Sendai virus fusion protein mediates simultaneous induction of MHC class I/II-dependent mucosal and systemic immune responses via the nasopharyngeal-associated lymphoreticular tissue immune system

Nasal administration of Ags using a novel hybrid Ag delivery vehicle composed of envelope glycoproteins of Sendai virus on the surface of liposome membranes (fusogenic liposome) efficiently delivered Ags to Ag-sampling M cells in nasopharyngeal-associated lymphoreticular tissue. Additionally, fusogenic liposomes also effectively delivered the Ags into epithelial cells and macrophages in nasopharyngeal-associated lymphoreticular tissue and nasal passages. In vitro Ag presentation assays clearly showed that fusogenic liposomes effectively presented encapsulated Ags via the MHC class II-dependent pathway of epithelial cells as well as macrophages. Fusogenic liposomes also have an adjuvant activity against mucosal epithelial cells to enhance MHC class II expression. According to these high delivery and adjuvant activities of fusogenic liposomes, nasal immunization with OVA-encapsulated fusogenic liposomes induced high levels of OVA-specific CD4(+) Th1 and Th2 cell responses. Furthermore, Ag-specific CTL responses and Ab productions were also elicited at both mucosal and systemic sites by nasal immunization with Ag-encapsulated fusogenic liposomes. These results indicate that fusogenic liposome is a versatile and effective system for the stimulation of Ag-specific immune responses at both mucosal and systemic compartments.

Local interferon-gamma levels during respiratory syncytial virus lower respiratory tract infection are associated with disease severity

To investigate the role of cell-mediated immunity during respiratory syncytial virus (RSV) infection, interferon (IFN)-gamma and interleukin (IL)-10 levels in nasopharyngeal secretions were measured in infants with lower respiratory tract infection (LRTI) caused by RSV. A novel technique was used to measure in vivo cytokine levels in nasopharyngeal aspirates (NPAs). Cytokine levels in the NPAs of 17 mechanically ventilated infants and 43 nonventilated hospitalized infants were compared. As expected, mechanically ventilated infants were significantly younger than nonventilated infants (7 vs. 14 weeks). IFN-gamma levels were above the limit of detection in the NPAs of 3 (18%) mechanically ventilated infants and in the NPAs of 26 (60%) nonventilated infants. IL-10 levels in the NPAs of mechanically ventilated and nonventilated infants were comparable. It is hypothesized that maturation-related mechanisms have a key role in the development of RSV LRTI that results in mechanical ventilation.

The role of bacteria as a local defence mechanism in the ear, nose and throat

The mucosae of the oro-nasopharynx in man are asymptomatically colonised by a commensal flora. This commensal flora consists largely of non-pathogenic bacteria but potentially pathogenic bacteria, such as S. pneumoniae, H. influenzae, M. catarrhalis can also be part of it. The commensal flora can be affected by host factors such as age or antibiotic usage but will in itself also affect its host. In addition to being a source of resistance genes it will also protect the host against exogenous, non-commensal pathogens. This protective effect is the result of three characteristics of the commensal flora. The commensal flora will hinder the establishment of new pathogens on the mucosa (termed colonisation resistance), it will especifically stimulate the immune system and it will induce formation of protective antibodies.

Phagocytosis in the nasopharyngeal secretion by cells from the adenoid

The aim of this study was to elucidate whether granulocytes and macrophages in surface secretion on the adenoid emanate from the adenoid and whether these cells participate in the control of the nasopharyngeal bacterial flora. Samples of the adenoid and its surface secretion were obtained during adenoidectomy from 12 children with recurrent acute otitis media, secretory otitis media or enlarged adenoids causing obstruction. Immunochemistry was used to examine the location of granulocytes and macrophages in the adenoid as well as the presence of IgA, IgM, IgG and plasma cells in the secretion. Phagocytosis in the secretion was examined in imprints stained with May Grünwald Giemsa. Acridine Orange and Gram staining were used to demonstrate the presence and location of bacteria in the secretion and mucosa. As a control, surface secretions were obtained from 12 children without any history of recurrent airway problems. Granulocytes and macrophages were observed in the epithelium of the adenoid and some of these cells penetrated the epithelial surface. Positive staining for IgA, IgM and IgG was observed in all secretions. In 10 of 12 children plasma cells were present in the secretion. Bacteria were observed in all imprints. With the exception of I child in each group phagocytosis of bacteria in the surface secretion was demonstrated from imprints in all children. We conclude that granulocytes and macrophages leave the adenoid and enter the surface secretion, where constant phagocytic activity takes place. The spatial relations between mononuclear and polymorphonuclear cells imply a possible cooperation between these cells in the overall control of the nasopharyngeal bacterial flora.

The nasopharynx and the middle ear. Inflammatory reactions in middle ear disease

The host-parasite interactions in the nasopharynx with bacterial colonization and antigen uptake in the lymphoid tissue, the adenoid, has an impact on the maturation of local and systemic immunity. The adenoid is a part of mucosa associated lymphoid tissue and is responsible for both effector and inductor functions in the nasopharynx. Increasing evidence supports the role of serum antibody in protecting the middle ear cavity from disease. There is evidence for a minor immunologic defect in a number of children with recurrent episodes of AOM.

Strategies of immunization against mucosal infections

The presence of secretory (S-) IgA in middle-ear fluid and localization of IgA-secreting cells in its mucosae suggest that the middle ear is an effector site of the mucosal immune system. Several strategies have been devised to induce potent, long-lasting, and recallable mucosal S-IgA antibodies, as well as circulating IgG antibodies and Th1- or Th2-type help, according to the most appropriate responses for a particular infection. Application of immunogens to inductive sites in the upper respiratory tract may be most effective for generating responses in the middle ear and nasopharynx for protection against the organisms responsible for otitis media.

Developing a nontypeable Haemophilus influenzae (NTHi) vaccine

There is a current high demand for nontypable Haemophilus influenzae (NTHi) vaccines. Various options for the composition of such vaccines are possible. Decisions about the vaccine composition have to take into account the antigenic variability of NTHi, so even complex immunogens such as whole bacteria would preferentially have a tailor-made antigenic composition. We will present a summary of NTHi vaccine development, describing research efforts from SmithKline Beecham and other laboratories. Currently, major (P1, P2, P4, P5) and minor (P6, D15, TbpA/B, ellipsis) outer membrane proteins, LPS, adhesins (HMW, Hia, pili, P5) are being studied. Preclinical results with LPD, P5 (LB1) and OMP26 from our laboratories will be described including the use of animal models of otitis and lung infection.

