truc F, Asselin-Paturel C, et al. (September 2008).
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nTreg cells develop in the thymus; iTreg cells develop outside the thymus in chronically inflamed tissue,
1710:"Studies on the mechanism of the immunological paralysis induced in mice by pneumococcal polysaccharides" 917: 834: 620: 390: 1129: 3637: 1117: 666: 114: 105:(IPEX) as examples. Furthermore, disruptions in immune tolerance are implicated in the development of 3459: 2720:"Stromal mesenteric lymph node cells are essential for the generation of gut-homing T cells in vivo" 3453: 2866: 2767:
Hadis U, Wahl B, Schulz O, Hardtke-Wolenski M, Schippers A, Wagner N, et al. (February 2011).
1917: 1633: 1232: 481: 336: 762:. Goblet cell-associated antigen passages (GAP) transfer low molecular weight soluble antigens to 584:
function associated with tolerance have been implicated for liver transplant patients. The unique
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the T cell did not encounter in the thymus (such as, tissue-specific molecules like those in the
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are present in such high concentration outside the thymus that they can bind to "weak" receptors.
244:, respectively. In these tissues, maturing lymphocytes are exposed to self-antigens presented by 184: 2260:
Clark DA, Chaouat G (December 2012). "Regulatory T cells and reproduction: how do they do it?".
3839: 3557: 3493: 1764:"Mechanisms of natural tolerance in the intestine: implications for inflammatory bowel disease" 990: 913: 792:
regulatory T cells (iTregs). Under inflammatory conditions, CD103+ dendritic cells will induce
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and activated iTregs or cross-reacting nTregs. Some maternal Treg cells also release soluble
339:(lymph nodes, mucosal-associated lymphoid tissue, etc.). This differentiation is mediated by 3449: 2858: 2622:"Intestinal inflammation abrogates the tolerogenic properties of MLN CD103+ dendritic cells" 2530:
McDole JR, Wheeler LW, McDonald KG, Wang B, Konjufca V, Knoop KA, et al. (March 2012).
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surface of the enterocytes. Here dendritic cells can interact with the presented antigens.
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Hammerschmidt SI, Ahrendt M, Bode U, Wahl B, Kremmer E, Förster R, Pabst O (October 2008).
1998: 1666: 1139: 804:. Retinoic acid is also programming the T cells to stay in the gut environment by inducing 636: 315: 311: 295: 257: 204:
Immunobiology defines tolerance as "immunologically unresponsive...to another's tissues.".
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transcription factor, which is responsible for the suppressive phenotype of these cells.
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Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
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Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
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This observation was experimentally validated by Leslie Brent, Rupert E. Billingham and
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of these patients implies their physiology may be predisposed toward immune tolerance.
2422: 2397: 34:'s state of unresponsiveness to substances or tissues that would otherwise trigger an 3731: 3497: 3403: 3342: 3338: 3299: 3295: 3264: 3208: 3146: 3089: 3054: 2997: 2962: 2913: 2870: 2839: 2790: 2749: 2700: 2651: 2602: 2561: 2512: 2498: 2463: 2427: 2378: 2326: 2277: 2243: 2231: 2193: 2158: 2109: 2105: 2071: 2014: 1963: 1921: 1877: 1842: 1785: 1780: 1763: 1731: 1682: 1637: 1598: 1542: 1490: 1441: 1392: 1341: 1287: 1236: 979: 941: 885: 861: 833:
and is therefore also a site of food tolerance induction. Upon high antigen exposure
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dendritic cells. CD103+ dendritic cells are associated with tolerance induction.
686: 581: 374: 300: 192: 94: 35: 81:. Deficiencies in either central or peripheral tolerance mechanisms can lead to 3773: 3718: 3659: 3579: 3552: 2398:"Oral tolerance, an active immunologic process mediated by multiple mechanisms" 1327: 965: 896:
to cause allergic reactions, can also reduce antibiotic allergies in children.
