© Borgis - New Medicine 3/1999, s. 72-73
Lidia Zawadzka-Głos1, Mieczysław Chmielik1, Maria Wąsik2
Immunological response in hypertrophied palatine tonsils and blood pre- and postadenotonsillotomy
1 Department of Pediatric Otorhinolaryngology, The Medical University of Warsaw, Poland
Head: Prof. Mieczysław Chmielik, M.D.
2 Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw, Poland
Head: Prof. Maria Wąsik, M.D.
Summary
Adenotonsillotomy (ATT) is one of the commonest surgical procedures. The tonsils take post in both the humoral and the cellular response of the immune system. In this controlled study we have made an attempt to assess the immune system one day before and one day after adenotonsillotomy in diferent age-related groups of children. Quantitative and qualitative disorders of the immune system were found in children with hypertrophied palatine tonsils.
Introduction
Adenotonsillotomy (ATT) is one of the commonest surgical procedures performed by pediatric otorhinolaryngologists. Although it is well-known and has been done for many years, it still remains unknown why we observe hypertrophied palatine tonsils in some children and why in some cases it reveales tendency to recover after operation. Apart from a long - suspected and also well - documented microbiological etiology the individual predisposition seems to be cennective with the individual condition of the immune system.
The tonsils take part in both the humoral and the cellular response of the immune system. They contain T and B lymphocytes as well as some additional cells. The mutual quantitative relation between the subpopulations of the cells present in the tonsils, particularly those expressing characteristic superficial antigens and receptors, may play a role in their excessive proliferation, leading to hypertrophy of the palatine tonsils. Changes in the composition of the lymphocyte subpopulation in the peripheral blood may be observed in a group of children with hypertrophied palatine tonsils. Those changes may reflect the individual maturation process of the immune system or, it is also possible, that they reveal a hereditary or an acquired deficiency of the immune system in children.
In this controlled study we have made an attempt to assess the immune system one day before and one day after adenotonsillotomy in diferent age-related groups of children.
Material and methods
Thirty-nine children with hypertrophy of the palatine tonsils were included in the study. After initial examinations they were divided into two age - related groups - younger (<7 years old) and older (> 7 years old). An analogous division by age was made in the control group. Blood tests in the group with hypertrophied tonsils were performed pre- and post-operatively between 6 and 18 months. Blood tests in the control group were only done once.
The spontaneous proliferative response of mononuclear cells (MNC) of the peripheral blood and of the tonsil tissue was examined after ATT, as was the ability to response after stimulation by PHA and SAC mitogens. Quantitative assessment of the subpopulation of T lymphocytes was performed by determination of the number of cells with superficial CD2+, CD4+, CD8+ and CD19+ antigens and immunoglobulin receptors IgG, IgM, IgD and (histocompatibility antigen) HLA - II antigen.
Results
Spontaneous proliferation of mononuclear cells in the peripheral blood was statistically significantly higher in a group of younger children with hypertrophied palatine tonsils compared to the results from the control group (p <0.002) and in the group after adenotonsillotomy (p <0.025). No statistically significant differences were found between the control group and the group of children over 7 years old after adenotonsillotomy. In this study we noticed that before adenotonsillotomy in both age - related groups the responses were within normal limits.
This drawss attention to the fact that in both age - related groups all results before adenotonsillotomy were within normal limits.
The spontaneous proliferation of the mononuclear cells of the tonsils was higher than the spontaneous proliferation of the mononuclear cells of the peripheral blood pre- and postoperatively.
Examination of the PHA or SAC stimulated proliferative response of the mononuclear cells of the peripheral blood in the normal group revealed that this activity depends on age and is markedly higher in younger children (<7 year old).
The tendency for PHA-stimulated proliferation of the mononuclear cells of the peripheral blood before adenotonsillotomy was significantly lower in both groups of patients compared to the control group (p <0.001 for children <7 years old and p <0.01 for children> 7 years old).
Examination of the PHA-stimulated proliferative response of the mononuclear cells after adenotonsillotomy showed significantly higher values in both age-related groups of children comparing to pre-operative values. In the group of younger children every result collected after operation had returned to normal values. Examination of the PHA-stimulated proliferative response of the mononuclear cells obtained from the tonsils showed significantly lower values compared to the response of cells obtained pre-operatively from the peripheral blood.