Type 1-like immune response is found in children with respiratory syncytial virus infection regardless of clinical severity

The immunological response of infants younger than six months to infection with respiratory syncytial virus (RSV) was studied in relation to clinical severity. IL-6 and IL-8 were found more frequently and at higher levels in the plasma samples of more severely ill patients and no significant differences were found in the levels of cytokines differentiating between Type 1 and Type 2 responses. Cellular infiltrates in nasopharyngeal washings consisted mainly of polymorphonuclear granulocytes and monocytes. Eosinophils, IgE positive cells and tryptase positive cells were found sporadically. Analyses of RSV stimulated T cell cultures established from peripheral blood mononuclear cells, for intracellular and secreted cytokines showed that, irrespective of clinical severity, the responses were dominated by the production of IFN-gamma, and that only low levels of IL-4 and IL-10 were detectable. Collectively these data do not indicate an association between clinical severity and a Type 2-like T cell response.

Evidence of M cells as portals of entry for antigens in the nasopharyngeal lymphoid tissue of humans

The nasopharyngeal tonsils (adenoids) are prominent components of human nasal-associated lymphoid tissues (NALT). However, the role of the nasopharyngeal tonsils in antigen uptake for initiation of the mucosal immune response is unknown. The aims of this study were to describe the ultrastructure and function of the M cells of the human nasopharyngeal tonsils and to clarify their capacity for antigen uptake. Tissues obtained from eight patients undergoing adenectomy were examined by light and electron microscopy. Lymphoepithelium covers the nasopharyngeal lymphoid tissue and consists of ciliary epithelium, non-ciliary epithelial cells, M cells, goblet cells, and many intraepithelial lymphoid cells. M cells have irregular and broad cytoplasm-containing microvilli on their surface and small vesicles in their cytoplasm. Many lymphoid cells were enfolded by M cells. The uptake of horseradish peroxidase (HRP) in the tissue in organ culture was studied using histochemical techniques. Excised adenoid tissue was incubated in RPMI 1640 culture media with HRP for 10, 30, and 60 min. HRP which had adhered to the surface was taken up in vesicles and then transported in vesicles and tubules by M cells. The M cells of nasopharyngeal lymphoid tissue were ultrastructurally and functionally similar to those in human Peyer's patches and colonic lymphoid follicles. These findings indicate that NALT bears similarities to the gut-associated lymphoid tissue, and its antigen uptake capacity may be important for initiation of immunity in the upper aerodigestive tract.

Bacterial phosphorylcholine decreases susceptibility to the antimicrobial peptide LL-37/hCAP18 expressed in the upper respiratory tract

A number of pathogens of the upper respiratory tract express an unusual prokaryotic structure, phosphorylcholine (ChoP), on their cell surface. We tested the hypothesis that ChoP, also found on host membrane lipids in the form of phosphatidylcholine, acts so as to decrease killing by antimicrobial peptides that target differences between bacterial and host membranes. In Haemophilus influenzae, ChoP is a phase-variable structure on the oligosaccharide portion of the lipopolysaccharide (LPS). There was a bactericidal effect of the peptide LL-37/hCAP18 on a nontypeable H. influenzae strain, with an increasing selection for the ChoP(+) phase as the concentration of the peptide was raised from 0 to 10 microgram/ml. Moreover, constitutive ChoP-expressing mutants of unrelated strains showed up to 1,000-fold-greater survival compared to mutants without ChoP. The effect of ChoP on resistance to killing by LL-37/hCAP18 was dependent on the salt concentration and was observed only when bacteria were grown in the presence of environmental choline, a requirement for the expression of ChoP on the LPS. Further studies established that there is transcription of the LL-37/hCAP18 gene on the epithelial surface of the human nasopharynx in situ and inducible transcription in epithelial cells derived from the upper airway. The presence of highly variable amounts of LL-37/hCAP18 in normal nasal secretions (<1.2 to >80 microgram/ml) was demonstrated with an antibody against this peptide. It was concluded that ChoP alters the bacterial cell surface so as mimic host membrane lipids and decrease killing by LL-37/hCAP18, an antimicrobial peptide that may be expressed on the mucosal surface of the nasopharynx in bactericidal concentrations.

The Waldeyer's ring

The palatine tonsils, nasopharyngeal tonsil (adenoid) and lingual tonsil constitute the major part of Waldeyer's ring or nasal-associated lymphoid tissue (NALT), with the tubal tonsils and lateral pharyngeal bands as less prominent components. The lymphoid tissue of Waldeyer's ring is located at the gateway of the respiratory and alimentary tract and belongs to the mucosa-associated lymphoid tissue (MALT). As tonsils are the first site of encounter with inhaled and ingested micro-organisms, they are considered the first line of defense against exogenous aggressors. The generation of B cells in the germinal centers of the tonsil is one of the most essential tonsillar functions. This manuscript aims to review the anatomy and current knowledge on the immunologic function of the Waldeyer's ring.

Nasopharyngeal tonsil's provision of the surface secretions with immunocytes, a property additional to antigen processing

As we recently found that IgA, IgM, and IgG are produced and secreted by immunocytes present in nasopharyngeal secretions, we tested the hypothesis that B- and T-lymphocytes in the surface secretions are derived from the nasopharyngeal tonsil in an active process. By immunohistochemistry, we found that numerous B- and T-lymphocytes were often accumulated in restricted areas in the epithelium, and some of these cells were demonstrated just beneath the epithelial surface or could be observed protruding into the lumen. A portion of these cells were Ki-67+, indicating clonal expansion and/or immunoglobulin class switching. Analyses of the surface secretions by immunocytochemistry also demonstrated B- and T-lymphocytes, as well as Ki-67+ cells--a finding that indicates that immunologically active cells are transported into the surface secretions. The results imply that there is a substantial migration from the nasopharyngeal tonsil of immunologically active cells into the surface secretions.

What is wrong in chronic adenoiditis/tonsillitis immunological factor

The local immune response in adenoid and tonsil tissue can be visualized and the complexity of the cytokine network and effector molecule expression has not been illustrated in several different tonsillar entities. Many factors still remain to be learned in order to help us to understand the interactions between microorganisms and host in peripheral lymphatic tissue.