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Sakaguchi S, Wing K, Onishi Y, Prieto-Martin P, Yamaguchi T (October 2009).
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The hypo-responsiveness induced by oral exposure is systemic and can reduce
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1881: 1846: 1828: 1789: 1735: 1678: 1602: 1546: 1494: 1445: 1396: 1345: 1291: 1144: 1109: 937: 909: 813:, which is required for the expansion of the regulatory T cell population. 776: 744: 466: 188: 70: 2637: 1686: 1377: 1312:"Coordination of tolerogenic immune responses by the commensal microbiota" 779:
with CD103+ dendritic cells and transfer antigens to the dendritic cells.
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may have evolved to prevent hypersensitivity reactions to food proteins.
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have also been implicated promoting differentiation of iTreg cells and
925: 877: 772: 736: 653: 632: 530: 402: 394: 133: 3235:"Decomposing health: tolerance and resistance to parasites in animals" 3132: 3115:
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Cytokine absorption leading to cytokine deprivation-mediated apoptosis
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detection and/or elimination by the host immune system. Induction of
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immunodysregulation polyendocrinopathy enteropathy X-linked syndrome
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Pain, swelling, and disruption of tissue function by inflammation.
714:. After receiving an antigen these dendritic cells migrate to the 706:
The soluble antigens in the lumen of intestine are transported to
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2578: 2134: 2091: 1461:"Role of plasmacytoid dendritic cell subsets in allergic asthma" 151:
to avoid detection and destruction by the host's immune system.
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Becker JC, Andersen MH, Schrama D, Thor Straten P (July 2013).
933: 893: 881: 719: 552: 534: 485: 459: 398: 264: 241: 237: 229: 148: 106: 47: 1569:"Immune-suppressive properties of the tumor microenvironment" 789: 763: 426: 366: 110: 3114: 2717: 2137:"Regulatory T cells: how do they suppress immune responses?" 1624:
Murphy K (2012). "Chapter 1: Basic Concepts in Immunology".
1258:"The pathogenesis of systemic lupus erythematosus-an update" 758:
Another pathway of soluble antigen transport occurs through
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Murphy K (2012). "Chapter 12: The Mucosal Immune System".
729: 159:
The phenomenon of immune tolerance was first described by
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Tissue damage by inflammatory mediators (immunopathology)
924:, and high expression of tolerance-inducing ligands like 892:. Repeated administration of antibiotics, which can form 3168: 3022: 2039: 904:
Immune tolerance is an important means by which growing
65:
Immune tolerance is important for normal physiology and
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from any of a variety of sources, including tolerizing
3169:
Medzhitov R, Schneider DS, Soares MP (February 2012).
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Ganguly D, Haak S, Sisirak V, Reizis B (August 2013).
1859: 1458: 840: 2810:"Plasmacytoid dendritic cells mediate oral tolerance" 2619: 2175: 1059:
Neutralizes toxins and eliminates dangerous organisms
820: 1988: 1089:
Less selection pressure on pathogens for resistance
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Direct damage by pathogen (toxins, digestion, etc.)
