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Immunology and Infection

Isolation of Tonsillar Mononuclear Cells to Study Ex Vivo Innate Immune Responses in a Human Mucosal Lymphoid Tissue

Published: June 14, 2020 doi: 10.3791/60914
* These authors contributed equally


In the present protocol, we explain how to easily process and culture tonsillar mononuclear cells from healthy humans undergoing partial surgical tonsillectomy to study innate immune responses upon activation, mimicking viral infection in mucosal tissues.


Studying isolated cells from mucosa-associated lymphoid tissues (MALT) allows understanding of immune cells response in pathologies involving mucosal immunity, because they can model host-pathogen interactions in the tissue. While isolated cells derived from tissues were the first cell culture model, their use has been neglected because tissue can be hard to obtain. In the present protocol, we explain how to easily process and culture tonsillar mononuclear cells (TMCs) from healthy human tonsils to study innate immune responses upon activation, mimicking viral infection in mucosal tissues. Isolation of TMCs from the tonsils is quick, because the tonsils barely have any epithelium and yield up to billions of all major immune cell types. This method allows detection of cytokine production using several techniques, including immunoassays, qPCR, microscopy, flow cytometry, etc., similar to the use of peripheral mononuclear cells (PBMCs) from blood. Furthermore, TMCs show a higher sensitivity to drug testing than PBMCs, which needs to be considered for future toxicity assays. Thus, ex vivo TMCs cultures are an easy and accessible mucosal model.


Studies on human organs are restricted due to accessibility as well as obvious ethical reasons. However, they are essential to fully understand the complexity of human biology. Cultures of isolated cells (primary cultures or cell lines) are a standard system in cell biology studies due to their availability. While isolated cell cultures have allowed outstanding discoveries, the use of cell lines has come upon closer scrutiny because they do not fully mimic in vivo organ biology. However, the culture of three-dimensional cells or tissue explants is highly complex4,5,6. Indeed, a piece of tissue or organ is highly heterogenous because its cell composition differs depending on the localization in the tissue. Thus, using tissue blocks requires the analysis of many technical and biological replicates, leading to the need of a large number of donors or patients.

The mucosa-associated lymphoid tissues (MALT) are structurally similar to the lymph nodes but have unique functions, because their main role is to regulate mucosal immunity7. Unlike the lymph nodes, which are usually located at some distance from the tissues, MALT are generally located immediately below the epithelium of the mucosal tissue. Histologically, they are mainly composed of high concentrations of B and T cells, but also antigen-presenting cells such as macrophages and dendritic cells. MALT constitute about 50% of the lymphoid tissue in the human body. MALT are subdivided into nine groups depending on their location: GALT (gut-), BALT (bronchus-), NALT (nasal-), CALT (conjunctival), LALT (larynx-), SALT (skin-), VALT (vulvo-), O-MALT (organized), and D-MALT (diffused). The O-MALT is mainly composed of the tonsils of Waldeyer's tonsillar ring and is the most accessible MALT8,9. Indeed, tonsils located in the oropharynx constitute the major barrier protecting the digestive and respiratory tracts from (potential) invasive microorganisms10. In addition, the tonsils are covered by a fine stratified squamous non-keratinizing epithelium, supported by a capsule of connective tissue containing blood vessels, nerves, and lymphatics, providing easy access to the immune cells11,12. Furthermore, tonsillectomy, the surgical act of removing tonsils, is a common procedure performed on children having sleep-disordered breathing, making tonsils an easily available tissue13 in physiological settings.

Tonsils allow the study of immune cell response in pathologies involving mucosal immunity. Indeed, in HIV infection, because tonsils are composed of a high concentration of immune cells, they are the main target of viral replication but also produce a large amount of cytokines that are not detected in the circulation14,15. At steady states, rare populations of innate-like cells are present in various mucosal tissues, including the tonsils, but are essentially absent from blood.

