Lymphocytes in the blood: normal, increased, decreased, causes of deviations. Lymphocytes in peripheral lymphoid organs Lymphocytes in the spleen

Treatment of Lymphocytoma of the spleen

What is Lymphocytoma of the Spleen

Lymphocytomas can be localized in different organs and tissues. Lymphocytoma of the spleen can be attributed to the number of well-studied lymphocytes. The age of patients with splenic lymphocytoma corresponds to that of patients with chronic lymphocytic leukemia.

Lymphocytoma of the spleen demonstrates a number of features of a lymphocytic benign tumor.

Pathogenesis (what happens?) during Splenic Lymphocytoma

At the same time, individual foci of proliferation of mature lymphocytes can be seen in the bone marrow trepanate. The detection of such proliferates, even with a normal blood composition and myelogram, should lead to the establishment of the tumor nature of the disease, to the diagnosis of splenic lymphocytoma, as opposed to the assumption of its increase due to hepatitis.

The structure of peripheral blood lymphocytes varies from patient to patient. In some cases, lymphocytes with dense pyknotic nuclei and narrow cytoplasm are found, in others they have a larger and loose nucleus, a wide cytoplasm with moderate basophilia. Sometimes these lymphocytes have nucleoli, and then some authors call the disease prolymphocytic lymphoma. As with chronic lymphocytic leukemia, leukocytosis in the blood is often accompanied by the detection of leukemia cells. Immunological analysis reveals that tumor cells belong to the B-system. Lymphocytoma of the spleen may be accompanied by the secretion of immunoglobulin, more often - M, less often - G.

Symptoms of Lymphocytoma of the spleen

The clinical picture of the disease consists of the usual manifestations for all hemoblastoses: weakness, increased fatigue, sweating. In the blood, as a rule, a normal level of leukocytes with a predominance of mature lymphocytes in the formula. The level of platelets in the blood at the time of diagnosis is usually normal, only after 7-10 years in some patients the number of platelets decreases to 1 H 105 - 1.4 H g105 (100,000-140,000) in 1 μl and below. In terms of red blood, some tendency to decrease is more often revealed, and in the level of reticulocytes - to an increase of up to 1.5-2%. Examination of the patient reveals an enlarged spleen. Lymph nodes are normal in size or slightly enlarged (some cervical or axillary - up to 1-1.5 cm). In the bone marrow punctate, there may be no lymphocytosis or it does not exceed 30% and does not allow us to speak categorically about the tumor nature of the process.

Diagnosis of Lymphocytoma of the spleen

Differentiation of splenic lymphocytoma with chronic lymphocytic leukemia, especially its splenic form, should be based on a significant increase in the spleen (protruding from the hypochondrium) with low (up to 2 H 104 in 1 μl) lymphocytosis, normal or slightly enlarged (from 1 to 2 cm) individual lymphatic nodes and focal proliferation of lymphocytes in the bone marrow. Chronic lymphocytic leukemia shows a different picture: first, the cervical, then axillary groups of lymph nodes increase, lymphatic leukocytosis steadily increases over several months, exceeding 2104 in 1 μl, progressive enlargement of the lymph nodes significantly outpaces the enlargement of the spleen, diffuse lymphatic proliferation is noted in the bone marrow.

Treatment of Lymphocytoma of the spleen

Removal of the spleen is the main treatment for this tumor in the early stages of the disease. In the coming weeks and months after removal of the spleen, lymphocytosis in the blood decreases, the level of platelets, red blood cells, if it was lowered, disappears or significantly decreases lymphatic infiltration of the bone marrow. At the same time, the general condition of patients significantly improves, the size of the lymph nodes decreases or normalizes. If there was a secretion of monoclonal immunoglobulin, its level after surgery either significantly decreases or ceases to be determined, circulating immune complexes cease to be determined or their level sharply decreases. Some decrease in the level of normal immunoglobulins observed in secreting lymphocytomas of the spleen after removal of the spleen may also disappear.

The histological picture of the removed spleen is determined by the nodular mature cell type of lymphatic proliferation. Lymph follicles may be almost normal, although their number is increased in contrast to the normal expected reduction in the number of follicles in the elderly. In some cases, large, merging follicles are found. In contrast to Brill-Simmers macrofollicular lymphoma with large light follicles, as a result of a sharp increase in the germinal center in splenic lymphocytoma, reproduction centers are usually absent at all, although in some cases they are very distinct.