743:. The partially degraded antigens are presented on 3164: 3162: 3160: 1514: 1512: 1510: 1508: 1506: 1504: 1459:Maazi H, Lam J, Lombardi V, Akbari O (June 2013). 982:, for instance, has been noted in infections with 751:. The MHCII carrying vesicles are released on the 739:. The antigens are then partially degraded in the 631:(sFGL2), which suppresses the function of DCs and 2892:"Mechanisms of peripheral tolerance to allergens" 1310:Round JL, O'Connell RM, Mazmanian SK (May 2010). 1008:Tradeoffs between immune tolerance and resistance 335:(iTreg cells) in the peripheral tissue or nearby 3902: 3232: 1519:Curotto de Lafaille MA, Lafaille JJ (May 2009). 421:The involvement of T cells, later classified as 3228: 3226: 3224: 3222: 3157: 1903: 1901: 1899: 1810: 1501: 1218: 1216: 1214: 1212: 1210: 1208: 1206: 1204: 1177: 1175: 1173: 1171: 1169: 1167: 1165: 1049:Risk of autoimmunity, hypersensitivity, allergy 825:Oral tolerance is also established by inducing 735:antigens Dissolved antigens can be taken up by 355:, or in certain conditions surrounding tissue. 2941:"Allergen immunotherapy for allergic rhinitis" 2620:Laffont S, Siddiqui KR, Powrie F (July 2010). 2087: 2085: 1941: 1939: 1937: 1562: 1560: 1558: 1556: 1409: 702:Mechanisms of oral tolerance for food antigens 38:. It arises from prior exposure to a specific 16:State of unresponsiveness of the immune system 3475: 3367: 3233:Råberg L, Graham AL, Read AF (January 2009). 3025:"Life history trade-offs in cancer evolution" 2938: 2850: 2042:"The role of dendritic cells in autoimmunity" 1757: 1755: 1753: 1305: 1303: 1301: 899: 3438:International Conference on Immune Tolerance 3219: 2480: 2294: 2259: 1896: 1255: 1201: 1162: 2865:(8th ed.). Garland Sciences. pp.  2082: 1934: 1916:(8th ed.). Garland Sciences. pp.  1632:(8th ed.). Garland Sciences. pp.  1553: 747:after lysosome merging with MHCII carrying 3482: 3468: 2346: 1761: 1750: 1298: 1231:(8th ed.). Garland Science. pp.  1086:Reduced tissue damage from immune response 462:(reduced proliferation and IL-2 signaling) 303:) that can respond to self-antigens that: 3452:at the U.S. National Library of Medicine 3397: 3258: 3202: 3171:"Disease tolerance as a defense strategy" 3140: 3048: 2956: 2907: 2833: 2784: 2743: 2694: 2645: 2596: 2555: 2506: 2421: 2372: 2320: 2209: 2207: 2152: 2065: 1836: 1779: 1725: 1592: 1536: 1484: 1435: 1386: 1376: 1335: 1281: 1256:Choi J, Kim ST, Craft J (December 2012). 615:(HLA-G) that inhibits attack by maternal 551:costimulation, while iTreg cells require 314:, brain, or spinal cord not expressed by 272: 2979: 2255: 2253: 2216:Current Opinion in Organ Transplantation 1410:Verbsky JW, Chatila TA (December 2013). 