Thus, mononuclear cells from tonsils (TMCs) are a more relevant and complex model than PBMCs and can answer more profound questions. On the other hand, the use of tissue explants can be complex and not always relevant to innate immune studies. Thus, we established a model to study mucosal immune activation using TMCs16. Here, we describe a method for efficient isolation of TMCs from fresh human tonsils. This method allows the recovery of a large number of immune cells while keeping their integrity for ex vivo studies.

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The specimens are not collected specifically for research purposes and the study is not considered invasive. However, human tonsils collection requires ethical approval by the local relevant authorities. In our case, it was approved by the Comité de Protection des Personnes (IDRCB/EUDRACT: 2018A0135847). Furthermore, consent of each patient or legal representative is requested to obtain donors' personal data (e.g., sex, age, history of ENT infections) that can help interpret experimental results.

1. Handling of the Human Tonsillar Tissue

  1. Put tonsils from every donor in one sterile 50 mL vial containing 25 mL PBS 1x and transport at room temperature (RT) to the laboratory according to the authority's recommendations (use three levels of protection: vials, a safety box, and a bag).
    NOTE: The entire procedure should be carried out in a biological safety level 2 laboratory. All human specimens should be handled with care as they have not been previously qualified and may contain infectious agents.
  2. Clean all tools in between each use.
    1. After use, disassemble the cell strainer and keep with all the other instruments (e.g., pestle, forceps) in a bath containing a detergent solution (1/10 volume detergent in H2O) overnight.
    2. Brush each utensil to remove the tissue and wash with clear water.
    3. Dry all parts well, then prepare the cell strainer (85 mL, 37 mm diameter) by placing a 60 mesh steel grid on top of a 10 mesh steel grid and tightly close the ring.
    4. Place all the tools in sterile bags and autoclave.

2. Dissection of the Human Tonsillar Tissue and Isolation of the Tonsillar Mononuclear Cells (TMCs)

  1. Place the cell strainer onto one 150 x 25 mm2 (SPL150) cell culture dish and all the instruments in another SPL150 to keep them sterile.
  2. Transfer the tonsils from the vial into the cell strainer using sterile forceps. Also pour in all of the PBS, which contains some cells that have egressed the tonsils. If necessary, add more PBS to immerse the grid.
    NOTE: The tissue should be immersed at all times to avoid desiccation.
  3. Remove cauterized, bloody, and fibroid tissue using forceps and a scalpel.
    NOTE: Tonsils removed from children do not need this step.
  4. Cut the tissues into small pieces of less than 0.5 cm in diameter using the scalpel and the curved tweezers. Cut all the tissue so that the small pieces can be immersed at all times.
  5. Place a few pieces of tissue in the cell strainer and scrape them onto the grid with a glass pestle until only a really thin layer of white stroma remains. Remove and discard the stroma to avoid clogging the grid.
  6. Once all the tissues have been squeezed through the grid, use a 10 mL pipette to transfer all the cell suspension onto the grid and scrape it one last time.
  7. Transfer the cell suspension with a 10 mL pipette into a sterile vial. Wash the grid and the cell strainer with PBS 1x. Let the cell suspension rest for 5 min at RT on the bench. This step allows the precipitation and agglomeration of the leftover stroma, dead cells, and any released DNA, and will facilitate the next step.
  8. Place a sterile 70 µm sieve on top of a new 50 mL vial (remove carefully from the envelope) and gently transfer the cell suspension onto it with a 10 mL pipette. Do not mix the suspension, because a pellet is frequently present. If the sieve is clogged, use the back of a sterile 1 mL pipette tip to scratch the cells trough the sieve. Change the sieve as often as necessary.
  9. Centrifuge the cells at 250 x g for 10 min at 4 °C.
  10. Discard the supernatant and resuspend the pellet by gently mixing the vial, then resuspend the cells in 35 mL of PBS.
  11. In a new vial, place a new 70 µm sieve on top and transfer the cell suspension onto it with a 10 mL pipette. If the sieve is clogged, use the technique detailed in step 2.7.

3. Isolation of the TMCs by Cell Density Gradient

NOTE: The TMCs can be used after step 2.10. However, to obtain a clearer cell solution and to remove other cell debris and any red cells, it is advised to perform a cell density gradient isolation of the mononuclear cells.