The imprint of the removed spleen and its punctate show the usual mature cell composition of lymphocytes and prolymphocytes. The puncture of the spleen has no diagnostic value, although it allows to reject the diagnosis of lymphosarcoma of the spleen.

Indications for removal of the spleen: a significant increase in the spleen (protrudes from under the costal margin), a feeling of heaviness, pulling pains in the left hypochondrium, the occurrence and increase of cytopenia in the peripheral blood, for secreting lymphocytes - a progressive increase in pathological immunoglobulin in the blood.

With lymphocytoma of the spleen, the liver is mostly little involved in the process. With a liver biopsy, usually performed during the removal of the spleen, focal, often periportal lymphatic infiltrates of various sizes are found. On examination, the patient noted some enlargement of the liver. After removal of the spleen, the size of the liver in most cases becomes normal: it is possible that a decrease in lymphatic infiltration plays a role in the contraction of the liver after surgery. In rare cases, with lymphocytoma of the spleen, but more often with lymphocytoma of the lymph nodes and generalized lymphocytoma, the liver is noticeably involved in the tumor process. At the same time, rather large nodular lymphatic infiltrates change the structure of the liver, squeezing the hepatic lobules or infiltrating them.

Reduction of lymph nodes, liver, reduction of lymphocytosis in the bone marrow after removal of the spleen with spleen lymphocytoma suggests that it is in it that the tumor precursor cells are located, and for the time being only the progeny of these cells metastasizes to the lymph nodes and bone marrow.

The spontaneous development of the disease leads to a gradual increase in the spleen with a very slow (years) increase in the number of lymphocytes in the blood. Later, an increase in lymph nodes (usually cervical) joins, and the process becomes indistinguishable from chronic lymphocytic leukemia.

A few years after the removal of the spleen, the lymphocytoma of the spleen often turns into ordinary chronic lymphocytic leukemia, the lymph nodes increase sharply. At this time, treatment is carried out in the same way as in chronic lymphocytic leukemia.

Thus, splenic lymphocytoma is a mature cell lymphocytic tumor localized mainly in the spleen, although the bone marrow, liver, and lymph nodes may be slightly involved in the process. Tumor growth in the spleen and other tissues in this form is nodular in most cases.

Which doctors should you contact if you have Lymphocytoma of the spleen

Hematologist

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1. Immunity - this is a way to protect the body from everything genetically alien (from pathogens of infectious and parasitic diseases, from internal factors that violate genetic constancy, from mutant cells, etc.). Immunology - doctrine of immunity. Immunogenesis- the process of formation of immunity. Immunomorphogenesis - cellular basis of immunogenesis. Immunomorphology- a branch of immunology that studies the cellular basis of immunity. Immunopathology - a branch of immunology that studies pathological processes and diseases resulting from impaired immunogenesis.

2. Morphology and function of the immune system Responsible for immunity in the body of animals and humans is the immune system, which provides control and genetic constancy of the internal environment of the body (immune homeostasis).

In the immune system, central and peripheral organs of immunity are distinguished: to central authorities include: bone marrow, thymus, bursa of Fabricius in birds; to peripheral organs immune system include: spleen, lymph nodes, lymphoid tissue of the digestive tract (tonsils, Peyer's patches and solitary follicles), lungs, skin and other organs, blood, lymph, mononuclear phagocyte system (MPS), Harder's gland and lacrimal gland in birds, skin and microglia of the CNS.

Bone marrow is a supplier of stem cells - the ancestors of all other blood cells, as well as B-lymphocytes in mammals.

Thymus (thymus gland) is a supplier of T-lymphocytes, which are formed in the thymus from bone marrow stem cells (in mammals and birds). Bursa Fabricius in birds, it transforms bone marrow stem cells into B-lymphocytes.

3. Immunocompetent cells: these include microphages, macrophages, lymphocytes.

Microphages: neutrophils and eosinophils, they have a high phagocytic activity. Macrophages: blood monocytes, connective tissue histiocytes, free and fixed macrophages of lymph nodes, bone marrow and spleen, alveolar macrophages of the lungs, Kupffer cells of the liver, peritoneal and pleural macrophages, osteoclasts of bone tissue, microglial cells of the nervous system, macrophages of the synovial membranes of the joints, epithelioid and giant inflammatory cells foci. They belong to the system of mononuclear phagocytes (MPS), convert the bacterial antigen into an immunogenic form in the form of RNA + antigen complexes, and transmit information about the antigen to T- and B-lymphocytes.

