New insight into an old concept: role of immature erythroid cells in immune pathogenesis of neonatal infection

Newborns are exceedingly susceptible to infection. However, very little is known about what governs the immunological differences seen in early life that result in extreme vulnerability to infection, nor how this changes during infancy. Herein, I provide evidence that the reduced ability to mount a protective immune response to pathogens is not due to an inherent immaturity of neonatal immune cells but instead the functions of these immune cells are actively suppressed by CD71(+) erythroid cells. Furthermore, the role of CD71(+) erythroid cells in host defense against infection is examined. CD71(+) erythroid cells are enriched in newborns and have distinctive immunosuppressive properties that leave them vulnerable to infection. Moreover, immature erythroid cells possess exclusive immunomodulatory properties and may play a role in immune ontogeny. In addition to these distinct features, CD71(+) erythroid cells impact digestive health by preventing excessive inflammation following the sudden transition from a sterile in utero setting to excessive colonization with commensals in the external environment. Ongoing research in identifying the beneficial and/or detrimental effects of immature erythrocytes on immune responses may serve to enhance protective newborn immune responses to infection and enable better vaccination strategies for the young to be designed.