Coinfection with influenza B virus does not affect association of Neisseria meningitidis with human nasopharyngeal mucosa in organ culture

There is an epidemiological association between influenza virus infection and meningococcal disease. Proposed mechanisms are the destruction of the normal epithelial barrier function of the upper respiratory tract by influenza virus or the expression of human or viral surface-exposed proteins that enhance bacterial adherence and/or invasion. To test these hypotheses, human nasopharyngeal mucosa specimens from a total of 19 individual donors were successfully infected with influenza B virus and then inoculated with serogroup B Neisseria meningitidis. Subsequent bacterial association with the epithelial surface was measured in three separate series of experiments by using transmission electron microscopy (n = 6), scanning electron microscopy (n = 6), and counting of viable bacteria within homogenates of explants (n = 7). Penetration of the mucosa was estimated by measuring the count of viable bacteria recovered from explants after exposure to sodium taurocholate. Bacterial association with the surface of explants was time dependent over 24 h of superinfection. Influenza virus did not positively or negatively influence bacterial attachment to or penetration of explant mucosa compared to those of uninfected controls, even when the period of preincubation with virus was extended to 7 days. When proteins were purified from mucosal epithelium and immobilized on nitrocellulose membranes, N. meningitidis attached predominantly to bands corresponding to proteins of 210 and 130 kDa. In the presence of influenza virus infection, these proteins were gradually lost over the course of 72 h. In conclusion, influenza B virus did not increase association of serogroup B N. meningitidis with human nasopharyngeal mucosa.

Nasopharyngeal-associated lymphoreticular tissue (NALT) immunity: fimbriae-specific Th1 and Th2 cell-regulated IgA responses for the inhibition of bacterial attachment to epithelial cells and subsequent inflammatory cytokine production

To investigate the antibacterial activity of mucosal Th1 and Th2 immune responses induced nasally and orally, mice were immunized with mucosal vaccine containing fimbrial protein of Porphyromonas gingivalis, a causative agent for a destructive chronic inflammation in the periodontium, and cholera toxin (CT) as mucosal adjuvant. Nasal vaccine containing low doses of fimbriae (10 micrograms) and CT (1 microgram) induced Ag-specific Th1/Th2-type response in CD4+ T cells in mucosal effector tissues, including nasal passage and submandibular glands, which accounted for the generation of Ag-specific IgA-producing cells. In contrast, oral immunization required higher amounts of fimbriae and CT for the induction of Ag-specific IgA responses. Fimbriae-specific IgA mAbs generated from submandibular glands of nasally immunized mice inhibited P. gingivalis attachment to and reduced subsequent inflammatory cytokine production from epithelial cells. These findings suggest that nasal vaccination is an effective immunization regimen for the induction of Ag-specific Th1 and Th2 cell-driven IgA immune responses that possess the ability to inhibit bacterial attachment to epithelial cells and subsequent inflammatory cytokine production.

Elevated cytokine concentrations in the nasopharyngeal and tracheal secretions of children with respiratory syncytial virus disease

BACKGROUND

Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract disease in infants. The role of inflammatory mediators in the pathogenesis of RSV disease is not well-understood. The present study was designed (1) to determine whether RANTES (regulated on activation, normal T cell expressed and presumably secreted), macrophage-inflammatory protein-1-alpha (MIP-1-alpha), interleukin (IL)-6, IL-8 and IL-10 can be detected in respiratory secretions of children with RSV infection and (2) to assess whether the concentrations of these cytokines in respiratory secretions correlate with white blood cell (WBC) counts and RSV concentrations and with disease severity.

METHODS

During the 1996 to 1997 RSV season, we studied prospectively 14 intubated and 14 nonintubated children hospitalized with RSV disease. Nasal wash (NW) and tracheal aspirate (TA) samples were obtained from intubated patients on Hospital Days 1, 3 and 5. NW samples were obtained from nonintubated patients on hospital days 1 and 3. Seven healthy children undergoing elective surgery served as controls. All samples were analyzed for: (1) WBC and differential counts; (2) concentrations of RANTES, MIP-1-alpha, IL-6, IL-8 and IL-10; and (3) quantitative RSV cultures, except in control patients.

RESULTS

RANTES, MIP-1-alpha, IL-6, IL-8 and IL-10 were detected in NW and TA samples from all children with RSV infection. The concentrations of these cytokines in samples obtained from children with RSV infection were significantly greater than those in samples obtained from control children. NW WBC counts significantly correlated with NW RANTES, IL-6, IL-8 and IL-10 concentrations, whereas TA WBC counts significantly correlated with TA IL-6, IL-8, IL-10 and MIP-1-alpha concentrations. NW RSV concentrations correlated with NW WBC counts and with NW cytokine concentrations. Among children with RSV infection nonintubated patients had greater NW WBC counts and NW RANTES concentrations than intubated patients. TA RANTES, IL-8 and IL-10 concentrations inversely correlated with clinical markers of RSV disease severity.

CONCLUSION

The presence of cytokines in NW and TA samples of children with RSV infection suggests that they have a role in mediating the respiratory tract inflammation induced by RSV. These observations could have implications for designing new therapeutic strategies directed at immunomodulation of RSV disease.

Immunologic and histologic observations in reovirus-induced otitis media in the mouse

The goals of this study were to develop a mouse model for virally induced otitis media, and to study the immune response to infection. Intranasal inoculation of mice by reovirus was used to induce otitis media. Immunohistochemical evidence for the presence of reovirus in the nasopharynx, eustachian tubes, and middle ears and the amount of infiltrating B-cells and T-cells in those sites were serially evaluated by painlessly sacrificing animals over a 21 -day period. Reovirus antigen was detected in the middle ear mucosa by day 4 in 75% of infected animals, and histologic evidence for otitis media was found in 54% of all infected animals. A significant increase in B-cells in the nasopharynx and eustachian tubes was noted 7 to 10 days following infection. The number of infiltrating T-cells did not vary significantly from that in the control animals at any of the sites. These results provide a basis for further investigations of the immune response in otitis media.

A primate model of respiratory syncytial virus infection

To determine whether bonnet monkeys are susceptible to infection and disease due to respiratory syncytial virus (RSV), 4 juvenile bonnet monkeys (Macaca radiata) were inoculated with RSV intratracheally and sacrificed at 3, 5, 7 and 9 days post infection. RSV was cultured from pre-autopsy broncheoalveolar lavage fluid from all 4 animals with a peak titre of virus on day 9. Serum RSV neutralizing antibody was present by day 7. Animals developed tachypnoea and chest retractions by 5th day post infection and 2 animals had lobular pneumonia on chest radiography. The pathological changes were of a bronchovascular inflammation, interstitial pneumonia and alveolitis, akin to that seen in humans. These findings show that bonnet monkeys can be infected with RSV, and can develop immune response and clinical and pathological changes similar to those seen in human infants with RSV disease. Thus intractracheal RSV inoculation of juvenile bonnet monkeys appears to be a good model to study pathogenesis of RSV disease.

