Download - Immunology Tonsil 2
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Dr. Dony Hartanto. SpTHT -KL, MKes.ENT-HNS, RSUD Sukoharjo/ UMS School of Medicine
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1. Weldeyer’s ring
2. Lymphoid compartments of palatine tonsil
3. Immunology process in palatine tonsil
4. Immunopathological aspect of palatine tonsil
• Tonsilitis and tonsilectomy
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1. Nasopharyngeal tonsil (NT) OR adenoid
2. Tubal tonsils (TT)
3. Palatine tonsils (PT)
4. Lingual tonsils (LT)
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entrance to the digestive & respiratory tracts
Immunological role:early recognition of antigen
initiation of an immune response.
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Play a role in the immune function
1. Reticular crypt of epithelium
2. The extrafolicular area
3. The mantle zone of lymphoid
follicles
4. The follicular germinal centres
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Lymphoid compartments of palatine tonsilReticulated crypt epithelium
Extrafollicularregion
Lymphoid follicle
Surface epithelium
Mantle zoneSecondary lymphoid follicle
B cellHEV
T cell
Germinal centre
capsule
Lymph vessel
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Reticulated crypt epithelium
Extrafollicular region Lymphoid follicle
•M cells•B cells•T cells (CD8 > CD4), •T cells •Plasma cells•Macrophages•Interdigitating dendritic cells•Mast cells
• T cells (CD4 > CD8)–Memory & naïve CD4
•Interdigitating dendritic cells•B cells •Plasma cells•Macrophages•HEV
•Germinal center•B cells
–Naïve B cells–Centrocytes–Centroblasts
•Plasma cells•Follicular dendritic cells•T cells (memory CD4)
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SSE: stratified squamous epithel, CT: connective tissue, LN: lymphatic nodule
Each tonsil contains 10 – 30 branched crypts Enlarge the surface up to 300 cm2 increase the surface for Ag contact
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1. Transportation of antigen by M cells or dendritic cells (DC) to the extrafollicular areas
2. Activation of T cells in the extrafollicular areaAPC: Interdigitating DC
(IDC)
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circulation
TONSIL
HEV
lymphatic
Only few immunocompetent cells are available in normal tonsil
Lymphocytes migrate continuously from the blood to tonsils
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3. Stimulation of naïve B cells in the extrafollicular zones by activated T cells Colonize the primary lymphoid follicles Act as “founder cells” for Germinal centres (GC)
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4. Clonal expansion of B cells
5. Somatic hypermutaion in B cell Ig V region
genes
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6. Positive selection of B cells that are able to receive Ag specific signals by high affinity
7. Differentiation to B memory cells and plasma cells of various immunoglobulins
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J chain is needed for the formation of sIgA and sIgM Termination of effector B cells:
Regional secretory effector sites (upper aerodigestive tract)
As extrafollicular plasma cells Join the systemic immune
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DOGMA:Decreased J-chain expression by
tonsilar B cells reduce sIg A levels in saliva
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Age (years)
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In children Reduce the level of IgA antibody to poliovirus
3-4 times in the nasopharyngeal secretions Delay the local immune response to
subsequent live oral polio vaccine Decrease serum Ig and salivary IgA for up to
3-4 yrs
Ogra, NEJM 1971; 284: 59-64 Jeschke, Klin Padiat 1980; 192: 51-60
Cantani et al., Ann. Allergy 1986; 57: 413-16Lenander-Lumikari et al., Pediatr Dent 1992; 14: 86-91
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Children 3 – 14 years old with tonsil & adenoid hypertrophy, measure of local and blod Ig A, Ig G, Ig M
Before tonsilectomy > control group One month after tonsilectomy < control group Six month after tonsilectomy = control goup
Zielnik-Jurkiewicz, jurkiewic. Int. J. Pediatr. Otolaryngol 2002; 64: 127-132 Kaygusuz ,el al. Int. J. Pediatr. Otolaryngol 2003; 67: 1311-1315
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Case : chronic tonsilitis, healthy children as control Measured count of blood B and T lymphocytes, Ig
G, Ig A, Ig M. Before tonsilectomy : B cells, Ig G, Ig A, Ig M. >
control After tonsilectony :
B cells : normal T cells : increase Ig G, Ig A and Ig M < before tonsilectomy Ig G, Ig A and Ig M = control
Ikinciogullari et al,. Int. J. Pediatr. Otolaryngol 2002. 66:251-257
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In young adultsA slight reduction of total IgM and salivary IgG antibodies to Streptococcus mutans and EBV
Kritila et al., Clin Immunol 1996: 80: 110-5
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In severe case in children: Reduce the number of episodes of sore
throat Reduce the days with sore throat
In less severely affected children: The impact is minimal
some children get better without any surgery
Burton, Glasziou. 2009
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