Regulatory T cells: the physiology of autoreactivity in dominant tolerance and “quality control” of immune responses

Summary: Little progress has been achieved over the last 20 years on the clinical management of several conditions that relate to self‐tolerance and to the regulation of immune responses: autoimmune diseases, transplantation tolerance, tumor immunity, allergy and vaccine development in chronic infections. These failures, it is argued, are due to the inability of the prevalent “recessive tolerance” concepts to accommodate physiological autoreactivity and the regulatory potential it embodies. In this review, the advantages of “dominant tolerance” models are underlined in the light of critical evidence and in the general context of the natural autoimmune activities. The role of regulatory T cells is discussed, notably in the regulation of inflammatory reactions and, more generally, in the “quality control” of immune responses. It is anticipated that progress will be brought about by dominant tolerance approaches, and through an increased knowledge of the differentiative pathways, repertoires, mechanisms of activation and effector functions of autoreactive, regulatory T cells.