The endolymphatic sac receives antigenetic information from the organs of the mucosa-associated lymphatic system

The endolymphatic sac holds the entire arrangement of immunocompetent cells and functions as an immunological potent control organ for the inner ear. The evidence of secretory immunoglobulin A and other features of lymphocyte subtypes characterizes the endolymphatic sac as an organ of the mucosa-associated lymphatic system (MALT). In this system a permanent recirculation of sensitized memory lymphocytes from one organ to the other has been demonstrated experimentally as serving to dispose memory lymphocytes after renewed antigenetic stimulus. The aim of this study was to prove the possible recirculation of antigen-sensitized lymphocytes to the endolymphatic sac after antigenic stimulus of another part of the mucosa-associated lymphatic system. The results are evidence that the endolymphatic sac is provided with immunocompetent cells which derive from the lymphatic tissue of the nasopharynx. While the origin of immunocompetent cells in the endolymphatic sac still remains uncertain, this study underlines the role of lympho-epithelial tissue of the nasopharynx as a possible cell source for the endolymphatic sac. The results might explain the altered or disturbed function of the endolymphatic sac as a possible cause of certain inner ear diseases.

Allergy for the laryngologist

Allergic disease can affect any portion of the respiratory tract, including the larynx, trachea, bronchial tree, nasal cavity, paranasal sinuses, nasopharynx, and pharynx. This review evaluates laryngeal manifestations of allergic disease and the impact of allergic mechanisms in disorders, within the scope of laryngology.

Intranasal immunization with polymer-grafted microparticles activates the nasal-associated lymphoid tissue and draining lymph nodes

Waldeyer's ring is located at the juncture of the respiratory and alimentary tracts, where it is bombarded by inhaled and ingested antigens. However, knowledge of its exact function or consequences of its removal is incomplete. Recently, the murine nasal-associated lymphoid tissue (NALT) has been reported to have functional similarities to Waldeyer's ring and, thus, might be a suitable model to examine the function of oronasopharyngeal lymphoid tissues. To explore the capability of NALT to incite local mucosal and systemic immunity, we immunized mice intranasally (i.n.) with 3-(triethoxysilyl)-propyl-terminated polydimethylsiloxane (TS-PDMS)-grafted microparticles (MP), an inoculant previously shown to induce robust systemic and mucosal humoral immunity following intragastric (i.g.) administration. We demonstrated that i.n. immunization with low doses of microentrapped, but not soluble, human serum albumin (HSA) evoked robust circulating IgG responses (P < 0.05). Additionally, NALT cells isolated from MP-treated mice proliferated in vitro when restimulated with HSA (P < 0.05), suggesting that i.n. immunization with HSA-containing MP incited specific immunity via NALT cell activation. Coinciding with these observations, after i.n. MP administration HSA-specific spot-forming cells (SFC) were observed in NALT, and later posterior cervical lymph nodes (pCLN) and spleen (SPL), suggesting that the observed MP-induced specific systemic antibody responses emanated from the NALT. We also showed that i.n. immunization with HSA-containing TS-PDMS-grafted MP stimulated interleukin-4 (IL-4)-secreting lymphocytes in the NALT. This cytokine microenvironment was probably responsible for driving the IgG1 sera response observed after i.n. MP administration, via the migration of NALT-derived IgG1-committed B cells. Interestingly, unlike i.g. MP administration, i.n. immunization with HSA-containing MP did not evoke detectable specific IgA in any lymphoid tissue examined, or in nasal secretions, probably reflecting differences between NALT and other mucosae-associated lymphoid tissues (MALT).

[Comparative study of secretory IgA]

OBJECTIVE

The aim of this study was measure and compare Secretory IgA levels in the respiratory tract.

DESIGN

Cross-sectional study.

SETTING

Neumology Department of General Hospital. La Raza Medical Center Mexico.

MATERIAL AND METHOD

There were 35 volunteers. Samples of sputum, washings nasopharyngeal and bronchial was obtained from thirty five patients with COPD. Measurement of SIgA levels was performed by nephelometric technique. Results is reported as ratio of SIgA concentration/Total proteins concentration named SIgA relative concentration. Correlation index was obtained of three type of samples.

RESULTS

The SIgA values of sputum, washings nasopharyngeal and bronchial was similar similar +/- 0.011, 0.064 +/- 0.007 and 0.082 +/- 0.017 respectively). Multiple correlation was r = 0.508 (p < 0.01).

The microbial ecology and immunology of the adenoid: implications for otitis media

The nasopharyngeal tonsil, or adenoid, is a major inductive site for the synthesis of J-chain-positive B cells that may migrate to other areas of the upper respiratory tract, such as the nasal mucosa, the parotid gland, the lacrimal gland, and the middle ear during inflammation. The production of secretory IgA by both the nasopharyngeal tonsil and the nasal mucosa plays a major role in local immune protection against bacteria and viruses. The release of cytokines from Th1 and Th2 lymphocytes must be appropriate for B cells to produce IgA. The factors or mechanisms responsible for this are not, at present, known, but it appears that there is a difference in the profiles of cytokine secretion by Th1 and Th2 lymphocytes in the adenoids in both otitis-prone, as well as nonotitis-prone children. We have suggested that if this specific immune system does not protect the host from invasion by potential pathogens, there are other modalities of therapy to protect the nasopharynx from colonization with pathogenic bacteria or viruses. These include the production of specific antibodies against bacterial surface proteins that have been identified as mucin-binding proteins. Alteration of the microbial flora with commensal organisms such as viridans streptococci can be utilized. These alpha-hemolytic streptococci probably function by producing an acid environment that prevents colonization of organisms such as nontypeable H. influenzae. Finally, the induction of specific SIgA by conserved outer membrane protein antigens of potential pathogens may be another strategy in the prevention of colonization of potential bacterial pathogens in the nasopharynx.

Relative immunogenicity and efficacy of two synthetic chimeric peptides of fimbrin as vaccinogens against nasopharyngeal colonization by nontypeable Haemophilus influenzae in the chinchilla

The OMP P5-homologous fimbriae of nontypeable Haemophilus influenzae (NTHi) are an adhesin and a virulence factor for otitis media in chinchilla models. We synthesized two peptides (LB1 and LB2) which incorporate determinants of the fimbrial subunit co-linearly synthesized with a "promiscuous" T-cell epitope from the fusion protein of measles virus. Sera obtained from immunized rabbits and chinchillas demonstrated significant reciprocal titers against both the homologous peptide and isolated fimbrial protein. Antisera also immunolabeled native fimbriae of whole unfixed NTHi. Immunization with LB1 or fimbrin resulted in elimination of NTHi from the chinchilla nasopharynx 2-3 weeks earlier than controls, respectively.

