The frail elderly: role of dendritic cells in the susceptibility of infection.

The decline in immunity in the elderly has largely been attributed to impairment of T cell mechanisms. This seems reasonable since the thymus involutes with age, so that the number of naïve cells to respond to new foreign antigens also declines. However, little is known about how aging affects antigen-presenting cells (APC) that are responsible for the initiation and outcome of effector T cell immune responses. This review focuses on the age-related alterations of a key APC, the dendritic cell (DC). Recent findings suggest that interleukin-10, a key cytokine that can suppress cell mediated immunity and maturation of DC subsets, is elevated in the very healthy elderly. However, production of IL-12, required for the initiation of T cell immune responses, declines in frail elderly along with DC antigen presenting function. These findings suggest that shifts in IL-10 and IL-12 may not only directly influence immune response but may also alter the balance and maturation of DC subsets. Finally, study of immunologic differences between the very healthy and frail elderly may reveal important changes in DC function and regulation influenced by age and/or environment (disease, nutrition, medications, etc.).