Fetal tolerance to noninherited maternal antigens Fetal T cells accumulate during in utero development. Even though the fetus is exposed to noninherited maternal antigens (NIMAs), fetal CD4+ T cells are capable of alloantigen-induced proliferation, preferentially differentiating to Treg cells and preventing a fetal immune response to maternal antigens. This expanded immune tolerance persists in both mother and offspring after birth and allows microchimeric cells to be retained in tissues. Postnatal tolerance to NIMAs NIMA-specific tolerance causes some interesting immunological phenotypes: sensitization to erythrocyte Rhesus factor (Rh) antigens is reduced among Rh- women born to Rh+ women, long-term kidney allograft survival is improved in NIMA-matched donor-recipient sibling pairs, or acuteness of bone marrow transplantation graft-versus-host disease is reduced, when recipients of donor stem cells are NIMA-matched. Cross-fostering animal studies show that when postnatal NIMA exposure though breastfeeding is eliminated, survival of NIMA-matched allografts is reduced. This suggests that to maintain NIMA-specific tolerance in offspring, breastfeeding is essential, but ingestion of mother’s cells alone does not prime NIMA-specific tolerance. Both prenatal and postnatal exposure to mother’s cells is required to maintain NIMA-specific tolerance. Benefits of microchimeric cells The severity of preexisting autoimmune disorders is reduced during pregnancy and it is most apparent when fetal microchimeric cells levels are highest - during the last trimester. These cells can also replace injured maternal cells and recover tissue function (type I diabetes mouse model showed replacement of defective maternal islet cells by fetal-derived pancreatic cells). Fetal microchimeric cells can differentiate into cell types that infiltrate and replace injured cells in models of Parkinson’s disease or myocardial infarction. They also help in wound healing by neoangiogenesis. Seeding of fetal microchimeric cells into maternal tissues has been proposed to promote care of offspring after birth (seeding of maternal breast tissue may promote lactation, and seeding of brain may enhance maternal attention). Relationship with autoimmune diseases and breast cancer Microchimerism has been implicated in autoimmune diseases. Independent studies repeatedly suggested that microchimeric cells of fetal origin may be involved in the pathogenesis of systemic sclerosis. Moreover, microchimeric cells of maternal origin may be involved in the pathogenesis of a group of autoimmune diseases found in children, i.e. juvenile idiopathic inflammatory myopathies (one example would be juvenile dermatomyositis). Microchimerism has now been further implicated in other autoimmune diseases, including systemic lupus erythematosus. Contrarily, an alternative hypothesis on the role of microchimeric cells in lesions is that they may be