We have analyzed PBL from 7 children exposed to CsA in utero and 4 children exposed to AZA in utero. Expression of CD3, CD4, CD8, and CD20 were normal for both groups of children; however, significant differences were detected in the expression of CD45RA, CD45R0, and CD29. While CsA-exposed children had higher density of CD45RA, and a higher proportion of CD45RA+R0- T cells, than did unexposed children, those exposed to AZA alone had decreased CD45RA+ and a large increase in CD45RA-R0+ T cells. It appears the exposure to CsA slightly delays T cell development, whereas exposure to AZA, without concomitant exposure to CsA, accelerates development to that of an adult. The effects of CsA abrogated the effects of AZA when both were present during pregnancy. The expression of CD29, the beta 1-integrin, on T cells has been linked to enhanced ability to respond to recall antigens and to home to sites of infection. Among children exposed to CsA, T cells from cord blood and a 5-month-old infant have a normal CD29 profile. However from 1 to 6 years of age the proportion of T cells expressing a high density of CD29 is significantly lower (4-fold) than that of T cells from unexposed children. Because these children have no outward signs of immunodeficiency, we postulate that this low proportion is still sufficient for normal immune responsiveness. The distribution of CD29 on T cells was different for the 3 study groups. Among CsA-exposed children, although the proportion of CD29hi T cells was much reduced, all were CD45RA+, as was also the case for unexposed children. In contrast, among children exposed only to AZA, the majority of CD29hi T cells were CD45R0+. Serological testing indicated that immunoglobulin and complement levels, as well as seroconversion in response to vaccination, were normal among CsA-exposed children, with no detectable autoantibodies to cellular or tissue components, including parietal cells. Unlike T cell development in inbred rodents, the immune system in humans appears to be remarkably resilient, and successfully adapts to the presence of CsA during its early developmental stages. This work suggests that the presence of CsA throughout pregnancy has only a minimal effect on fetal immune development and appears to have less impact on T cells than does exposure to AZA only. We conclude that children exposed to CsA in utero are not likely to be at risk of immunodeficiency or autoimmunity.