Mechanism of antibody-mediated reduction of nasopharyngeal colonization by Haemophilus influenzae type b studied in an infant rat model

The mechanism of antibody-mediated reduction of Haemophilus influenzae type b (Hib) carriage was studied in the infant rat colonization model. Monoclonal Hib polysaccharide (PS) antibody (MAb) given intranasally or intraperitoneally and human secretory anti-Hib PS IgA given intranasally inhibited colonization by Hib during the entire follow-up period (2-48 h after challenge) but did not affect colonization by Hi, a noncapsulated variant of Hib. F(ab')2 fragments, prepared from the MAb or from human serum anti-Hib IgG reduced Hib colonization as efficiently as the uncleaved molecules. Complement depletion by cobra venom treatment had no effect on the antibody-mediated reduction of Hib colonization. These results indicate that Fc-mediated activities of immunoglobulins are not essential in the reduction of Hib colonization. Instead, antibodies to Hib most likely reduce colonization by a direct effect on growth of the bacteria or their adherence to the nasopharyngeal mucosa.

Effect of treatment with nasal IgA on the incidence of infectious disease in world-class canoeists

Earlier studies of endurance athletes have shown decreased levels of secretory IgA and an increased frequency of upper respiratory tract (URT) infections after periods of hard training. In this study, 14 world-class canoeists were studied during very hard physical training, after lower-intensity training combined with 17 days of treatment with nasal IgA, and during low intensity training off-season. The ELISA method was used to determine IgA in nasopharyngeal (nph) secretions and saliva (s). The results demonstrated unchanged nph secretions before, during and after IgA treatment (IgAbulin, Immuno AG, Vienna, Austria). Saliva Ig-A increased significantly from a median value of 147 micrograms/ml (range 37-634) to 410 micrograms/ml (range 82-974) (p < 0.05) during treatment. Thereafter, s-IgA decreased to 244 micrograms/ml (range 85-689) off-season. A control group of untrained students showed similar nph IgA to that of the elite canoeists. The athletes receiving nasal IgA showed no signs of URT and were considered healthy during 14.5 days out of 17 days of treatment as compared to 12.3 healthy days out of 17 days in the control group. In summary there was no significant decrease in IgA in untreated elite canoeists as compared to untrained controls. Nasal IgA treatment increased the IgA level in saliva only, but no significant decrease in URT symptoms was seen during the IgA treatment period.

Undetectable IgE responses after respiratory syncytial virus infection

Sequential nasopharyngeal secretions were collected from 81 infants from one day to three months after admission to hospital with respiratory syncytial virus (RSV) infection. Samples from 21 infants were assayed for anti-RSV IgE in an antigen capture ELISA assay. No IgE antibodies were detected although an assay of IgA antibodies carried out in parallel by a similar technique detected IgA antibodies in the secretions of all patients tested. Neither prior absorption of IgA or IgG, concentration of the secretions by freeze drying, nor enzyme amplification of the assay revealed any virus specific IgE. Using an antibody capture ELISA with a sensitivity of 0.85 IU/ml, IgE could be detected in sequential secretions of only one of the 81 RSV infected infants studied. Further testing of the secretions from 12 of these patients and those of a further 15 using an enzyme amplified assay with a sensitivity of 0.1 IU/ml revealed no further positives. Low concentrations of IgE were found in the sera of the majority of infants with RSV infection but they did not differ from those of virus negative children of a similar age collected between RSV epidemics. No rise in mean serum IgE concentrations between acute and convalescent samples was observed. No virus specific IgE was detected in the sera of any infant using the enzyme amplified antigen capture ELISA.

Antigen specific immunoglobulin production by NALT lymphocytes in rats

In this study, we examined the antigen specific immunoglobulin (Ig) contents in nasopharyngeal lavage fluid and antigen specific Ig production by NALT lymphocytes in rats immunized by various routes. OA specific IgG SFC in NALT lymphocytes was higher than that in spleen lymphocytes in locally immunized rats, whereas the inverse relationship was noted in generally immunized rats. These OA-specific IgG SFC were remarkably increased in NALT, but not so increased in spleen following nasal booster challenge. However, the number of OA specific IgA SFC in freshly obtained lymphocytes was very low in both NALT and spleen even after topical antigen challenge. A significant increase of antigen-specific IgA and IgG levels was noted in the naso-pharyngeal lavage fluid of immunized animals, whereas these Ab levels were not changed 48 h after topical antigen challenge. OA specific IgA SFC were revealed to be increased after in vitro stimulation with lipopolysaccaride (LPS). A preliminary study showed that further increase of antigen-specific IgA as well as IgG production by NALT lymphocytes occurred in the presence of TGF-beta and IL-5.

The role of adenoids in nasopharyngeal colonization with nontypeable Haemophilus influenzae

Nasopharyngeal colonization with nontypeable Haemophilus influenzae (NTHi) and immune responses in the adenoid were studied in 18 patients with otitis media with effusion (OME) who underwent adenoidectomy. NTHi in excised adenoid tissue and in nasopharyngeal secretions was examined by quantitative culture assay. NTHi was detected in 13 adenoid samples and 12 nasopharyngeal secretions. In 11 cases, NTHi was cultured from both samples of nasopharyngeal secretion and adenoids, and the concentration of NTRi in nasopharyngeal secretions was significantly correlated with that in adenoids. A significant negative correlation was observed between anti-NTHi IgA antibody titers and the number of NTHi in nasopharyngeal secretions. The number of NTRi in nasopharyngeal secretions and adenoids was decreased in the cases having a large number of NTHi-specific IgA and IgG antibody-producing cells in their adenoids. The results suggest that mucosal immunity in the nasopharynx is responsible for reducing the colonization of NTHi, and that the adenoid plays an important role in regulating the immune responses.

