Embed Size (px)
Citation preview
11
Anatomy physiology andAnatomy physiology andImmunology Immunology ofof
Palatine Tonsils and Palatine Tonsils and AdenoidAdenoid
ByByDrFazel Khaliq OmariDrFazel Khaliq Omari
ENT Dep NMHENT Dep NMHJUNE 2012JUNE 2012
22
Waldeyerrsquos RingWaldeyerrsquos RingDefinitionDefinition
Ring of Lymphoid tissue guarding Ring of Lymphoid tissue guarding entrance to the digestiveentrance to the digestive
amp respiratory tractsamp respiratory tractsIt plays an important role in It plays an important role in early early
recognition of pathogenicrecognition of pathogenicmicroorganisms microorganisms amp amp initiation of an immune initiation of an immune
responseresponse1 Nasopharyngeal1 NasopharyngealTonsil (Adenoid)Tonsil (Adenoid)2 Tubal Tonsils2 Tubal Tonsils
3 Palatine Tonsils3 Palatine Tonsils4 Lingual Tonsils4 Lingual Tonsils
5 Lat Pharyngeal bands5 Lat Pharyngeal bands
33
ndash The Palatine tonsils
A pair of lymphoid tissue masses lying on either side of the oropharynx
Normal tonsils are flush with the edges of the fauces
Medial surface is covered by mucousmembrane showing 8-30 depressions(crypts) The largest crypt crypta magna)
separatesthe upper pole from the tonsillar body
44
This is a typical tonsil the association of This is a typical tonsil the association of lymphatic tissue and an overlying stratified lymphatic tissue and an overlying stratified squamous epithelium are the identifying squamous epithelium are the identifying histologicalhistological features features
55
The Palatine tonsils Its lateral (deep) surface is bounded by a fibrous
tissue capsule which separates the tonsil from its bed
that is made up of Superior constrictor muscle Glossopharyngeal nerve Facial artery Buccopharyngeal fascia The lower pole may extend to the BOT amp become continuous with the lingual tonsil
66
77
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
22
Waldeyerrsquos RingWaldeyerrsquos RingDefinitionDefinition
Ring of Lymphoid tissue guarding Ring of Lymphoid tissue guarding entrance to the digestiveentrance to the digestive
amp respiratory tractsamp respiratory tractsIt plays an important role in It plays an important role in early early
recognition of pathogenicrecognition of pathogenicmicroorganisms microorganisms amp amp initiation of an immune initiation of an immune
responseresponse1 Nasopharyngeal1 NasopharyngealTonsil (Adenoid)Tonsil (Adenoid)2 Tubal Tonsils2 Tubal Tonsils
3 Palatine Tonsils3 Palatine Tonsils4 Lingual Tonsils4 Lingual Tonsils
5 Lat Pharyngeal bands5 Lat Pharyngeal bands
33
ndash The Palatine tonsils
A pair of lymphoid tissue masses lying on either side of the oropharynx
Normal tonsils are flush with the edges of the fauces
Medial surface is covered by mucousmembrane showing 8-30 depressions(crypts) The largest crypt crypta magna)
separatesthe upper pole from the tonsillar body
44
This is a typical tonsil the association of This is a typical tonsil the association of lymphatic tissue and an overlying stratified lymphatic tissue and an overlying stratified squamous epithelium are the identifying squamous epithelium are the identifying histologicalhistological features features
55
The Palatine tonsils Its lateral (deep) surface is bounded by a fibrous
tissue capsule which separates the tonsil from its bed
that is made up of Superior constrictor muscle Glossopharyngeal nerve Facial artery Buccopharyngeal fascia The lower pole may extend to the BOT amp become continuous with the lingual tonsil
66
77
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
33
ndash The Palatine tonsils
A pair of lymphoid tissue masses lying on either side of the oropharynx
Normal tonsils are flush with the edges of the fauces
Medial surface is covered by mucousmembrane showing 8-30 depressions(crypts) The largest crypt crypta magna)
separatesthe upper pole from the tonsillar body
44
This is a typical tonsil the association of This is a typical tonsil the association of lymphatic tissue and an overlying stratified lymphatic tissue and an overlying stratified squamous epithelium are the identifying squamous epithelium are the identifying histologicalhistological features features
55
The Palatine tonsils Its lateral (deep) surface is bounded by a fibrous
tissue capsule which separates the tonsil from its bed
that is made up of Superior constrictor muscle Glossopharyngeal nerve Facial artery Buccopharyngeal fascia The lower pole may extend to the BOT amp become continuous with the lingual tonsil
66
77
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
44
This is a typical tonsil the association of This is a typical tonsil the association of lymphatic tissue and an overlying stratified lymphatic tissue and an overlying stratified squamous epithelium are the identifying squamous epithelium are the identifying histologicalhistological features features
