Thoracic Manifestations of Rheumatoid Arthritis

Your Nose Has Its Own Army Of Immune Cells — Here's How It Protects You

The nose knows: immune cells in the nasal passageways stand ready to produce antibodies against incoming pathogens.Credit: Getty

The nose is home to a host of long-lived immune cells that stand ready to fend off viral and bacterial infections, according to the most detailed look yet at the immune players that make up the first line of defence for the lungs1.

The findings, published on 31 July in Nature, show that the nose and upper airway — which includes the mouth, sinuses and throat but not the windpipe — serve as key training grounds where immune cells 'memorize' intruding pathogens. These memories allow the cells to defend against future attacks by similar microorganisms. The data could speed up development of mucosal vaccines, administered through the nose or throat, which immunologists say could be more effective than vaccines injected into muscles.

This "exciting study" shows that an "arsenal of immune cells capable of fighting off respiratory infections" can be reliably detected in the upper airways of both young adults and older people, who typically have weaker immune responses, says Linda Wakim, an immunologist at the University of Melbourne in Australia who was not involved with the research.

On the nose

Previous research on the immune system has focused on immune cells in the blood and lower airways, primarily because these regions are relatively accessible through blood draws and some types of biopsy and organ donation, says study co-author Sydney Ramirez, an infectious-disease physician and immunologist at the La Jolla Institute for Immunology in California.

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Then came the COVID-19 pandemic and the emergence of variants, such as Omicron, that proliferate with high efficiency in the upper airway. These developments prompted Ramirez and her colleagues to find ways to sample and better understand how immune cells in the upper airways interact with pathogens and develop immune memory.

The team turned to nasopharyngeal swabs, which can reach the back of the nose and were widely used in high-income countries for SARS-CoV-2 tests. The researchers swabbed about 30 healthy adults every month for more than one year to see how their immune-cell populations changed over time. They found millions of immune cells in these samples, including cells that provide immune memory.

Nasal defence force

The researchers also learnt that they could swab hard-to-reach immune organs called the adenoids, which are tucked away at the back of the nose. These organs analyse inhaled air and contain structures called germinal centres. These structures, which are also found in other immune tissues, act as training camps where the immune agents called B cells learn to make effective antibodies.

Adenoids shrink in adulthood, yet the researchers found active germinal centres in the adenoids of study participants of all ages — findings that should be "reassuring for all of us over 20 years old", Ramirez says. The researchers also inadvertently found evidence of these germinal centres' effectiveness: several participants contracted COVID-19 during the study, and the researchers found that these participants' noses hosted B cells that specialize in targeting SARS-CoV-2.

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Germinal centres are typically active only during and shortly after acute infection or immunization, yet the authors found active germinal centres even when participants didn't report feeling sick. Using this new swabbing technique, researchers might soon understand what's driving the centres' activity and how SARS-CoV-2 infection shapes these immune responses, says Donna Farber, an immunologist at Columbia University in New York City, who was not involved with the study.

These findings can also offer a "very valuable" quantitative method to measure the changes in immune response after vaccination, particularly to test intranasal vaccine candidates, Farber says. But she adds that they also show how high a hill there is to climb: if the immune system is constantly active in the upper airways, pre-existing antibodies might block the protective effects of intranasal vaccines.

What's Going Around: Infections, Flu, Scarlet Fever, Stomach Viruses

Here's our weekly round-up of what illnesses are spreading the most in Metro Detroit communities, according to our local doctors and hospitals.

WAYNE COUNTY – COVID, outdoor injuries, upper respiratory viruses, sinus infections, seasonal allergies, scarlet fever.

Dr. Tiffney Widner -- Children's Hospital of Michigan Pediatrician

"We're seeing viral upper respiratory issues and sinus infections, seasonal allergies and we're seeing a few cases of scarlet fever. Usually what happens with scarlet fever is they will complain of a sore throat and then they get an all-over rash. After the rash goes away, they get peeling of the skin. So if parents are noticing peeling, especially of the hands or feet, they should come in. When we don't catch or treat strep throat, it can progress to scarlet fever. Untreated strep infections can affect your kidneys, and we want to make sure they're ok. So if your child is complaining of a bad sore throat, they should be seen by their pediatrician."

Dr. Jennifer Stephens-Hoyer -- Emergency Department, Henry Ford Medical Center Plymouth

"We have been seeing a spike in COVID infections. Most are mild, though patients still feel unwell. Right now, those who are up in age have been more likely to require hospitalization."

Dr. Zafar Shamoon -- Emergency Chief, Corewell Health Dearborn Hospital

"We are experiencing an upswing in COVID but conditions are not terribly severe. Other than that, we're seeing typical summer falls and trauma injuries from car accidents."

OAKLAND COUNTY – COVID, sports injuries, croup, stomach viruses.

Dr. Matthew Compton -- DMC Huron Valley-Sinai Hospital Chief of Emergency Medicine

"We're in the mid-summer – people are conscious about being safe around the water and they're not coming in with heat exhaustion as often. That's certainly something we're concerned about with the hot weather now and over the next couple of days. Another thing people need to be mindful of is drinking while enjoying summertime endeavors, like a campfire or while boating. That can get very dangerous very quickly. We are seeing some cases of COVID coming in, but we haven't really seen an uptick. It's floating around and we have had hospitalizations related to it."

Dr. David Donaldson -- Emergency Chief, Corewell Health Beaumont Troy Hospital

"There have been quite a few COVID cases lately causing GI symptoms, including diarrhea, nausea, abdominal pain, and vomiting. We've also seen several extremity sports injuries."