Antibody-secreting cells and their relation to humoral antibodies in serum and in nasopharyngeal aspirates in children with pneumococcal acute otitis media

Mucosal and systemic antibody responses to pneumococcal capsular polysaccharide were studied in 17 children with culture-verified pneumococcal acute otitis media. Serotype-specific antibody-secreting cells (ASCs) in peripheral blood and antibodies in acute and convalescent sera and nasopharyngeal aspirates were measured. A polysaccharide-specific ASC response was induced in all subjects. The response was age dependent, and the dominant antibody class was IgA. Three children > 24 months old had > 100 IgA-class ASCs/10(6) cells and serum and nasopharyngeal IgA responses; 2 had only a nasopharyngeal IgA response. None of 8 children < 24 months old showed a systemic response; however, a nasopharyngeal IgA response was detected in 1. Results suggest that whole pneumococci can induce a mucosal polysaccharide-specific antibody response independent of the systemic response. Results are also in accordance with earlier studies suggesting that the mucosal immune system matures earlier in life than does the systemic immune response.

Nasopharyngeal antibodies to pneumococcal capsular polysaccharides in children with acute otitis media

Antibodies to pneumococcal capsular polysaccharides were measured by EIA in acute- and convalescent-phase nasopharyngeal aspirates from 120 children with acute otitis media. Nasopharyngeal IgM- and IgG-class antibodies were rare, whereas IgA was detected more often, occurred independently from serum IgA, and correlated with the presence of the secretory component in pneumococcal antibody, indicating local production of IgA. Thirty-four percent of the children with pneumococci in middle ear fluid developed a nasopharyngeal IgA response to the polysaccharide pool of serotypes 6B, 14, 19F, and 23F compared with 7% of the children with pneumococci only in the nasopharynx or not found at all (P = .004). The responses were observed in children of all ages, the youngest 6 months of age. This supports the hypothesis that mucosal immunity to bacterial polysaccharides matures earlier than systemic immunity.

Different kinetics of antibody responses between IgA and IgG classes in nasopharyngeal secretion in infants and children during primary respiratory syncytial virus infection

The secretory antibody responses in 34 infants and children (20 days-17 months old) with lower respiratory tract disease following primary respiratory syncytial virus (RSV) infection were determined using a sensitive tissue culture enzyme linked immunosorbent assay. None of the patients in the acute phase showed IgA antibody responses. In contrast significant IgG antibody responses which were thought to be maternally derived were observed in infants younger than 2 months of age. In the convalescent phase sample, significantly high IgA antibody responses were observed in all patients except one, and there was no significant difference in magnitude of antibody activity between patients younger than 8 months and patients older than 8 months. However, IgG antibody responses in infants younger than 8 months were significantly lower than in subjects 8 to 17 months old. Notably, infants younger than 2 months developed no significant IgG antibody activity in the convalescent phase. These observations suggest that the antibody activity which contributes to recovery from primary infection by RSV in younger infants may be IgA rather than IgG class antibodies. These observations also suggest that the presumptive immunosuppression mediated by maternally derived antibodies may predominantly influence the IgG antibody response rather than the development of local IgA antibody activity.

Comparative evaluation of immunization with live attenuated and inactivated poliovirus vaccines

The development of serum and nasopharyngeal antibody response, as well as the magnitude and temporal pattern of fecal shedding of vaccine and revertant polio-viruses, have been examined in infants previously immunized with one or more doses of orally administered live attenuated poliovaccine, enhanced potency inactivated polio-vaccine, or both. The nature of serum immune response appears to be similar after either immunization schedule, although the antibody titers are quantitatively higher after two doses of EP-IPV than those observed after a similar schedule with OPV. Highest antibody activity is generally detected in subjects immunized with a combination of EP-IPV followed by OPV. ELISA antibody activity in the nasopharynx was regularly detected after either form of immunization. However, neutralizing and VP3 poliovirus virion protein-specific antibody responses in the nasopharynx were consistently observed in subjects immunized with OPV or EP-IPV followed by OPV. Subjects immunized with EP-IPV alone exhibit significantly lower or absent neutralizing or VP3-specific responses. The nucleic acid sequences of the purified RNA obtained from all virus isolates have also been examined in the 5' noncoding region by dideoxy-sequencing to determine whether the viruses shed represent revertants (vaccine), non-revertants, or both. The frequency and duration of vaccine virus shedding appears to be similar in both immunization schedules. Revertant virus shedding was not demonstrated 30 days after immunization with OPV alone. However, shedding of revertants was detected for as long as 60 days in some subjects previously immunized with EP-IPV. The duration of shedding of revertant virus differed with different serotypes and different immunization regimens. Prior immunization with one or more doses of OPV reduced the length of shedding of revertant virus. Significantly, however, prior immunization with one or more doses of EP-IPV was not associated with reduced shedding of revertant virus types. Based on these observations and a number of other epidemiologic data summarized in this review, it is clear that both OPV and EP-IPV when used alone are highly effective and safe in inducing effective immunity to polio-virus and in the eradication of poliomyelitis. While the combination schedule employing EP-IPV followed by OPV should result in a decline of vaccine-associated paralytic (VAP) disease in OPV recipients, such immunization schedules may have little or no impact on the development of VAP in susceptible contacts. Furthermore, the logistics and the cost of combination schedules must be considered before current recommendations based on the use of OPV or EP-IPV alone are revised.

Development of interleukin 6 and tumor necrosis factor alpha activity in nasopharyngeal secretions of infants and children during infection with respiratory syncytial virus

Cytokine (interleukin 6 [IL-6] and tumor necrosis factor alpha [TNF-alpha]) activity in nasopharyngeal secretions of 21 infants and children (19 days to 16 months old) infected with primary respiratory syncytial virus was determined by an enzyme-linked immunosorbent assay. IL-6 and TNF-alpha were detectable in 100% (21 of 21) and 67% (14 of 21) of cases during the course of infection, respectively. Generally, TNF-alpha activity was high in the acute phase and declined thereafter, sometimes to undetectable levels. IL-6 activity was also highest in the acute phase and declined thereafter in infants younger than 5 months, while in patients older than 5 months, it-increased during the course of the disease to peak in the early convalescent phase. These observations suggest that inflammatory cytokines are produced in vivo in infants and children in response to primary respiratory syncytial virus infection and may be involved in disease pathogenesis. However, the mechanism of induction of cytokines may be different for infants and children in different age groups.

Pathophysiology of pneumonia

The care and management of the pneumonia patient are formidable challenges to the physician. As long as the basic underlying host defense defects in these patients remain elusive, the clinician's approach will remain symptomatic and empirical. Further knowledge of the underlying pathophysiology of pneumonia will undoubtedly provide innovative approaches to both the prevention and the early and effective treatment of this infection. Clearly, the development of a multimodal approach, including components of immune modulation and immune restoration, is needed to improve the multiple defects in the host defense system; however, the normal host defense system operates in a delicate balance. Efforts to stimulate the immune system nonselectively may prove to be as deleterious to the patient as are the negative effects of their immunocompromised state.

