A revised view of the central nervous system microenvironment and major histocompatibility complex class II antigen presentation.

There are numerous observations reporting that phagocytes expressing major histocompatibility complex (MHC) Class II molecules are associated with the central nervous system (CNS) in normal and pathological conditions. Although MHC Class II expression is necessary for antigen presentation to CD4 + T-cells, it is not sufficient and co-stimulatory molecules are also required. We review here recent in vivo studies demonstrating that the microglia and perivascular macrophages are unable to initiate a primary immune response in the CNS microenvironment, but may support secondary immune responses. Although in vitro studies show that microglia do not support a primary immune response leading to T-cell proliferation, they do show that microglia may protect the CNS from the unwanted attentions of autoreactive T-cells by inducing their apoptosis. The lack of cells in the CNS parenchyma with the ability to initiate a primary immune response has a cost, namely that pathogens may persist in the CNS undetected by the immune system.