1358: 1184:"Nobel Lecture: Immunological Tolerance" 964: 490:lymphocyte function-associated antigen 1 416: 198: 154: 99:autoimmune polyendocrine syndrome type 1 1365:Clinical & Developmental Immunology 1181: 730:Antigen presentation to dendritic cells 290: 3903: 3071: 2856: 2395: 2204: 1907: 1656: 1623: 1222: 567: 324: 3463: 2402:The Journal of Clinical Investigation 2342: 2340: 2250: 1079:Energy and resources lost to pathogen 782: 547:nTreg cells, when activated, require 343:produced upon T cell activation, and 2724:The Journal of Experimental Medicine 2675:The Journal of Experimental Medicine 2487:Clinical and Experimental Immunology 809:present in this environment secrete 591: 563:Tolerance in physiology and medicine 220: 124:, immune tolerance is vital for the 58:, taking place in other tissues and 841:Hypersensitivity and oral tolerance 393:(IDO) that depletes the amino acid 365:that make IL-10 but do not express 13: 2939:Petalas K, Durham SR (June 2013). 2337: 2262:Journal of Reproductive Immunology 1813:"The thymus and central tolerance" 1811:Sprent J, Kishimoto H (May 2001). 821:Other mechanisms of oral tolerance 14: 3922: 3426: 2481:Miron N, Cristea V (March 2012). 1130:Evolutionary medicine § tradeoffs 680: 647: 246:medullary thymic epithelial cells 136:response sufficiently to prevent 3339:10.1111/j.0105-2896.2006.00411.x 3296:10.1111/j.1600-065x.2006.00445.x 2982:Pediatric Allergy and Immunology 2499:10.1111/j.1365-2249.2011.04523.x 2349:"Oral tolerance to food protein" 2106:10.1046/j.1440-1711.2002.01068.x 1781:10.1097/00054725-200407000-00023 1762:Jump RL, Levine AD (July 2004). 1573:Cancer Immunology, Immunotherapy 946:myeloid derived suppressor cells 722:and induce differentiation into 718:. Here they interact with naïve 605:major histocompatibility complex 3361: 3318: 3275: 3108: 3065: 3016: 2973: 2932: 2883: 2801: 2760: 2711: 2662: 2613: 2572: 2523: 2474: 2438: 2389: 2295:Christiansen OB (August 2013). 2288: 2169: 2128: 2033: 1982: 1853: 1804: 1701: 1650: 1617: 1182:Medawar P (December 12, 1960). 691:its associated lymphoid tissues 389:also exists. Some DCs can make 3809:Immunoglobulin class switching 3074:British Journal of Haematology 2626:European Journal of Immunology 2347:Pabst O, Mowat AM (May 2012). 1452: 1403: 1352: 1249: 539:gut-associated lymphoid tissue 1: 2011:10.1016/j.febslet.2013.05.023 1416:Current Opinion in Pediatrics 1262:Current Opinion in Immunology 1155: 868:at mucosal surfaces suppress 642:Immune tolerance in pregnancy 635:involved in inflammation and 598:Immune tolerance in pregnancy 411:activation-induced cell death 2826:10.1016/j.immuni.2008.06.017 2786:10.1016/j.immuni.2011.01.016 2598:10.1016/j.immuni.2013.12.012 2460:10.1053/j.gastro.2007.02.043 2313:10.1016/j.molimm.2012.08.025 2228:10.1097/MOT.0b013e3283636fd5 1538:10.1016/j.immuni.2009.05.002 1428:10.1097/mop.0000000000000029 1150:Plant tolerance to herbivory 951: 835:plasmacytoid dendritic cells 87:systemic lupus erythematosus 7: 2094:Immunology and Cell Biology 1768:Inflammatory Bowel Diseases 1123: 1120:, and other such diseases. 667:inflammatory bowel diseases 619:. These cells also express 391:Indoleamine 2,3-dioxygenase 10: 3927: 3638:Polyclonal B cell response 2396:Weiner HL (October 2000). 