Lymphocytes(T and B cells). T-lymphocytes(helpers, killers, suppressors, enhancers, T-differentiators) are involved in cellular immunity, delayed-type allergies, transplantation immunity and in the development of a number of autoimmune syndromes and diseases. Morphologically, they are small in size (6.5 μm), with a round, intensely stained nucleus, a narrow rim of the cytoplasm, a weakly expressed perinuclear zone, contain acid phosphatase, and there are few receptors on the surface. Contained in the thymus, T-dependent zones of peripheral organs of immunity. During the immune response, they turn into immune lymphocytes (killers), which destroy antigens and foreign cells with the participation of cytolytic factors, and memory lymphocytes.

B-lymphocytes 8.5 μm in size, the nucleus is lighter, there is a wide rim of the cytoplasm and a well-defined perinuclear zone. There are many receptors on the surface, contain alkaline phosphatase. They provide humoral immunity, are involved in the development of immediate-type allergies and some autoimmune syndromes and diseases. In peripheral organs, immunity is contained in T-independent zones.

In an immune response, B-lymphocytes transform into antibody-producing plasma cells and memory lymphocytes. Plasma cells (plasmocytes) have a size of 20 - 30 microns, oblong or rounded, the nucleus is located on the periphery, the chromatin of the nucleus is in the form of wheel spokes. A light perinuclear zone is well defined around the nucleus.

Plasma cells synthesize 5 classes of antibodies (immunoglobulins): G , A, M, D , E, which play a major role in the fight against bacteria and viruses (IgG), create conditions for phagocytosis of the antigen by micro- and macrophages (IgM), play an important role in the pathogenesis of allergic reactions (IgE) and the creation of local secretory immunity in the intestines and lungs (IgA ).

Drawing. Localization of T- and B-lymphocytes in the lymph node. T-lymphocytes are contained in the paracortical zone, B-lymphocytes - in lymphoid follicles, in the brain cords and the cortical layer.

Drawing. Localization of T- and B-lymphocytes in the spleen. T-lymphocytes are found around the central arteries of the lymphoid follicles in the form of clutches (periarterially), B-lymphocytes are found in the peripheral zones of the lymphoid follicles.

Drawing. Plasma cell (pyronin methyl green stain). The cytoplasm of the cell is sharply pyroninophilic, stained red. The nucleus is located eccentrically, blue. The bright perinuclear zone is visible.

Drawing. Electron diffraction pattern of a plasma cell. The granular endoplasmic reticulum is well developed, on the membranes of which a large number of ribosomes are located, where antibodies (immunoglobulins) are synthesized. Near the nucleus lies a well-developed Golgi apparatus. Mitochondria are visible.

Svetlana Vasilievna Chulkova", Ivan Sokratovich Stilidi2, Evgeny Vyacheslavovich Glukhov3, Lyudmila Yuryevna Grivtsova4, Sergei Nikolayevich Nered5, Nikolai Nikolayevich Tupitsyn6

THE SPLEEN IS THE PERIPHERAL ORGANS OF THE IMMUNE SYSTEM. IMPACT OF SPLENECTOMY ON IMMUNE STATUS

PhD, Senior Researcher, Laboratory of Hematopoiesis Immunology, Department of Clinical Immunology, Research Institute of Clinical Oncology, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences ("5478, Russian Federation, Moscow, Kashirskoye shosse, 24 ) 2 Corresponding Member of the Russian Academy of Medical Sciences, Professor, Doctor of Medical Sciences, Head, Surgical Department No. 6 of Abdominal Oncology of the Research Institute of Clinical Oncology of the N. N. Blokhin Russian Cancer Research Center of the Russian Academy of Medical Sciences ("5478, RF, Moscow , Kashirskoe shosse, 24) 3Post-graduate student, Surgical Department No. 6 of Abdominal Oncology, Research Institute of Clinical Oncology, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences ("5478, Russian Federation, Moscow, Kashirskoe shosse, 24) 4K MD, Senior Researcher, Laboratory of Hematopoietic Immunology, Department of Clinical Immunology, Research Institute of Clinical Oncology, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences (5478, Moscow, Kashirskoe Shosse, 24) 5 D. MD, Leading Researcher, Surgical Department No. 6 of Abdominal Oncology, Research Institute of Clinical Oncology, N. N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences (5478, Moscow, Kashirskoye Shosse Se, d. 24) 6 Doctor of Medical Sciences, Professor, Head, Laboratory of Hematopoiesis Immunology, Department of Clinical Immunology, Research Institute of Clinical Oncology, FSBI «N.N. N. N. Blokhin" RAMS ("5478, Russian Federation, Moscow, Kashirskoe shosse, 24)

