After sequential expansion and contraction phases in response to MCMV infection, Ly49H+ NK cells tend to persist in the circulation, accounting for a more efficient response to reinfection [42, 47]. By analogy with the adaptive immune response, the term “memory NK cell” was coined to define this pattern of response, and it has been speculated that NKG2C+ NK cells might

be a human counterpart of Ly49H+ murine NK cells [32, 41]. Nevertheless, despite that circumstantial observations support that NKG2C+ NK cells might contribute to controlling HCMV viremia [34], as yet there is no formal evidence supporting that they specifically exert their effector functions against HCMV-infected cells, protecting against viral reactivation or reinfection [48]. Restrictions in sample volume did not allow to perform functional studies of

NKG2C+ NK cells, FK506 purchase as those reported in adult HCMV-infected individuals [31]. Studies in immunodeficiencies and immunosuppressed patients indirectly suggest that the magnitude of the NKG2C+ expansion may be inversely related to the effectiveness of the T-cell mediated response to HCMV infection [31, 32, 34-36]. As shown for other pathogens (e.g., HBV), we hypothesized that vertical HCMV transmission might favor the establishment of partial tolerance, impairing an effective T-cell-mediated control of the infection, and promoting in this case the expansion BYL719 supplier of NKG2C+ NK cells. Nevertheless, the minimal phenotypic changes detected in asymptomatic cases is consistent with the view that, irrespective of the time of infection and immune immaturity, an effective control of the pathogen may limit its impact on the NKR distribution. These observations, together

with the expansion of NKG2C+ cells observed in postnatal infection and in healthy adults, point out that other factors (e.g., viral load, virus and host genetics, frequency of viral reactivation) determine the magnitude of HCMV impact on the NK-cell compartment. In this regard, differences in viral exposure might explain why the expansion of NKG2C+ cells appeared more marked in children with postnatal Inositol oxygenase infection than in the group with congenital asymptomatic infection. Early postnatal infection often occurs along breastfeeding due to viral excretion in maternal milk, causing symptomatic disease in some newborns particularly in premature infants. By contrast, transplacental transmission is restricted to the time window of maternal viremia, and appears a relatively unpredictable infective pathway, as illustrated by the identification of twins with discordant infection. Whether the response of NK cells to HCMV may contribute to the immunopathogenesis of clinical disorders along acute congenital symptomatic infection remains an open issue.