2046:Nature Reviews. Immunology 1948:Nature Reviews. Immunology 1862:Nature Reviews. Immunology 1328:10.1016/j.jaut.2009.11.007 1118:inflammatory bowel disease 900:The tumor microenvironment 858:hypersensitivity reactions 629:fibrinogen-like proteins 2 595: 480:costimultory molecules on 185:Sir Frank McFarlane Burnet 115:inflammatory bowel disease 85:, with conditions such as 3872: 3830: 3772: 3673: 3603: 3511: 3504: 2297:"Reproductive immunology" 2274:10.1016/j.jri.2012.07.007 2190:10.1016/j.cca.2012.04.024 1585:10.1007/s00262-013-1434-6 1274:10.1016/j.coi.2012.10.004 3454:Medical Subject Headings 3433:Immune Tolerance Network 2141:International Immunology 1727:10.4049/jimmunol.74.1.17 1034:Elimination (resistance) 482:antigen presenting cells 458:after contact, inducing 353:antigen presenting cells 163:in 1945, who noted that 128:of genetically distinct 3390:10.1126/science.1148526 3195:10.1126/science.1214935 2861:Janeway's Immunobiology 1912:Janeway's Immunobiology 1628:Janeway's Immunobiology 1316:Journal of Autoimmunity 1227:Janeway's Immunobiology 1056:Reduces pathogen burden 870:type 2 CD4 helper cells 613:Human Leukocyte Antigen 611:cells express a unique 24:immunological tolerance 3752:Tolerance in pregnancy 3494:adaptive immune system 3251:10.1098/rstb.2008.0184 3029:Nature Reviews. Cancer 1829:10.1098/rstb.2001.0846 1679:10.1098/rspb.1983.0039 991:Listeria monocytogenes 970: 914:tumor microenvironment 716:mesenteric lymph nodes 484:upon interaction with 451:secretion upon contact 409:tissues can result in 250:thymic dendritic cells 132:, as it moderates the 3787:Somatic hypermutation 3621:Polyclonal antibodies 3616:Monoclonal antibodies 3327:Immunological Reviews 3284:Immunological Reviews 2638:10.1002/eji.200939957 2154:10.1093/intimm/dxp095 1714:Journal of Immunology 1092:Promotes commensalism 968: 417:nTreg vs. iTreg cells 199:Definitions and usage 155:Historical background 3804:Junctional diversity 3572:Antigen presentation 2736:10.1084/jem.20080039 2687:10.1084/jem.20070719 2301:Molecular Immunology 2184:(17–18): 1414–1418. 1140:Infectious tolerance 637:antigen presentation 312:islets of Langerhans 296:Peripheral tolerance 291:Peripheral tolerance 273:peripheral tolerance 91:rheumatoid arthritis 56:peripheral tolerance 3799:V(D)J recombination 3782:Affinity maturation 3534:Antigenic variation 3382:2007Sci...318..812R 3187:2012Sci...335..936M 2958:10.4193/Rhino12.086 2548:10.1038/nature10863 2003:2013FEBSL.587.2074V 1671:1983RSPSB.218..259F 1378:10.1155/2012/207403 1359:Perniola R (2012). 1062:Prevents parasitism 985:Helicobacter pylori 568:Allograft tolerance 499:Contact-independent 318:in thymic tissues). 145:pathogenic microbes 83:autoimmune diseases 46:, occurring in the 3443:2011-02-19 at the 2353:Mucosal Immunology 980:regulatory T cells 971: 783:Regulatory T cells 724:regulatory T cells 675:ulcerative colitis 472:Downregulation of 437:Contact-dependent: 269:regulatory T cells 120:In the context of 3898: 3897: 3826: 3825: 3576:professional APCs 3376:(5851): 812–814. 