Correspondence address: 115478, Russian Federation, Moscow, Kashirskoe shosse, 24 N. N. Blokhin, RAMS, Surgical Department No. 6 of Abdominal Oncology, Glukhov Evgeny Vyacheslavovich; e-mail: [email protected]

The literature review is devoted to the immunocompetent organ - the spleen. A brief analysis of the structure of the spleen and its functions is given. The lymphocytes contained in the spleen are described in detail. Particular attention is paid to the effect of splenectomy on the immune status of the body.

Key words: spleen, lymphocytes, immunocompetent cells, immunity, immunosuppression, gastrosplenectomy.

The main component of the human immune system is lymphoid tissue, which is based on reticular fibers and reticular cells that form a network with cells of various sizes. The loops of this network contain immunocompetent cells (ICCs) capable of carrying out various kinds of immunological reactions. All ICCs originate from a single ancestral stem cell in the red bone marrow and are divided into 2 types: granulocytes and agranulocytes. Granulocytes include neutrophils, eosinophils, and basophils; agranulocytes include macrophages, B- and N-lymphocytes.

There are central organs of the immune system: thymus and red bone marrow, where the lymphatic

Nered S. N., Tupitsyn N. N., 2014

UDC 612.411/.418:616.441-089:612.017.1 (048.8)

ez, - as well as peripheral organs and systems. The latter include the spleen, lymph nodes, liver, lymphatic accumulations in various organs, and ICC circulation pathways.

It is in the peripheral organs of the immune system that the antigen meets the ICC. The antigen in complex with molecules of the major histocompatibility complex is exposed by antigen-presenting cells on their surface. Lymphocytes can recognize such complexes by interacting with them, and as a result, a cascade of cellular reactions is triggered, which leads to the development of a specific immune response.

The anatomical and physiological principle of the immune system is organocirculatory. This means that ICCs are constantly in a state of recirculation, i.e., lymphocytes recirculate between lymphoid organs and non-lymphoid tissues.

through the lymphatic vessels and blood. This is necessary to create conditions for the antigen to meet with single lymphocytes, since each individual antigen is recognized by only a very small part of the lymphocyte population.

Immature lymphocytes enter the peripheral lymphoid organs and return to the circulatory bed already in the form of effector cells for subsequent distribution throughout the lymphatic system, as well as for selective return to the place of their first encounter with the antigen - to anatomically specialized zones of peripheral organs. This process is often called the "homing effect" in the literature.

One of the most important peripheral organs of the immune system is the spleen. The content of lymphocytes in the white pulp of the spleen reaches 85% of the total number of cells, which is almost 25% of all lymphocytes in the body, and almost 50% of the lymphocytes of the white pulp of the spleen are B-cells. Thus, it is the spleen, along with the lymph nodes, that is the organ that provides humoral immunity.

Despite its relatively small size (weighing only 150 g), the spleen is well supplied with blood: 200-300 ml of blood flows through it every minute, which corresponds to approximately 5% of the volume of blood ejected by the heart during this time.

In the spleen, a red pulp is distinguished, which makes up from 70 to 80% of the mass of the organ, and a white pulp, which accounts for from 6 to 20% of the mass of the spleen. The red pulp is represented by venous sinuses and pulpal cords. In it, the destruction of erythrocytes and their absorption by macrophages occurs. The white pulp of the spleen is dominated by lymphocytes. They accumulate around the arterioles in the form of the so-called periarteriolar clutches. The T-dependent zone of the sleeve directly surrounds the arteriole, and B-cell follicles are located closer to the edge of the sleeve.

Lymphocytes that form clusters of white pulp along the course of the central arteries are represented by T-lymphocytes, of which 75% are CD4 + cells, and 25% are CD8 + lymphocytes. In the spleen, there are only peripheral (naive and mature) T-lymphocytes that have been selected in the thymus. Under the influence of an antigenic stimulus, these cells are activated, similar to what happens in the lymph nodes.