Systemic and mucosal immunity induced by BCG vector expressing outer-surface protein A of Borrelia burgdorferi

The bacillus Calmette-Guerin (BCG) is a live attenuated strain of Mycobacterium bovis which offers potential advantages as a vector for mucosal delivery of antigens. Recombinant BCG elicits protective humoral immune responses to a variety of antigens. Furthermore, BCG binds specifically to microfold cells present in the epithelium overlying lymphoid follicles throughout the mucosal immune system. Here we show that a single intranasal vaccination with recombinant BCG expressing the outer-surface protein A antigen from B. burgdorferi results in a prolonged (more than one year) protective systemic IgG response and a highly sustained secretory IgA response which is disseminated throughout the mucosal immune system. Furthermore, intranasal immunization induces marked, organized lymphocyte accumulation in the proximal nasopharyngeal lymphoid tissue as well as at distal mucosal sites; the appearance and persistence of lymphoid aggregates correlates with the secretory immune responses. Thus intranasal immunization with recombinant BCG is a powerful method for inducing long-lasting secretory and systemic immune responses.

Diesel exhaust particles induce local IgE production in vivo and alter the pattern of IgE messenger RNA isoforms

Diesel exhaust particles (DEP) have been implicated in the increased incidence of allergic airway disorders. We investigated the effects of DEP on localized immunoglobulin production by performing nasal challenges with varying doses of DEP and analyzing the local immune response in nasal lavages obtained before and after. A significant rise in nasal IgE but not IgG, IgA, IgM, or albumin was observed in subjects 4 d after challenge with 0.30 mg DEP, equivalent to exposure on an average Los Angeles day. Direct evidence for DEP-enhanced local production of IgE was that challenge increased the number of IgE-secreting cells in lavage fluid from < 1 in 2,000,000 to > 1 in 100,000 but did not alter the number of IgA-secreting cells. There was a concomitant increase in epsilon mRNA production in the lavage cells. Additionally, DEP altered the relative amounts of five different epsilon mRNAs generated by alternative splicing, mRNAs that code for different IgE proteins. These results show that DEP exposure in vivo causes both quantitative and qualitative changes in local IgE production. The implication is that natural exposure to DEP may result in increased expression of respiratory allergic disease.

Cytokines in nasopharyngeal secretions; evidence for defective IL-1 beta production in children with recurrent episodes of acute otitis media

The host-parasite relationship in the nasopharynx of young children with bacterial colonization and antigen uptake in the mucosa and lymphatic tissue provides an opportunity to investigate infectious/inflammatory processes and responses. IL-1 beta, IL-6 and tumour necrosis factor-alpha (TNF-alpha) were analysed in nasopharyngeal secretions and serum from children with or without recurrent episodes of acute otitis media, from healthy adults and adults with or without recurrent episodes of acute otitis media, from healthy adults and adults with hypogammaglobulinaemia or selective deficiency of IgG3. Nasopharyngeal secretions generally contained substantial amounts of IL-1 beta, IL-6 and TNF-alpha. In contrast, IL-1 beta, IL-6 and TNF-alpha were not detectable in sera on the same occasion. Children were found to have higher levels of IL-1 beta, IL-6 and TNF-alpha than healthy adults and than adults with immunodeficiency. High levels of IL-1 beta were associated with low or undetectable levels of IL-6 and TNF-alpha, whereas the opposite pattern was seen in association with low levels of IL-1 beta. This was especially true for children with recurrent episodes of acute otitis media (RAOM). In children with nasopharyngeal colonization with Haemophilus influenzae, significantly higher levels of IL-1 beta, IL-6 and TNF-alpha (P = 0.0001, respectively) were found compared with non-colonized children. Notably, the RAOM children exhibited significantly lower levels of IL-1 beta, IL-6, and TNF-alpha in nasopharyngeal secretions (P = 0.0001, 0.01 and 0.0001, respectively) than healthy children. These results demonstrate local production of inflammatory cytokines in nasopharynx, related to bacterial colonization, and suggest that children with RAOM are poor nasopharyngeal cytokine producers.

Effect of maternal antibody on IgA antibody response in nasopharyngeal secretion in infants and children during primary respiratory syncytial virus infection

The IgA antibody response to respiratory syncytial virus (RSV) was determined in nasopharyngeal secretions (NPS) of 22 infants and children infected with RSV group A strains, employing an ELISA. The antibody activity observed during the convalescent phase against whole virus, fusion glycoprotein (F) and large glycoprotein (G) was examined in young infants (under 6 months) and compared with that of older individuals (6 to 16 months). Both groups showed similar degrees of IgA antibody activity to whole virus in NPS; however, older individuals showed a significantly higher activity of IgA F antibody than that of IgA G antibody in the NPS. On the other hand, in the NPS of young infants, IgA F antibody was somewhat suppressed and IgA G antibody activity predominated over that of IgA F. Pre-existing (maternal) serum IgG anti-RSV F antibody activity was higher than that of antibody to G. A significant reverse correlation was observed between the activity of pre-existing serum IgG F antibody and NPS IgA F antibody in the convalescent phase after primary infection with RSV. These observations suggest that maternally derived RSV IgG antibody, which contains abundant anti-F activity, may suppress the development of IgA F antibody response at infection sites in the respiratory tract in young infants during primary RSV infection. These changes may be related to the severity of acute infection and longer convalescence often observed in young infants during RSV infection.

Interrupting the transmission of wild polioviruses with vaccines: immunological considerations

In 1988 the World Health Assembly set the goal of global poliomyelitis eradication by the year 2000. Substantial progress has been made, and 143 countries reported no poliomyelitis cases associated with the wild virus in 1993. This article reviews the immunological considerations relevant to interrupting the transmission of wild polioviruses with vaccines. Although serum immunity prevents poliomyelitis in the individual, it is local immunity that is important in preventing the transmission of polioviruses in the community. Natural infection and vaccination with oral polioviruses vaccine (OPV) produce local immunity in the intestine and the nasopharynx in about 70-80% of individuals. In contrast, inactivated poliovirus vaccine (IPV) produces local intestinal immunity in only 20-30% of the individuals. With either vaccine, however, a substantial proportion of the immunized population can transmit the wild virus. Moreover, although serum immunity is long-lasting, limited data suggest that local immunity may not be as persistent. To interrupt the transmission of wild polioviruses efforts should be made to achieve and sustain high levels of poliovirus vaccine coverage. Recent outbreaks show that wild poliovirus poses a risk for unimmunized individuals, even when overall coverage levels are high. Delivery of poliovirus vaccine to hard-to-reach populations will be of increasing importance as countries progress toward the final stages of poliomyelitis eradication. The immunization status of persons from poliomyelitis-free countries should be updated prior to travel to poliomyelitis-endemic areas.