55
The Palatine tonsils Its lateral (deep) surface is bounded by a fibrous
tissue capsule which separates the tonsil from its bed
that is made up of Superior constrictor muscle Glossopharyngeal nerve Facial artery Buccopharyngeal fascia The lower pole may extend to the BOT amp become continuous with the lingual tonsil
66
77
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
55
The Palatine tonsils Its lateral (deep) surface is bounded by a fibrous
tissue capsule which separates the tonsil from its bed
that is made up of Superior constrictor muscle Glossopharyngeal nerve Facial artery Buccopharyngeal fascia The lower pole may extend to the BOT amp become continuous with the lingual tonsil
66
77
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
66
77
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
77
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
88
Blood supply of palatine tonsils 1048708 Tonsillar branch of Facial artery(main) 1048708 Ascending palatine a 1048708 Dorsalis linguae a 1048708 Descending palatine a 1048708 Ascending pharyngeal a Lymphatic drainage Upper deep cervical LNs (esp the
Jugulo-diagastric LN)
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
99
Physiological considerationsVelopharyngeal sphincterClosure of the sphincter-like mechanism between the oropharynxamp nasopharynx is essential for normal deglutition ampspeechIt is effected by combined- Postero-superior movement of the soft palate- Medial movement of the lat ph walls- Slight anterior movement of post ph wall (Passavantrsquos ridge)The uvula plays an important role in the perfection of this closure
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1010
Physiological considerations Functions of the Oropharynx 1 Common pathway for food amp air 2 Respiratory function (Patent pathway
between nose amp larynx) 3 Reflex actions (sneezing coughing amp
vomiting) 4 Speech resonance (articulation of
vowels) 5 Deglutition (2nd ldquopharyngealrdquo phase of
swallowing) 6 Drainage of mucus from nasopharynx
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1111
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1212
ImmunologyImmunology
General DefinitionsGeneral Definitions
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1313
Hematopoietic and stromal cell Hematopoietic and stromal cell
differentiationdifferentiation
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1414
Mast cells are found in the perivascular spaces of most tissues and contain pro-Mast cells are found in the perivascular spaces of most tissues and contain pro-inflammatory and vasoactive mediatorsinflammatory and vasoactive mediators
The reticuloendothelial systemThe reticuloendothelial system
(RES)(RES) is also called the is also called the mononuclear mononuclear phagocytotic system phagocytotic system (MPS) Lymphoid organs (MPS) Lymphoid organs belonging to the RES are the bone marrow belonging to the RES are the bone marrow the liver the spleen the lymph nodes the the liver the spleen the lymph nodes the microglia of the brain the thymus tonsils as microglia of the brain the thymus tonsils as well as MALT BALT GALT and SALT (see well as MALT BALT GALT and SALT (see below)below) (bronchus-associated lymphoid (bronchus-associated lymphoid tissue = BALT) in the gut (gut-associated tissue = BALT) in the gut (gut-associated lymphoid tissue = GALT) and in the skin lymphoid tissue = GALT) and in the skin (skin-associated lymphoid tissue = SALT(skin-associated lymphoid tissue = SALT
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1515
Immune SystemImmune System the organ the organ system that system that protects the protects the
human body from human body from foreign foreign
substances substances uncontrolled cell uncontrolled cell proliferation and proliferation and
tissue tissue disorganizationdisorganization
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1616
Pathogens
Several types of pathogens exist that pose a problem for the human body to maintain homeostasis (maximally healthy state)
External Pathogens viruses bacteria fungi and protozoa
Internal Pathogens bacteria and tumor cells
External microbes serve several useful functions including fermentation and decomposition of plants and trees to produce useful nutrients
Internal microbes (microflora) help with digestion of food items that generate fatty acids vitamins and nutrients
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1717
Lymphoid Organs Major Function Production of immune cells (leukocytes) and
interaction with pathogens to initiate potent immune responses
Primary lymphoid organs produce and develop immune cells includes bone marrow and thymus
Secondary lymphoid organs site of interaction between immune cells to elicit strong immune responses at site of infection includes spleen lymph nodes tonsils Peyerrsquos patches and appendix
