The intestinal immune system has generated two arms of adaptive anti-inflammatory defense which normally preserve the epithelial barrier: (i) immune exclusion performed by secretory IgA (SIgA) (and SIgM) antibodies to control surface colonization of micro-organisms and dampen penetration of potentially harmful antigens; and (ii) suppressive mechanisms to avoid hypersensitivity to innocuous antigens, particularly food proteins and the commensal microbiota. The latter phenomenon (‘oral tolerance’) largely depends on regulatory T (Treg) cells induced in mesenteric lymph nodes to which mucosal dendritic cells carry exogenous antigens and become conditioned for stimulation of Treg cells. Polymeric Ig receptor (pIgR/SC) knock-out mice that lack SIgA and SIgM show decreased epithelial barrier function and increased uptake of antigens from food and commensal bacteria. They therefore have a hyper-reactive immune system which is counteracted by enhanced intestinal tolerance induction as a homeostatic back-up mechanism.
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This practical guide thoroughly discusses both well-established and new interventions that are applied to the spine for the purpose of pain relief.
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