Respiratory syncytial virus (RSV) bronchiolitis: comparative study of RSV groups A and B infected children

The grouping characteristics of 29 respiratory syncytial virus (RSV) present in nasopharyngeal cells collected from hospitalized children with bronchiolitis during the 1990 RSV season in Porto Alegre, RS, were analysed. Twenty-two were grouped as belonging to group A and 7 to group B. Cyanosis, oxygen therapy, cough, length of hospitalization and atelectasis were observed to be more frequently found within group B infected children. Other clinical signs and symptoms were similarly found in both groups.

Detection of alpha-interferon in nasopharyngeal secretions and sera in children infected with respiratory syncytial virus

We investigated the relationship between respiratory syncytial virus (RSV) antigen and interferon (IFN) in nasopharyngeal secretions (NPS) and sera obtained from 252 patients infected with RSV. A total of 146 (57.9%) of 252 patients had IFN in NPS with a mean titer of 28 units/ml and IFN was detected in 164 (71.6%) of 229 patients in the acute stage sera with a mean titer of 28 units/ml. IFN activities were neutralized with antiserum to IFN-alpha. RSV antigen in NPS decreased on Day 5 and later in parallel with the change of mean titer of IFN in NPS. IFN in NPS was detected in 40 to 60% of the samples with some fluctuation in the acute stage. Within 4 days IFN was detected in more than 70% of the sera whereas on Day 5 and later the IFN positivity rate decreased in sera. RSV antigen in NPS decreased in the older patient groups. No significant change of positive rate of IFN in NPS was observed in different age groups and the mean titer of IFN in NPS and sera did not vary with age, except in those younger than 3 months and older than 3 years of age.

Anti pneumococcal antibody activity in nasopharyngeal secretions in healthy adults and children

The local antibody activity to Streptococcus pneumoniae serotype 6B was measured in nasopharyngeal secretions from 20 healthy adults and 43 children, 1-3 years of age, 14 of whom were healthy and 29 were at risk for developing recurrent episodes of acute otitis media (RAOM) according to the criteria described below. In children, anti pneumococcal IgA and IgG antibody activity was of the same magnitude in both groups. Adults showed significantly higher specific IgA activity. Antibody activity of the IgG isotype was also higher in adults, possibly reflecting the higher serum antibody levels. The children at risk of developing RAOM had significantly higher levels of secretory component (SC) in their nasopharyngeal secretions. Our data suggest that local immunity in the nasopharynx is not fully developed in young children, which might contribute to bacterial survival and colonization in the region.

A magnetic resonance imaging evaluation of histamine-mediated allergic response in the guinea pig nasopharynx

BACKGROUND

Magnetic resonance imaging (MRI) is a powerful technique for visualizing tissues with a high water content. In this study we used MRI to evaluate the effect of antigen and mediators of allergic responses on the nasopharyngeal airway of guinea pigs.

METHODS AND RESULTS

Longitudinal relaxation time-weighted transverse images of the nasopharyngeal airway revealed a clearly defined airway lumen and mucosa. Topical administration of ovalbumin (0.00006% to 0.06%) to the nasopharyngeal airway of sensitized guinea pigs caused a concentration-dependent reduction (34% +/- 1%, maximum) in airway luminal volume and a corresponding increase (28% +/- 3%, maximum) in the volume of the airway mucosa. These effects were duplicated by histamine (10(-5) to 10(-3) mol/L), but not by methacholine (10(-3) mol/L). The antigen-induced changes in airway and mucosal volumes were dose-dependently inhibited by the H1-antagonist loratadine (0.3 to 3 mg/kg, administered orally). On the other hand, topical administration of a decongestant drug, oxymetazoline (250 micrograms per guinea pig), had no effect on the response to antigen.

CONCLUSIONS

These results indicate that MRI is a useful technique to measure allergic responses in the airways and identify that histamine is an important mediator of the obstruction that occurs in the nasopharyngeal airway of guinea pigs after antigen challenge.

Local antibody response to P6 of nontypable Haemophilus influenzae in otitis-prone and normal children

The local antibody response to the outer membrane protein, P6, of nontypable H. influenzae was measured in middle ear fluids of 30 children during 46 episodes of otitis media, and in nasopharyngeal secretions from 7 children evaluated on 18 occasions. Immunoglobulin G antibody to P6 was detected in 92% of middle ear fluid compared to 70% for IgM, 78% for IgA, and 45% for secretory IgA. Antibody levels ranged from a high of 249 ng/ml for IgG to a low of 11 ng/ml for IgM. Concentrations of P6 specific IgG in the middle ear fluid was directly related to the concentration in the serum, r = 0.89, p < 0.001, and inversely related to the number of bacteria present, r = -0.62, p < 0.05. In contrast, IgA and secretory IgA antibodies to P6 were common (96% and 95%, respectively) and in relatively high concentrations (33 ng/ml and 29 ng/ml, respectively) in nasopharyngeal secretions. There was no relationship between nasopharyngeal and serum levels of antibodies. These data suggest that antibody to P6 nontypable H. influenzae is common, diffuses into the middle ear spaces passively from the serum during otitis media, and is manufactured locally in the nasopharynx in response to colonization.

Asthma and sinusitis

Important relationships exist between the upper and lower airways. It is well known that sinusitis and asthma coexist in many patients, and evidence is accumulating that there may be a cause-and-effect relationship, that is, that sinusitis is an important trigger for asthma. Studies in children and adults indicate that appropriate medical and/or surgical therapy of sinusitis frequently leads to improvement in the asthmatic state. Possible mechanisms for this relationship include the eosinophil acting as an effector cell, inflammatory mediators, and a vagal reflex. Further investigations need to examine both prospective studies of the effect of medical therapy for sinusitis on asthma and basic mechanisms relating the upper and lower airways.

The role of nasopharyngeal lymphoid tissue

Nasal-associated lymphoid tissue (NALT), which comprises paired lymphoid organs in the nasopharynx of rodents, is the principal mucosal lymphoid tissue of the respiratory tract. As described in this review, NALT bears certain similarities to the Peyer's patches of the intestine but the two differ remarkably in morphology, lymphoid migration patterns and the binding properties of their high endothelial venules (HEV).