In the spleen, B-cell activation processes also take place. B-cells specific for autologous antigens do not enter the follicles, they linger in the outer zone of the periarteriolar lymphoid muffs and die.

During the immune response to various antigens, the binding of the B-lymphocyte-specific immunoglobulin receptor occurs, after which the movement of all B-cells in the outer zone of the periarteriolar lymphoid clutches slows down significantly. In the event that there is no interaction with T-cells necessary for the implementation of the immune response to thymus-dependent antigens, activated B-lymphocytes die. In the presence of cooperation with

T-cells naive B-cells arrive mainly in the follicles, where they undergo differentiation in the germinal centers during the primary immune responses.

In secondary immune responses of B-memory cells to thymus-dependent antigens, pronounced B-cell proliferation and differentiation into plasma cells are observed within the outer zone of the periarteriolar lymphoid clutches; follicular B-cell proliferation is somewhat weaker than with primary responses.

In addition, the spleen has a distinct population of cells that separate the white from the red pulp. This area is called the marginal or marginal zone, where both T- and B-cells are located with the relative predominance of the latter. Marginal zone cells are located in the network of primary blood sinuses of the spleen, which allows them to interact with blood-borne antigens. The marginal zone B cell population is not homogeneous: it includes naive B cells, as well as immunological memory B cells generated during both T-dependent and T-independent type 1 antibody responses.

Marginal zone B cells are not recirculating, although they are derived from recirculating B lymphocytes that have returned to the splenic marginal zone. These cells have specific morphological features: immunoglobulin (Ig) M molecules are expressed on their membrane, but IgD molecules are absent. They are characterized by high expression of CR2 receptors (CD21 molecules), which allows them to successfully bind TH-2 antigens (T-cell independent type 2 antigens), presented, in particular, on encapsulated bacteria. B-lymphocytes with this phenotype are also found in other lymphoid tissues, but only the marginal zone of the spleen accumulates the largest number of these cells in the body.

In the marginal zone of the spleen, dendritic cells (DC) are also determined. These cells were discovered in 1808 by P. Langerhans. There are immature and mature DCs.

Immature DCs take up antigens from the circulation but are unable to present antigens and stimulate T cells. Immature DCs vigorously take up antigens by phagocytosis and pinocytosis and then undergo a complex maturation process.

Mature DC present previously ingested antigenic material and thus induce a T cell response. This is due to a significant increase in the expression of HLA antigens and co-stimulatory molecules. Mature DCs migrate to the T-cell zones of the white pulp of the spleen, where they form a pool of interdigitating DCs. There, they activate naive antigen-specific T helpers to differentiate into T helper type 2 (Th2), which induce B cell growth and antibody production. Thus, DC play a dual role: at the immature cell stage, they are early antigen-specific effectors of the antiviral and antibacterial immune response, while at the mature cell stage, they are involved in the induction of an antigen-specific response.

against these pathogens. DC activity changes with age.

In addition to the lymphoid elements proper, much attention of researchers is attracted by the stromal cells of the spleen, which perform not only stromal, but also regulatory functions. Spleen stroma cells are of great importance, since, by producing a number of cytokines, they have a regulatory effect on the proliferation and differentiation of natural killer (NK-cells) and ^ and B-lymphocytes. According to I. G. Belyaeva et al. , after xenotransplantation of stromal cells of the spleen, a stromal network is formed, which is filled with the recipient's own cells, which form an actively working spleen pulp. According to the authors, this leads to an improvement in the functional parameters of the hematopoietic, hemostatic and immune systems compared with those after splenectomy. This reduces the likelihood of septic and thromboembolic postoperative complications and increases the body's immune resistance.

Thus, the spleen performs two main functions: it is a large phagocytic filter in the body and the most significant antibody-producing organ. A distinctive feature of spleen phagocytes is that they are able to absorb non-opsonized microbial particles, while liver mononuclear phagocytes are able to phagocytize only opsonized particles. Slow blood flow in the red pulp promotes close and prolonged contact of antigens with phagocytes, so the process of phagocytosis is possible without specific ligand-receptor interactions. This unique ability of the phagocytes of the spleen determines its important role in cleansing the body from infectious agents at an early stage of bacterial invasion, to the production of specific antibodies.

