Critical evaluation of regulatory T cells in autoimmunity: are the most potent regulatory specificities being ignored?

The identification of CD4+ CD25+ Foxp3+ regulatory T (Treg) cells as natural regulators of immunity in the periphery and tissues has stimulated tremendous interest in developing therapeutic strategies for autoimmune diseases. In this review, the site of origin, antigen specificity, homing markers and cytokine profiles of Treg cells were evaluated in autoimmune colitis and type 1 diabetes, two examples in which Treg cells were effective as therapy. These studies were compared with studies of Treg cells in experimental autoimmune encephalomyelitis and multiple sclerosis, where successful therapy has not yet been achieved. Antigen-specific Treg cells appear to have more potent activity than polyclonal Treg cells and therefore hold more promise as therapeutic agents. However, Treg cells specific for the pathogenic T effector cells themselves have largely been overlooked and deserve consideration in future studies.