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1818
Cells of the Immune System
Mononuclear Cells Polymorphonuclear CellsB lymphocytes Eosinophils
T lymphocytes Basophils Granulocytes
MonocytesMacrophages Neutrophils
Natural Killer cells Mast cells
Dendritic cells
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
1919
Immune Cells Exhibit Variety of Functions
Immune Cell General FunctionB lymphocytes Production of antibodies
T lymphocytes Cell cytotoxicity (specific)
Monocytes Phagocytosis lymphocyte stimulation
Natural Killer cells Non-specific cell cytotoxicity
Dendritic cells Phagocytosis lymphocyte stimulation
Granulocytes Phagocytosis
Mast cells Histamine release
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2020
Types of Immune ResponsesInnate Response - removes pathogen quickly but does not generate memory cells if pathogen is encountered a second time
Adaptive Response - kills pathogens and generates memory cells to increase pathogen clearance if re-encountered slower process
Cellular Response - facilitates cytotoxicity of pathogens by breaking up the cellular membrane
Humoral Response - generates antibodies that neutralize the effects of invading pathogens
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2121
Different Pathogens Require Different Responses
Antigen Type of ResponseBacteria Innate
Viruses Adaptive
Fungi Humoral
Tumor Cells Cellular
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2222
Diseases of the Immune System Autoimmune Disease class of disorders
generally defined by overactivity of the immune system
Systemic Lupus Erythematosus (Lupus) abnormal generation of antibodies against various organs usually aggravated during pregnancy
Multiple Sclerosis breakdown in myelin sheath of nerve fibers due to attack by cells of the immune system
Rheumatoid Arthritis abnormal immune responses against joints by cytotoxic T lymphocytes usually alleviated during pregnancy
Autoimmune disorders have a 2- to 10-fold higher incidence in females compared to males indicating a role for steroid hormones
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2323
Human immune systemHuman immune system
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2424
DeDevelopment of immune systemvelopment of immune system
Bone marrowBone marrow
LymphocyteLymphocyte
precursorsprecursors
T-lymphocytes CytotoxicT-cell(mostly cd8tcells)
thymus
Memory t cells
Cellular immunityCells mediated
Helper t cells(cd4tcells)
BlymphocytesBursal equivalent(liver bone marrow)
Plasma cell IgGIgAIgMIgDIgE
Humoral immunityAntibody mediated immunity
Memory B cells
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2525
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2626
Role of the tonsils within the Role of the tonsils within the immune immune systemsystem
The tonsils have no afferent lymphaticsThe tonsils have no afferent lymphatics
The contain both B and T lymphocytesThe contain both B and T lymphocytes
Both cell mediated and humoral immunity is presentBoth cell mediated and humoral immunity is present
These cells (B) have the capability to synthesize These cells (B) have the capability to synthesize specific antibodiesspecific antibodies
Inflammatory change within the tonsils may be a Inflammatory change within the tonsils may be a manifestation of this functionmanifestation of this function
The fact that tonsillitis is often recurrent suggests that The fact that tonsillitis is often recurrent suggests that there there
may be some may be some intrinsic defect either in the tonsilsintrinsic defect either in the tonsils themselves themselves
or in or in patients immunitypatients immunity
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2727
defensindefensin [difenprimesin] [difenprimesin] a peptide with natural a peptide with natural antibiotic antibiotic
activity found within human activity found within human nneutrophilseutrophils Three types of defensins Three types of defensins have been identified each consisting have been identified each consisting of a chain of about 30 amino acids of a chain of about 30 amino acids Similar molecules occur in white Similar molecules occur in white blood cells of other animal species blood cells of other animal species They show activity toward viruses They show activity toward viruses and fungi in addition to bacteriaand fungi in addition to bacteria((ααββӨӨ))
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2828
Low-power microscope magnification of a cross-section through one of the Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top) Stratified epithelium (e) covers the throats surface and (at the top) Stratified epithelium (e) covers the throats surface and continues as a lining of the crypt Beneath the surface are numerous nodules continues as a lining of the crypt Beneath the surface are numerous nodules (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the (f) of lymphoid tissue Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the saliva as salivary nodules toward the surface and will eventually mix with the saliva as salivary corpuscles corpuscles