In works devoted to the study of the function of the spleen and performed on animals, it has been shown that after splenectomy in the blood serum, the level of IgM and the phagocytic activity of neutrophilic granulocytes decrease. However, if the spleen is reimplanted, the IgM concentration rises. Scientists have found that IgM play an important role in the induction of apoptosis of tumor cells and B-lymphocytes.

It should be emphasized that the spleen is the main site of IgM synthesis. Antibodies of the IgM class are the earliest in immunogenesis and make up about 6% of all immunoglobulins; their half-life is 5-6.5 days. Antibodies of the IgM class are produced by activated B cells during the primary immune response in peripheral lymphoid organs, which also include lymph nodes and lymphoid formations of the mucous membranes.

However, spleen cells are able to produce various cytokines. The experiment showed that during antigenic stimulation, splenocytes produce interleukin (IL) 2, interferon-y and IL-7, which, in turn, stimulate the proliferation of B-cells and their production of immunoglobulins.

The question of the effect of surgical intervention on the immune status of a person has long been discussed. It has been shown that quantitative and qualitative changes are observed in the cellular link of immunity under the influence of surgical intervention. The content of CD3 + , CD4 + , CD8 + , CD16 + , CD20+ and DR+ cells decreases, but the concentration of IL-2, IL-6 and tumor necrosis factor in serum increases. In the phagocytic system of immunity, the number of main phagocytic cells (neutrophils and monocytes) decreases and their ability to phagocytosis decreases. The presentation of foreign antigens by macrophages to T- and B-lymphocytes is impaired. Changes in humoral immunity consist in lowering the level of immunoglobulins of all classes (IgG, IgA, IgM). In general, surgery is a complex and multifaceted effect on the immune system. It has a different effect on immunoregulatory cells that are functionally opposite to each other: activation of Th2 cells leads to the development of surgical infections, activation of Th1 cells leads to the development of septic shock. All these changes in the immune system are characteristic of any type of surgical intervention, but they are usually transient.

It is known that hyposplenism is caused by a number of disorders in the links of cellular and humoral immunity. So, W. Times et al. showed that the removal of the spleen leads to disruption of phagocytic activity, especially in relation to non-opsonized microbes, an increase in the period of stay of lymphocytes in the peripheral circulation, a decrease in the content of IgM in serum, inhibition of complement activation along the alternative pathway, a decrease in the production of tuftsin, an increase in the activity of autoantibodies, a decrease in the number of T-suppressor cells.

Along with this, in the work of B. Balsalorbe et al. It was found that immunosuppression also manifests itself in the form of a decrease in the number of CD3 + cells, mainly due to T-helpers (CD4), and in the form of a decrease in the proliferative response of lymphocytes to the action of mitogens.

These data are consistent with the results of research by Japanese colleagues. Since 1960, patients with gastric cancer have been subjected to obligatory gastrosplenectomy in Japan in order to achieve more adequate lymph node dissection. As a result of the studies conducted in such patients, a decrease in the number of CD3 + , CD4 + and CD8 + cells was revealed against the background of a compensatory increase in the content of NK cells (CD16 + and CD57 +). The authors concluded that splenectomy leads to a significant weakening of T-cell responses. To correct the identified disorders, patients who underwent splenectomy were recommended spleen autotransplantation.

So, the spleen is the most important peripheral organ of the immune system. More than 80% of ICC is concentrated in the spleen. Along with this, its DC and stromal cells play a huge role in the formation of a full-fledged immune response. The spleen is not only an important antibody-producing organ, but also a unique phagocytic filter of the body due to the ability of its phagocytes to absorb non-opsonized microbial particles.

Thus, operations resulting in the removal of the spleen cause significant damage to the links of both cellular and humoral immunity and lead to persistent impairment of the immune response mechanisms.

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Received 12/22/2013

Svetlana Vasilievna Chulkova", Ivan Socratovich Stilidi2, Evgeny Vyacheslavovich Glukhov3, Lyudmila Yurievna Grivtsova4, Sergey Nikolayevich Nered5, Nikolay Nikolayevich Tupitsyn6