  1. Add 15 mL of the density gradient medium (d = 1.076 g/mL) in a new 50 mL vial. Pour the TMCs solution on top of the density gradient medium, being careful to minimize mixing of the suspension with the density gradient medium.
  2. Centrifuge the solution at 1,000 x g for 30 min at RT with acceleration and break off.
  3. Remove with a 10 mL pipette and discard the upper layer (containing mostly PBS 1x) without disturbing the interface between the TMCs and the density gradient medium.
    NOTE: The TMCs contains a low number of erythrocytes, therefore the solution is clear. Thus, the interface between the solution of TMCs in PBS and the density gradient medium can be difficult to visualize. Accordingly, cells can be resuspended in RPMI 1640 supplemented with 20 mM HEPES (without FBS) before the density gradient is performed.
  4. Remove the TMCs with a sterile 1 mL pipette tip and place in a new 50 mL vial.
  5. Wash the cells by adding 50 mL of PBS containing 2% of fetal bovine serum (FBS) and 2 mM EDTA and centrifuge the tube at 250 x g for 10 min at 4 °C to remove the remaining platelets.
  6. Repeat step 3.5, but centrifuge the tube at 400 x g for 10 min at 4 °C.
  7. Prepare culture medium (R10) by supplementing RPMI 1640 with 10% heat inactivated FBS, 2 mM L-glutamine, and the antibiotic solution (100 U/mL penicillium and 100 µg/mL streptomycin).
  8. Resuspend the TMCs in 10 mL of R10 and count the cells. On average, this technique yields 5 x 108-2 x 109 TMCs per pair of tonsils. The cells can now be used for investigations like PBMCs from whole blood (e.g., purification of specific cell type, cell culture, flow cytometry, RT-qPCR, freezing, etc.).
  9. If needed, freeze the cells for further use using standard techniques for primary cell freezing.
    1. Count the number of cells.
    2. Centrifuge the cells and remove the supernatant. Dissolve the pellet in enough 100% FBS for a final concentration of 1 x 108 cells/mL, then add the same volume of an 80% FBS + 20% DMSO solution. The cells will then be at 5 x 107 cells/mL. This step should be done at 4 °C and the FBS and DMSO solution should be kept at 4 °C before using.
    3. Distribute 1 mL of the cell solution into cryotubes and put them in a slow freezing container that has been at 4 °C overnight to control the rate of cell freezing. Place it at -80 °C.
    4. To thaw the cells, place the cryovials in a warm bath at 37 °C for a few seconds with constant agitation. As soon as the cells start to thaw, transfer them to 49 mL of R10 and centrifuge to remove the DMSO. Count the cells and use them as PBMCs.
      NOTE: Although freezing and thawing the TMCs will remove debris, it will also damage some rare cell types. If clumps or debris are present after thawing, it is best to pass the cell suspension through a sterile 70 µm sieve before using it.