3181:(6071): 936–941. 3133:10.1111/imm.12036 3086:10.1111/bjh.12380 2994:10.1111/pai.12001 2909:10.1111/all.12085 2876:978-0-8153-4243-4 2730:(11): 2483–2490. 2542:(7389): 345–349. 2365:10.1038/mi.2012.4 2147:(10): 1105–1111. 1997:(13): 2074–2078. 1927:978-0-8153-4243-4 1823:(1409): 609–616. 1665:(1212): 259–285. 1643:978-0-8153-4243-4 1477:10.1111/all.12166 1242:978-0-8153-4243-4 1101: 1100: 1095:Lower energy cost 886:atopic dermatitis 592:Fetal development 465:Interaction with 407:immune privileged 325:central tolerance 283:process detailed 254:bone marrow cells 226:Central tolerance 221:Central tolerance 210:immunosuppression 44:central tolerance 3918: 3792:Clonal selection 3764:Immune privilege 3759:Immunodeficiency 3714:Cross-reactivity 3704:Hypersensitivity 3509: 3508: 3484: 3477: 3470: 3461: 3460: 3450:Immune+tolerance 3420: 3419: 3401: 3365: 3359: 3358: 3322: 3316: 3315: 3279: 3273: 3272: 3262: 3230: 3217: 3216: 3206: 3166: 3155: 3154: 3144: 3112: 3106: 3105: 3069: 3063: 3062: 3052: 3020: 3014: 3013: 2977: 2971: 2970: 2960: 2936: 2930: 2929: 2911: 2887: 2881: 2880: 2864: 2854: 2848: 2847: 2837: 2805: 2799: 2798: 2788: 2764: 2758: 2757: 2747: 2715: 2709: 2708: 2698: 2681:(8): 1765–1774. 2666: 2660: 2659: 2649: 2632:(7): 1877–1883. 2617: 2611: 2610: 2600: 2576: 2570: 2569: 2559: 2527: 2521: 2520: 2510: 2478: 2472: 2471: 2454:(5): 1866–1876. 2448:Gastroenterology 2442: 2436: 2435: 2425: 2414:10.1172/jci11348 2393: 2387: 2386: 2376: 2344: 2335: 2334: 2324: 2292: 2286: 2285: 2257: 2248: 2247: 2211: 2202: 2201: 2173: 2167: 2166: 2156: 2132: 2126: 2125: 2089: 2080: 2079: 2069: 2037: 2031: 2030: 1986: 1980: 1979: 1943: 1932: 1931: 1915: 1905: 1894: 1893: 1857: 1851: 1850: 1840: 1808: 1802: 1801: 1783: 1759: 1748: 1747: 1729: 1705: 1699: 1698: 1654: 1648: 1647: 1631: 1621: 1615: 1614: 1596: 1579:(7): 1137–1148. 1564: 1551: 1550: 1540: 1516: 1499: 1498: 1488: 1456: 1450: 1449: 1439: 1407: 1401: 1400: 1390: 1380: 1356: 1350: 1349: 1339: 1322:(3): J220–J225. 1307: 1296: 1295: 1285: 1253: 1247: 1246: 1230: 1220: 1199: 1198: 1196: 1194: 1179: 1046:High energy cost 1020: 1019: 847:hypersensitivity 454:Upregulation of 30:, refers to the 22:, also known as 20:Immune tolerance 3926: 3925: 3921: 3920: 3919: 3917: 3916: 3915: 3901: 3900: 3899: 3894: 3868: 3822: 3768: 3747:Clonal deletion 3675: 3669: 3599: 3500: 3488: 3445:Wayback Machine 3429: 3424: 3423: 3366: 3362: 3323: 3319: 3280: 3276: 3245:(1513): 37–49. 3231: 3220: 3167: 3158: 3113: 3109: 3070: 3066: 3041:10.1038/nrc3606 3035:(12): 883–892. 3021: 3017: 2978: 2974: 2937: 2933: 2888: 2884: 2877: 2855: 2851: 2806: 2802: 2765: 2761: 2716: 2712: 2667: 2663: 2618: 2614: 2577: 2573: 2528: 2524: 2479: 2475: 2443: 2439: 2394: 2390: 2345: 2338: 2293: 2289: 2258: 2251: 2212: 2205: 2174: 2170: 2133: 2129: 2090: 2083: 2058:10.1038/nri3477 2038: 2034: 1987: 1983: 1960:10.1038/nri2785 1944: 1935: 1928: 1906: 1897: 1874:10.1038/nri1707 1868:(10): 772–782. 