THE SPLEEN AS A PERIPHERAL IMMUNITY ORGAN. SPLENECTOMY EFFECT ON THE IMMUNITY STATUS

" MD, PhD, Senior Researcher, Hemopoiesis Immunology Laboratory, Clinical Immunology Division, Clinical Oncology Research Institute, NN Blokhin RCRC (24, Kashirskoye sh., Moscow, ""5478, RF) 2 MD, PhD, DSc, Professor, Associate Member of RAMS, Head, Abdominal Oncology Surgery Department No. 6, Clinical Oncology Research Institute, NN Blokhin RCRC (24, Kashirskoye sh., Moscow, ""5478, RF) 3 MD, Postgraduate Student, Abdominal Oncology Surgery Department No. 6, Clinical Oncology Research Institute, NN Blokhin RCRC (24, Kashirskoye sh., Moscow, ""5478, RF) 4 MD, PhD, Senior Researcher, Hemopoiesis Immunology Laboratory, Clinical Immunology Division, Clinical Oncology Research Institute, NN Blokhin RCRC (24, Kashirskoye sh., Moscow, "" 5478, RF)

5 MD, PhD, DSc, Leading Researcher, Abdominal Oncology Surgery Department No. 6, Clinical Oncology Research Institute, NN Blokhin RCRC (24, Kashirskoye sh., Moscow, ""5478, RF) 6 MD, PhD, DSc, Professor, Head, Hemopoiesis Immunology Laboratory, Clinical Immunology Division, Clinical Oncology Research Institute, NN Blokhin RCRC (24, Kashirskoye sh., Moscow, "" 5478, RF)

Address for correspondence: Glukhov Evgeny Vyacheslavovich, Abdominal Oncology Surgery Department No. 6, Clinical Oncology Research Institute, N. N. Blokhin RCRC, 24, Kashirskoye sh., Moscow, 115478, RF; e-mail: [email protected]

The paper reviews the literature on an immunocompetent organ, the spleen. Spleen structure and functions are analyzed briefly. Spleen-contained lymphocytes are described in detail. Special attention is paid to the effect of splenectomy on body immune status.

Key words: spleen, lymphocytes, immunocompetent cells, immunity, immunosuppression, gastrosplenectomy.

1 - erythrocyte, 2 - segmented neutrophil, 3 - stab neutrophil, 4 - eosinophil, 5 - basophil, 6 - lymphocyte, 7 - monocyte.

Hello dear readers!

Last time you learned about the amazing immune cells - monocytes and macrophages and their role in protecting our body from infections. Today it's my turn to tell you about lymphocytes, the smallest cells immune system.

Before moving on to this topic, let's list the organs that are directly involved in the implementation of the body's immune defense.

central authorities immune system are red marrow and thymus. Spleen, lymph nodes and lymphoid tissue intestines, skin, bronchi, etc. belong to peripheral immune organs.

red bone marrow is the place where all blood cells are born from stem cells. It is located in the spongy substance of flat bones and in the epiphyses (rounded end part) of tubular bones.

thymus or thymus gland is the central organ of immunity. Here, about 70% of all lymphocytes mature and learn, and hormones that stimulate the immune system are produced. It is interesting that the time of the greatest activity of the thymus coincides with the growth of the body and its maturation, since it is at this time that immunity is laid and lymphocytes undergo their training. Therefore, in children's blood tests, the number of lymphocytes is always higher than in adults.

Spleen- a depot for erythrocytes and the largest organ of the immune system. This is one of the centers of hematopoiesis and maturation of immune cells in a growing fetus. The spleen plays a particularly important role in cell deposition and immunity in children and adolescents. Its weight at this time reaches 150 g. It is known that in the spleen there is a deposition of mature blood cells, phagocytosis of foreign particles, neutralization of toxins, maturation of lymphocytes and degeneration of monocytes into macrophages. In addition, old red blood cells and platelets are destroyed in the spleen.

The lymph nodes - These are accumulations of lymphocytes located along the lymphatic vessels. Especially large accumulations of lymphocytes are observed in places of probable invasion of infection. For example, the well-known "tonsils", which cause a lot of trouble for moms and dads, are often enlarged in children. In combat contact with the microbial flora, lymphocytes are located in the bronchi and intestines. The areas of lymphatic tissue here are very extensive and in the case of a severe infection, immune cells die immediately after a fierce struggle. In this case, the wall can become thinner and then the toxins break into the blood, poisoning the body.