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
2929
Cytokine actionCytokine action Cytokines are humoral immunomodulatory Cytokines are humoral immunomodulatory
proteins or glycoproteins which control or proteins or glycoproteins which control or modulate the activities of target cells modulate the activities of target cells resulting in gene activation leading to resulting in gene activation leading to mitotic division growth and differentiation mitotic division growth and differentiation migration or apoptosis They are produced migration or apoptosis They are produced by wide range of cell types upon antigen-by wide range of cell types upon antigen-specific and non-antigen specific stimuli It specific and non-antigen specific stimuli It has been reported by many studies that the has been reported by many studies that the clinic outcome of many infectious clinic outcome of many infectious autoimmune or malignant diseases appears autoimmune or malignant diseases appears to be influenced by the overall balance of to be influenced by the overall balance of production (profiles) of pro-inflammatory and production (profiles) of pro-inflammatory and anti-inflammatory cytokinesanti-inflammatory cytokines
Natural killer cells produce cytokines (TNF Natural killer cells produce cytokines (TNF infinINF infinINF ӨӨ))
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
3030
determination of cytokine profiles in determination of cytokine profiles in tonsil study will provide key tonsil study will provide key information for further in-depth information for further in-depth analysis of the cause and underlying analysis of the cause and underlying mechanisms of these disorders as mechanisms of these disorders as well as the role and possible well as the role and possible interactions between the T- and B-interactions between the T- and B-lymphocytes and other lymphocytes and other immunocompetent cells immunocompetent cells
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
3131
Section of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOIDSection of human tonsil showing MALT MUCOSAL ASSOCIATED LYMPHOID
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
3232
INFLAMATION OF THE TONSILSINFLAMATION OF THE TONSILS
Antigens are continuously present on the Antigens are continuously present on the crypt epithelium giving rise to lymphocyte crypt epithelium giving rise to lymphocyte activation activation
thus a certain amount of inflammation is thus a certain amount of inflammation is physiological physiological
The impairment of the ability of immunologic The impairment of the ability of immunologic response in tonsils by inflammation may be response in tonsils by inflammation may be related to related to PGE2PGE2 The more severe the The more severe the inflammation the more hazardous to the inflammation the more hazardous to the local immunologic defence of tonsils is It is local immunologic defence of tonsils is It is possible that PGE2 plays an important role possible that PGE2 plays an important role in this respectin this respect
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
3333
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
3434
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
3535
although the tonsils contain the although the tonsils contain the complete set of cellular components complete set of cellular components necessary for primary and secondary necessary for primary and secondary immune responses the precise immune responses the precise contribution of these lymphoid contribution of these lymphoid structures to induction and regulation structures to induction and regulation of mucosal and systemic immune of mucosal and systemic immune responses to inhaled or ingested responses to inhaled or ingested antigens is still unclear antigens is still unclear
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
3636
ReferenceReference1-Arthur GJohnson Microbiology and Immunology 31-Arthur GJohnson Microbiology and Immunology 3rdrd
ed 1996 Lippincott Williams ampWilkinsed 1996 Lippincott Williams ampWilkins
2-Scott-Browns Otolaryngology head and neck surgery 2-Scott-Browns Otolaryngology head and neck surgery 77thth ed ed
volume 1 2008 Edward Arnold Ltdvolume 1 2008 Edward Arnold Ltd
3-The American Journal of pathology Dec 2000 3-The American Journal of pathology Dec 2000 4-Anatomy amp Physiologyof the Pharynx Emad A Magdy MD Assistant ProfessorDepartment of Otorhinolaryngology Faculty of Medicine Alexandria
University