Examination of the proliferative activity of B lymphocytes was carried out using stimulation by SAC mitogen of mononuclear cells obtained from peripheral blood. Differences between results obtained from the control group and both groups of patients before and after adenotonsillotomy were found to be statistically significant. After operation all results were within normal limits in the group of younger children. The SAC- stimulated proliferative response of the mononuclear cells obtained from the tonsils had a significantly lower value compared to cells obtained from the peripheral blood, but in the children above 7 years old these values were similar.
Quantitative assessment of the subpopulation of T lymphocytes was performed by determination of the number of cells with superficial CD2+, CD4+, and CD8+ antigens. The percentage and the absolute values were analyzed. In the younger children the percentage of CD4+ lymphocytes and the absolute value of CD2+ lymphocyte were lower before operation compared to the control group and these values were found to be significant. Adenotonsillotomy led to a subsequent reduction of the level of CD2+ and CD4+ lymphocytes. In the group of older children differences were not significant.
The percentage of T lymphocytes in the tonsils was significantly lower than in blood. The CD4+/CD8+ ratio was higher in tonsils than in blood. In 3 cases CD4+ and CD8+ antigens were found in the cells isolated from the tonsils. Assessment of the subpopulation of B lymphocytes showed a decreased percentage of CD19+ and HLA -II in the younger children pre- and post-operatively.
The percentage of B lymphocytes showing sIgM, sIgG, sIgD expression before adenotonsillotomy had a value comparable to the control group. After operation a significant decrease of subpopulation sIg expression B lymphocytes was observed. A similar observation was made on the absolute number of B lymphocyte.
A significant advantage of B lymphocytes in the tonsils compared to blood was found.
Conclusions
Examination of the subpopulation of lymphocytes in the peripheral blood performed after adenotonsillotomy showed that most children with hypertrophied palatine tonsils had significant disturbances compared to a control group at the same age. A statistically decreased percentage of CD4+ and CD19+ lymphocytes observed before operation remained decreased after it. It should be noticed that the percentage of lymphocytes showing expression of superficial immunoglobulin decreased after adenotonsillotomy.
The results of this study lead to the following conclusions:
1. Quantitative and qualitative disorders of the immune system were found in the children with hypertrophied palatine tonsils.
2. Adenotonsillotomy influences some of the functional parameters of the immune response. The values of PHA and SAC and spontaneous proliferation returned to normal in younger children.
3. Adenotonsillotomy intensifies the quantitative changes in the configuration of the subpopulation of the peripheral blood lymphocytes, particularly in younger children.
4. The indications for adenotonsillotomy should be precisely considered, especially as far as the immune system of children younger than 7 years old is concerned.
Piśmiennictwo
1. Abbey K., Kawabata I.: Computerized three-dimensional reconstruction of the crypt system of the palatine tonsil. Acta Otolaryngol. (Stockch) 1988; suppl 454:39-42. 2. Kossowska E.: Otolaryngologia wieku rozwojowego. PZWL, W-wa, 1979. 3. Miszke A.: Współczesne poglądy na rolę migdałków podniebiennych. Otolaryng. Pol., 1989, XLIII, 3:174-179. 4. Nowara E. et al.: Die Gaumentonsillen als teil des lymphatischen System Ein und Ausstrom nengebildeter Lymphocyten-HNO, 1986, 34: 164. 5. Ostrowski: Histologia. PZWL, W-wa, 1995, 475-519. 6. Poppema S. et al.: Distribution of T cell subsets in human tonsils. J. Exp. Med. 1981; 153:30-41. 7. Sieluzycki Cz.: Alergologia dla otolaryngologów. PZWL, W-wa, 1988. 8. Sugiyama M. et al.: T cell subsets in the tonsil in relation to age analyzed with monoclonal antibodies and fluorescence activated cell sarter (FACS). Inst. J. Pediatric. Otorhinolaryngol., 1983, 6:195-204. 9. Yamanaka N. et al.: Immubohistochemical study of tonsil. Distribution of T cell subsets. Acta Otolaryngol. 1993, 96:509-516. 10. Yamanaka N. et al.: Sponteneaus DNA synthesis in adenoidal lymphocytes from healthy children and from children with otitis media with effusion. Acta Otolaryngol (Stockch) 1985; 100:399-404.