Lymphocytes- these are the smallest cells immune system, they make up 20 to 35% of all white cells. The life of lymphocytes begins in the bone marrow and thymus gland, and the main places of their work are the lymph nodes, spleen, intestines, lungs, etc. Arteries and veins serve mainly only for the transport of these cells.
Two types of lymphocytes are distinguished in the blood: 70% of all lymphocytes are trained in the thymus and therefore are called thymus-dependent (T-lymphocytes), while the rest of the lymphocytes mature in the bone marrow itself and are called B-lymphocytes. After entering the bloodstream, their paths diverge. For T cells, as for other white blood cells, blood is just a way station. From the blood, they move to the lymphoid organs, where they complete their studies and begin phagocytosis of foreign particles, as well as diseased and tumor cells that occur hourly in the tissues and organs of our body. Such lymphocytes are called killers, that is, killers. In addition to killer T-lymphocytes, there are helper lymphocytes that help in the immune response to B-lymphocytes and T-lymphocytes - suppressors that can suppress immune responses.

B-lymphocytes make up a smaller part, only 20 - 30% of all blood lymphocytes. They can be identified by special

outgrowths on the surface - immunoglobulins. Circulating through the blood, they are only carriers of immunological memory, which contain many variants of various antibodies. When a specific antigen enters the body, they begin to multiply intensively, mature and turn into plasma cells, which just sit at the sites of penetration of the antigen and synthesize antibodies. The process of formation of antibodies is strictly specific and persists most often for life. For example, having been ill with childhood diseases (chickenpox, whooping cough, measles), we are no longer susceptible to them. This is the importance of vaccinations, when a child is given vaccines - weakened or killed pathogens. After 3-4 weeks, a sufficient titer of antibodies accumulates in the blood to neutralize a foreign agent, for example, during household contact with patients.

Immunity, in which antibodies are dissolved in the blood and are in constant readiness to attack against their antigen, is called humoral ("humor" - liquid) immunity. Cellular immunity is a reaction associated with phagocytosis.

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Vascularization. The bone marrow is supplied with blood through vessels that penetrate through the periosteum into special openings in the compact substance of the bone. Entering the bone marrow, the arteries branch into ascending and descending branches, from which the arterioles radiate. First, they pass into narrow capillaries (2-4 microns), and then in the endosteum area they continue into wide thin-walled sinuses with slit-like pores (diameter 10-14 microns). Blood is collected from the sinuses into the central venule. The constant gaping of the sinuses and the presence of gaps in the endothelial layer are due to the fact that the hydrostatic pressure in the sinuses is slightly increased, since the diameter of the efferent vein is smaller compared to the diameter of the artery. Adventitia cells adjoin the basement membrane from the outside, which, however, do not form a continuous layer, which creates favorable conditions for the migration of bone marrow cells into the blood. A smaller part of the blood passes from the side of the periosteum into the channels of the osteons, and then into the endosteum and sinus. As it comes into contact with bone tissue, the blood is enriched with mineral salts and hematopoietic regulators.

Blood vessels make up half (50%) of the mass of the bone marrow, of which 30% are in the sinuses. In the bone marrow of different human bones, the arteries have a thick middle and adventitious membranes, numerous thin-walled veins, and the arteries and veins rarely go together, more often apart. capillaries There are two types: narrow 6-20 microns and wide sinusoidal (or sinuses) with a diameter of 200-500 microns. Narrow capillaries perform a trophic function, wide capillaries are the place for the maturation of erythrocytes and the release of various blood cells into the bloodstream. The capillaries are lined with endotheliocytes lying on a discontinuous basement membrane.

innervation. The nerves of the vascular plexuses, the nerves of the muscles and special nerve conductors to the bone marrow participate in the innervation. Nerves enter the bone marrow along with blood vessels through the bone canals. Then they leave them and continue as independent branches in the parenchyma within the cells of the cancellous bone. They branch into thin fibers, which either come into contact with the bone marrow vessels again and end on their walls, or end freely among the cells of the bone marrow.

Age changes. Red bone marrow in childhood fills the epiphyses and diaphyses of tubular bones and is located in the spongy substance of flat bones. At about 12-18 years of age, the red bone marrow in the diaphysis is replaced by yellow. In old age, the bone marrow (yellow and red) acquires a mucous consistency and is then called gelatinous bone marrow. It should be noted that this type of bone marrow can also occur at an earlier age, for example, during the development of the bones of the skull and face.

Regeneration. Red bone marrow has a high physiological and reparative regenerative capacity. The source of formation of hematopoietic cells are stem cells, which are in close interaction with the reticular stromal tissue. The rate of bone marrow regeneration is largely related to the microenvironment and special growth-stimulating factors of hematopoiesis.