1858: 1854: 1809: 1805: 1760: 1751: 1706: 1702: 1655: 1651: 1644: 1622: 1618: 1565: 1554: 1517: 1502: 1457: 1453: 1408: 1404: 1357: 1353: 1308: 1299: 1254: 1250: 1243: 1221: 1202: 1192: 1190: 1188:The Nobel Prize 1180: 1163: 1158: 1126: 1010: 954: 902: 843: 823: 785: 732: 708:dendritic cells 704: 695:intestinal wall 683: 671:Crohn's disease 650: 600: 594: 586:gene signatures 570: 565: 419: 349:dendritic cells 337:lymphoid tissue 293: 223: 201: 193:clonal deletion 157: 95:type 1 diabetes 36:immune response 28:immunotolerance 17: 12: 11: 5: 3924: 3914: 3913: 3896: 3895: 3893: 3892: 3887: 3882: 3876: 3874: 3870: 3869: 3867: 3866: 3861: 3860: 3859: 3849: 3848: 3847: 3836: 3834: 3828: 3827: 3824: 3823: 3821: 3820: 3811: 3806: 3801: 3796: 3795: 3794: 3789: 3778: 3776: 3774:Immunogenetics 3770: 3769: 3767: 3766: 3761: 3756: 3755: 3754: 3749: 3744: 3739: 3734: 3722: 3721: 3719:Co-stimulation 3716: 3711: 3706: 3701: 3696: 3691: 3686: 3679: 3677: 3671: 3670: 3668: 3667: 3662: 3660:Immune complex 3656: 3655: 3650: 3645: 3640: 3635: 3634: 3633: 3628: 3623: 3618: 3607: 3605: 3601: 3600: 3598: 3597: 3592: 3587: 3582: 3580:Dendritic cell 3568: 3567: 3562: 3561: 3560: 3558:Conformational 3555: 3544: 3543: 3538: 3537: 3536: 3531: 3526: 3515: 3513: 3506: 3502: 3501: 3487: 3486: 3479: 3472: 3464: 3458: 3457: 3447: 3435: 3428: 3427:External links 3425: 3422: 3421: 3360: 3317: 3274: 3218: 3156: 3127:(2): 105–115. 3107: 3080:(3): 313–325. 3064: 3015: 2972: 2931: 2902:(2): 161–170. 2882: 2875: 2849: 2820:(3): 464–475. 2800: 2779:(2): 237–246. 2759: 2710: 2661: 2612: 2591:(2): 248–261. 2571: 2522: 2493:(3): 405–412. 2473: 2437: 2408:(8): 935–937. 2388: 2359:(3): 232–239. 2336: 2287: 2249: 2222:(4): 416–420. 2203: 2168: 2127: 2100:(2): 131–137. 2081: 2052:(8): 566–577. 2032: 1981: 1954:(7): 490–500. 1933: 1926: 1895: 1852: 1803: 1774:(4): 462–478. 1749: 1700: 1649: 1642: 1616: 1552: 1531:(5): 626–635. 1500: 1471:(6): 695–701. 1451: 1422:(6): 708–714. 1402: 1351: 1297: 1268:(6): 651–657. 1248: 1241: 1200: 1160: 1159: 1157: 1154: 1153: 1152: 1147: 1142: 1137: 1132: 1125: 1122: 1099: 1098: 1097: 1096: 1093: 1090: 1087: 1082: 1081: 1080: 1077: 1072: 1066: 1065: 1064: 1063: 1060: 1057: 1052: 1051: 1050: 1047: 1044: 1041: 1036: 1030: 1029: 1026: 1023: 1009: 1006: 953: 950: 901: 898: 842: 839: 822: 819: 784: 781: 731: 728: 712:lamina propria 703: 700: 682: 681:Oral tolerance 679: 649: 648:The microbiome 646: 596:Main article: 593: 590: 569: 566: 564: 561: 560: 559: 556: 555:costimulation. 545: 542: 523: 522: 521: 520: 517: 511: 501: 500: 496: 495: 494: 493: 470: 463: 452: 439: 438: 418: 415: 405:expression by 320: 319: 308: 292: 289: 222: 219: 200: 197: 181: 180: 156: 153: 79:gut microbiota 15: 9: 6: 4: 3: 2: 3923: 3912: 3909: 3908: 3906: 3891: 3888: 3886: 3883: 3881: 3878: 3877: 3875: 3871: 3865: 3862: 3858: 3855: 3854: 3853: 3850: 3846: 3843: 3842: 3841: 3838: 3837: 3835: 3833: 3829: 3819: 3815: 3812: 3810: 3807: 3805: 3802: 3800: 3797: 3793: 3790: 3788: 3785: 3784: 3783: 