Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 2016 ESPO Congress Immunomodulatory effect of Polypodium leucotomos (Anapsos) in child palatine tonsil model Carolina Sánchez-Rodríguez a,* , Keyliz R. Peraza Cruces b , Laura Rodrigáñez Riesco c , José Antonio García-Vela d , Ricardo Sanz-Fernández e a European University of Madrid, Calle del Tajo S/N 28670 Villaviciosa de Odón, Madrid, Spain b Department of Biochemistry, University Hospital of Getafe, Carretera de Toledo, km 12, 5, 28905, Getafe, Madrid, Spain c Department of Otolaryngology, University Hospital of La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain d Department of Hematology, University Hospital of Getafe, Carretera de Toledo, km 12, 5, 28905, Getafe, Madrid, Spain e Department of Otolaryngology, University Hospital of Getafe, Carretera de Toledo, km 12, 5, 28905, Getafe, Madrid, Spain ARTICLE INFO Keywords: Polypodium leucotomos, Anapsos Child palatine tonsil Cytokines Immune cells Immunoglobulins ABSTRACT Background: Recurrent tonsillitis might reduce the immunological capability of fighting against the infection of tonsil tissue. Polypodium leucotomos (Anapsos) immunomodulating effect has been subject of research in the last years. The aim of this research is to test the in vitro immunomodulating capacity of Anapsos in a child palatine tonsil explants model. Methods: Palatine tonsils explants of children undergoing amigdalectomy were stimulated with mononuclear cells obtained from their own blood by density gradient centrifugation. Some were then treated with Anapsos while others rest untreated. Cytokines were measured by ELISA, immune cells activation was measured by flow cytometry and activation of immunoglobulins was appreciated by indirect immunofluorescence in tonsils tissue. Results: Anapsos activates Natural Killers cells. It increases IL-2 and IFN-γ levels by the activation of Th2 lym- phocytes, and IL-10, by the Th1 lymphocytes. Anapsos also increases immunoglobulins IgM, IgD and IgG4 by B- lymphocyte activation in tonsils tissue. Conclusion: Anapsos has an immunomodulating effect, both in humoral and cellular responses, which might benefit children suffering of recurrent tonsillitis as it could enhance their immune system. This effect might reduce the number of episodes suffered and therefore the number of children undergoing surgery. 1. Introduction Infectious tonsillitis is common cause for consulting the otorhino- laryngologist in the pediatric population [1,2]. Recurrent tonsillitis episodes may be due to antibiotic resistances or a lack of infection eradication, which might reduce the immunological capability of fighting against the infection of tonsil tissue [1,2]. This process usually ends with the surgical removal of the palatine tonsils of Waldeyer's ring with the consequent decrease of quality and quantity of the local host response to infection as they content a cluster of B and T cells, inter- digitating cells (IDC), macrophages, antibody-forming cells (AFC) and follicular dendritic cells (FDC) [2]. One major function of cytokines produced by T cells in lymphoid tissues is to provide necessary signals for activation, proliferation and differentiation of B cells that have been exposed to antigens [3]. The fern Polypodium leucotomos grows in the rainforest of Central and South America. Early studies showed evidence of antitumor effects [4–6]. Sub- sequent studies demonstrated that it has antioxidant, anti-in- flammatory, and photoprotective properties: inhibit oxidative stress, lipid peroxidation, dermal mast cell infiltration, inflammatory cyto- kines, DNA damage and UV skin damage [7–9]. In vitro and in vivo studies performed with a phytoextract called Anapsos, obtained from the rhizomes of this fern, have already shown changes in certain im- mune cell subsets and cytokines [4,10–12]. It has been the subject of research in the last years, in order to analyse its possible im- munomodulating effect [6,13] and its application in some autoimmune diseases [14–16]. Anapsos oral administration increases suppression rate, lymphoblast response to mitogens, serum immunoglobulin levels, and the proportion of CD8 + cells (cytotoxic/suppressor) [17]. Only minor side effects have been reported, such as abdominal pain. Therefore it modulates IL-1β, https://doi.org/10.1016/j.ijporl.2018.01.030 Received 18 December 2017; Received in revised form 23 January 2018; Accepted 23 January 2018 * Corresponding author. E-mail addresses: carolina.sanchez2@universidadeuropea.es (C. Sánchez-Rodríguez), keylizmd@gmail.com (K.R. Peraza Cruces), laurarodriganez@gmail.com (L. Rodrigáñez Riesco), jgarciav@salud.madrid.org (J.A. García-Vela), rsanzf@salud.madrid.org, ricardosanz.orl@gmail.com (R. Sanz-Fernández). International Journal of Pediatric Otorhinolaryngology 107 (2018) 56–61 Available online 31 January 2018 0165-5876/ © 2018 Elsevier B.V. All rights reserved. T