Emergency Department, Henry Ford West Bloomfield Hospital

"We are seeing a lot of patients with abdominal pain, chest pain, and respiratory issues."

WASHTENAW COUNTY – COVID, upper respiratory infections, influenza, asthma & COPD flare-ups.

Dr. Brad Uren -- Clinical Associate Professor of Emergency Medicine, Michigan Medicine

"Still seeing rising numbers of COVID cases. Some have required admission but not to ICU. Some other flu and COVID negative URIs are also common. Some asthma and COPD exacerbations from URIs and also weather changes this week as well."

MONROE COUNTY – Heat exhaustion, influenza, abdominal pain.

Emergency Center, ProMedica Monroe Regional Hospital

"With the Monroe County Fair this week, ProMedica Monroe Regional Hospital – Emergency Center is seeing an increase in heat exhaustion. We are also seeing several patients coming in with abdominal pain, chest pain and influenza A."

MACOMB COUNTY – COVID, poison ivy, sunburn, seasonal allergies, outdoor injuries, stomach viruses.

Dr. Steven Yester -- Emergency Physician at McLaren Macomb

"There has been a noticeable, though slight, increase in the number of patients testing positive for COVID-19, with patients experiencing mild symptoms. Allergy sufferers have been experiencing symptoms mirroring upper respiratory infections caused by seasonal allergies. The trend of viral gastroenteritis from the past several weeks has shown signs of tapering off. Orthopedic injuries and, to a lesser extent, soft tissue injuries continue to be the most common reason patients are seeking care in the emergency department."

Dr. Maria Samuel -- Primary Care Physician, Henry Ford Medical Center Sterling Heights

"Patients are coming in with sunburn, poison ivy rash and COVID."

LIVINGSTON COUNTY -- did not report this week.

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Enhancing Respiratory Health Amidst Monsoon Through Ayurveda

The prevailing concerns of Keralites during every monsoon season are ailments related to the immune system, particularly respiratory health. The cold and humid environment of the monsoon creates favourable conditions for respiratory infections and aggravates conditions like asthma. The state experiences high humidity during the monsoon, which becomes a breeding ground for molds and micro-pathogens. Moreover, with low levels of ventilation, indoor pollution accumulates allergens, leading to shortness of breath and worsening respiratory health, which results in allergies, asthma, and bronchitis. 

Common Respiratory Illnesses During the Monsoon

●       Asthma: A lung disease caused by the inflammation of the airways. The presence of increased and active allergens or micro-pathogens during the monsoon causes inflammation with increased mucus, leading to shortness of breath, wheezing, and chest tightness.

●       Allergic Rhinitis: A condition of inflammation inside the nose caused by allergens present in the atmosphere. Allergies are common and increase during this season, with symptoms like sneezing, a runny or stuffy nose, and coughing.

●       Upper Respiratory Tract Infections are usually viral infections that cause inflammation in the nose, throat, and upper airways. These infections are commonly known as colds or flu, with symptoms like fever, cough, sore throat, and fatigue.

●       Bronchitis often develops during the monsoon season, presenting symptoms such as airway swelling, cough, and phlegm accumulation.

●       Pneumonia: An infection in the lungs caused by bacteria, viruses, or fungi. Pneumonia can result from negligence and lack of timely medical attention, especially in children and the elderly. 

The perfect way to address these respiratory concerns during the monsoon is to boost the immune system. It is necessary to prepare your body to fight against these infections. Ayurveda's long heritage prioritizes treating the underlying cause of the illness. Its tradition focuses on holistic methods to boost immunity, proposing natural remedies for these ailments. Traditional knowledge on cure must be applied scientifically to cater to modern times and prepare effective concoctions for respiratory ailments. 

The medicines for treating respiratory ailments should have the following five properties:

Anti-inflammatory properties to reduce inflammation hindering the airways.

Expectorant effects to expel mucus and clear the airways.

Bronchodilation action to widen the airways for conditions like asthma.

Antioxidant support to combat oxidative stress in the respiratory system.

Immune-modulating effects to stimulate the immune system and maintain respiratory health. 

For the treatment of asthma, Ayurveda emphasizes using herbs with nourishing and alleviative properties to rejuvenate lung tissues. These herbs protect the lungs while permanently eliminating asthma and allergies. Ayurvedic herbs such as ashwagandha, gooseberry, dry ginger, black pepper, long pepper, and adulsa are known for their anti-inflammatory, antimicrobial, and expectorant properties. They help to permanently reduce inflammation in the lung tissues, promote easy breathing by clearing the airways, removing constriction in the lungs, and loosening phlegm. Immunomodulation through continuous medication can eliminate lung diseases like asthma. 

If children with allergic bronchitis, showing symptoms like cough, sneezing, runny nose, phlegm, and suffocation, are treated with Ayurvedic medicine from the very beginning, they can permanently avoid the risk of asthma in the future. 

In addition to medication, regular exercise should be included to stimulate cellular immunity and increase blood circulation. One should maintain personal hygiene by covering sneezes and coughs, washing hands frequently to prevent the spread of infection, practicing breathing exercise like Pranayama to increase lung capacity, consuming warm and nutritious food rich in vitamins and keeping the body sufficiently hydrated. These practices are also crucial for supporting immune function and overall respiratory health. 

About author - Dr. J. Hareendran Nair, Founder & Managing Director -Pankajakasthuri Herbals India

This article is part of a featured content programme.

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