3780: 3779: 3777: 3775: 3771: 3765: 3762: 3760: 3757: 3753: 3750: 3748: 3745: 3743: 3742:Clonal anergy 3740: 3738: 3735: 3733: 3730: 3729: 3728: 3724: 3723: 3720: 3717: 3715: 3712: 3710: 3707: 3705: 3702: 3700: 3697: 3695: 3692: 3690: 3687: 3685: 3681: 3680: 3678: 3672: 3666: 3663: 3661: 3658: 3657: 3654: 3651: 3649: 3646: 3644: 3641: 3639: 3636: 3632: 3631:Microantibody 3629: 3627: 3624: 3622: 3619: 3617: 3614: 3613: 3612: 3609: 3608: 3606: 3602: 3596: 3593: 3591: 3588: 3586: 3583: 3581: 3577: 3573: 3570: 3569: 3566: 3563: 3559: 3556: 3554: 3551: 3550: 3549: 3546: 3545: 3542: 3539: 3535: 3532: 3530: 3527: 3525: 3522: 3521: 3520: 3517: 3516: 3514: 3510: 3507: 3503: 3499: 3495: 3492: 3485: 3480: 3478: 3473: 3471: 3466: 3465: 3462: 3455: 3451: 3448: 3446: 3442: 3439: 3436: 3434: 3431: 3430: 3417: 3413: 3409: 3405: 3400: 3395: 3391: 3387: 3383: 3379: 3375: 3371: 3364: 3356: 3352: 3348: 3344: 3340: 3336: 3332: 3328: 3321: 3313: 3309: 3305: 3301: 3297: 3293: 3289: 3285: 3278: 3270: 3266: 3261: 3256: 3252: 3248: 3244: 3240: 3236: 3229: 3227: 3225: 3223: 3214: 3210: 3205: 3200: 3196: 3192: 3188: 3184: 3180: 3176: 3172: 3165: 3163: 3161: 3152: 3148: 3143: 3138: 3134: 3130: 3126: 3122: 3118: 3111: 3103: 3099: 3095: 3091: 3087: 3083: 3079: 3075: 3068: 3060: 3056: 3051: 3046: 3042: 3038: 3034: 3030: 3026: 3019: 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Owen 138:miscarriage 67:homeostasis 60:lymph nodes 52:bone marrow 3911:Immunology 3873:Substances 3737:Peripheral 3725:Inaction: 3604:Antibodies 3585:Macrophage 3498:complement 3121:Immunology 2988:(1): 3–9. 1371:: 207403. 1156:References 874:mast cells 862:Treg cells 654:microbiome 574:allografts 469:on T cells 423:Treg cells 395:tryptophan 359:Treg cells 333:Treg cells 134:alloimmune 3890:Cytolysin 3880:Cytokines 3727:Tolerance 3676:tolerance 3595:Immunogen 3399:1842/2140 2945:Rhinology 2244:205838923 1070:Tolerance 1028:Benefits 952:Evolution 866:Th3 cells 794:Th1 cells 749:endosomes 741:lysosomes 363:TR1 cells 165:dizygotic 130:offspring 126:gestation 122:pregnancy 75:allergens 3905:Category 3840:Cellular 3684:Immunity 3682:Action: 3665:Paratope 3653:Idiotype 3643:Allotype 3611:Antibody 3565:Mimotope 3529:Allergen 3512:Antigens 3505:Lymphoid 3441:Archived 3416:16697260 3408:17975068 3355:19863894 3347:16903913 3312:37377768 3304:17100888 3269:18926971 3213:22363001 3151:23216602 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Index

immune system
immune response
antigen
central tolerance
thymus
bone marrow
peripheral tolerance
lymph nodes
homeostasis
autoimmunity
allergens
gut microbiota
autoimmune diseases
systemic lupus erythematosus
rheumatoid arthritis
type 1 diabetes
autoimmune polyendocrine syndrome type 1
immunodysregulation polyendocrinopathy enteropathy X-linked syndrome
asthma
atopy
inflammatory bowel disease
pregnancy
gestation
offspring
alloimmune
miscarriage
pathogenic microbes
cancers
Ray D. Owen
dizygotic

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