When an infection occurs in a tissue such as the skin, free antigen and antigen-bearing dendritic cells travel from the site of infection through the afferent lymphatic vessels into the draining lymph nodes (Fig. 1.21)—peripheral lymphoid tissues where they activate antigen-specific lymphocytes. The activated lymphocytes then undergo a period of proliferation and differentiation, after which most leave the lymph nodes as effector cells via the efferent lymphatic vessel. This eventually returns them to the bloodstream (see Fig. 1.18), which then carries them to the tissues where they will act. This whole process takes about 4–6 days from the time that the antigen is recognized, which means that an adaptive immune response to an antigen that has not been encountered before does not become effective until about a week after infection (see Fig. 1.7). Naive lymphocytes that do not recognize their antigen also leave through the efferent lymphatic vessel and are returned to the blood, from which they continue to recirculate through lymphoid tissues until they recognize antigen or die.
The lymph nodes are highly organized lymphoid organs located at the points of convergence of vessels of the lymphatic system, which is the extensive system that collects extracellular fluid from the tissues and returns it to the blood (see Fig. 1.18). This extracellular fluid is produced continuously by filtration from the blood and is called lymph. Lymph flows away from the peripheral tissues under the pressure exerted by its continuous production, and is carried by lymphatic vessels, or lymphatics. One-way valves in the lymphatic vessels prevent a reverse flow, and the movements of one part of the body in relation to another are important in driving the lymph along.
As noted above, afferent lymphatic vessels drain fluid from the tissues and carry pathogens and antigen-bearing cells from infected tissues to the lymph nodes (Fig. 1.22). Free antigens simply diffuse through the extracellular fluid to the lymph node, while the dendritic cells actively migrate into the lymph node, attracted by chemokines. The same chemokines also attract lymphocytes from the blood, and these enter lymph nodes by squeezing through the walls of specialized blood vessels called high endothelial venules (HEV), named for their thicker, more rounded appearance relative to flatter endothelial cells in other locations. In the lymph nodes, B lymphocytes are localized in follicles, which make up the outer cortex of the lymph node, with T cells more
Fig. 1.21 Circulating lymphocytes encounter antigen in peripheral lymphoid organs.
Lymphocytes and lymph return to blood via the thoracic duct Naive lymphocytes enter lymph nodes from blood infected peripheral tissue lymph node heart Antigens from sites of infection reach lymph nodes via lymphatics