As part of a prospective study of dengue virus infections during infancy in San Pablo, Philippines, we collected peripheral blood mononuclear cells (PBMC) from healthy infants at approximately two months of age. We measured pDC IFN-α and tumor necrosis factor-α (TNF-α) production to 1

μM R-848 stimulation by intracellular cytokine staining (ICS) in healthy infant PBMC from 47 randomly selected donors (ages

=

2.1 [1.6-3.8] months). Figure a shows the gating strategy for the flow cytometry. pDCs were 2.2 [0.8-6.2]% of live PBMC in our early infancy samples. We found that the percentage of IFN-α

+

pDCs (Figure b), but not TNF-α

+

pDCs (Figure c), was significantly higher in female infants compared to male infants following 1

μM R-848 stimulation. There were no significant differences in age or World Health Organization (WHO) anthropometric measures between the sexes (weight-for-age, length-for-age, weight-for-length, or body mass index-for-age z scores). PBMC viability was measured by trypan blue exclusion in the cell cultures and was similar between the two sexes (data not shown). Higher R-848 and TLR7-mediated pDC IFN-α production has been previously reported in adult females compared to adult males [
8,
9]. To the best of our knowledge, this is the first time a similar phenomenon has been reported during early infancy. TLR7 expression has not been found to be different between the sexes [
8]. In one report, 17-β-estradiol was reported to augment TLR9-mediated pDC IFN-α production [
14]; but in another report, 17-β-estradiol did not affect TLR7-mediated pDC IFN-α production [
8]. The reported effects of progesterone on TLR-mediated pDC IFN-α production have also been conflicting. Meier et al. demonstrated that plasma progesterone levels significantly correlated with pDC IFN-α production in response to stimulation with an HIV-1–derived TLR7/8 ligand [
9]. By contrast, Hughes et al. found that progesterone inhibited CpG-mediated and vesicular stomatitis virus-induced IFN-α production by pDCs [
10].
During the “mini-puberty” stage [
11], male infants have markedly higher circulating testosterone and dihydrotestosterone (DHT) levels compared to female infants [
15]. We therefore hypothesized that androgen signaling would decrease pDC IFN-α production in response to R-848 stimulation. DHT is a more potent androgen than testosterone [
16]. Pretreatment of female adult pDCs with DHT decreased R-848-stimulated IFN-α production, but not TNF-α production, in a dose dependent manner (Figure ). A similar finding was seen for CpG-mediated TLR9 stimulation in the pDCs (data not shown). The downregulation of TLR7 and TLR9 stimulated pDC IFN-α production contrasts with the reported positive associations between androgens and serum inflammatory markers [
17]. pDC IFN-α production is dependent on interferon regulatory factor 7 (IRF7) [
18]. The IRF7 promoter contains androgen responsive elements and higher levels of IRF7 have been seen in the lungs of female Norway rats compared to males [
19]. We postulate that the lower R-848 stimulated pDC IFN-α production in male infants is at least partly due to androgen effects on IRF7 levels within the first six months of life. Future studies are planned to examine the effect of androgens on pDC IRF7 levels.
Female infants enjoy a survival benefit compared to male infants in the first six months of life. In particular,
Staphylococcus aureus infections [
20] and respiratory viral infections such as respiratory syncytial virus (RSV) [
21] predominate in males during early infancy.
Staphylococcus aureus and several airborne and respiratory RNA viruses (including RSV) can modulate TLR7-mediated pDC IFN-α production during their pathogenesis [
22-
24]. Higher pDC IFN-α production in females during early infancy may contribute to their survival benefit. Later in life, this sex effect may contribute to a higher incidence of SLE and autoimmune diseases in females [
12,
13].