4. Phenotyping of TMCs by Flow Cytometry

  1. Retrieve 5 x 106 cells from the previous solution for each antibody mixture panel that needs to be tested and place in a 5 mL cytometry tube. Retrieve 1 x 106 cells for the unstained control.
  2. Wash the cells in PBS and centrifuge at 400 x g for 5 min at 4 °C. Resuspend them in 500 µL of PBS (1 x 106 cells/mL) and incubate with a viability stain for 30 min at 4 °C in the dark.
  3. Add 5 µL heat inactivated human AB serum per 100 µL of cell suspension and incubate for 15 min at 4 °C in the dark.
  4. Wash the cells in PBS + 2% FBS + 2 mM EDTA (Wash Buffer) and centrifuge at 400 x g for 5 min at 4 °C.
  5. Resuspend the TMCs in 500 µL of Wash Buffer containing the antibodies as detailed in Table 1. Incubate the cells for 30 min at 4 °C in the dark.
  6. Wash the cells in Wash Buffer and centrifuge at 400 x g for 5 min at 4 °C. Resuspend the TMCs in 500 µL of PBS containing 0.5% of paraformaldehyde (PFA). Keep in the dark at 4 °C until acquisition by flow cytometry.
    NOTE: PFA is hazardous. Use a commercial ready-to-use solution to prepare the 0.5% PFA solution.
Antibody Clone Fluorochrome Company
Live-Dead BV405 ThermoFisher Scientific
CD3 SP34-2 V500 BD Pharmingen
CD8 SK1 Amcyan BD Pharmingen
CD8 BW135/80 VioBlue Miltenyi Biotec
CD4 RPA-T4 PE-Cy7 BD Pharmingen
CD45 HI30 PerCP-cy5.5 BD
CD19 HD237 ECD Beckman Coulter
CD20 2H7 Alexa Fluor 700 BD Pharmingen
CD14 M5E2 PE-cy7 BD Pharmingen
CD14 M5E2 APC BD Pharmingen
CD16 3G8 APC-H7 BD Pharmingen
CD56 MEM188 PE BD Pharmingen
CD123 7G3 PE BD Pharmingen
BDCA-1 L161 Pacific Blue BD Pharmingen
BDCA-3 AD5-14H12 FITC Miltenyi Biotec
BDCA-4 AD5-17F6 APC Miltenyi Biotec
HLA-DR G646-6 PerCP-cy5.5 BD Pharmingen
CD11c 3.9 Alexa Fluor 700 ebiosciences

Table 1: List of antibodies for cell characterization by flow cytometry.

5. Example of Activation of TMCs and Measurement of Cytokine Production

  1. Dilute the TMCs in R10 medium to get a concentration of 2 x 106 cells/mL.
  2. Distribute 400,000 TMCs in 200 µL of R10 in a 96 well round bottom plate.
  3. To activate the cells, add 5 µg/mL of the TLR7/8 agonist resiquimod (R848) overnight.
  4. Centrifuge the plates and retrieve the TMCs' supernatant and freeze it for further analysis. Cytokine production will be assessed using bead-based immunoassays to quantify multiple soluble cytokines simultaneously using a flow cytometer following the manufacturer's protocol.
  5. Assess the viability of the cells using a luminescent cell viability assay following the manufacturer's protocol. Briefly, add 60 µL of cell viability solution to the wells and measure luminescence within 10 min (acquisition for 1 s/well).

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Representative Results

We first characterized the immune profile of cells present in the culture and analyzed the amount of TMCs. We phenotyped the TMCs from tonsils with flow cytometry. As shown in Figure 1, all major immune cell types present in PBMCs from blood were represent in the TMCs from tonsils. However, in TMCs the frequency of all cell types, except B cells, were lower than in PBMCs.

Figure 1
Figure 1: Phenotyping of TMCs in tonsils. TMCs from healthy donors were obtained after dissection of human tonsillar tissue and isolation of cells. (A) Cells were stained, and data were acquired by flow cytometry. Data represent a representative experiment. (B) The table summarizes the percentage of each cell type in live TMCs in tonsils from six different healthy donors and compares each to the percentage of each cell type in PBMCs from blood, as defined in the literature18,19. Data are shown as the percentage of live cells SD. Please click here to view a larger version of this figure.

We then tested the immunological responses of the TMCs. One way to reproduce a cell's activation against a pathogen is to stimulate the innate immune sensors from the Toll-Like Receptors (TLRs) family. TLRs are mainly present in monocytes/macrophages, all dendritic cell (DC) subtypes, plasmacytoid dendritic cells (pDCs), and also in B cells. In this example, we studied TLR7 and TLR8, because they specialize in antiviral responses and most cases of tonsillitis (i.e., tonsil infections) are caused by a viral infection. Thus, TMCs from tonsils (graph in blue) from seven healthy donors were stimulated overnight with the TLR7/8 ligand resiquimod (R848). As in PBMCs (graph in green), activation through TLR7/8 signaling triggered production of type I interferons (IFN) and pro-inflammatory cytokines. In fact, the cytokine most highly produced in TMCs upon activation was IFNα, a member of the type I IFN family that is mainly involved in innate immunity against viral infection and is mostly produced by the pDCs. All cytokines tested, except IFN2/3 and IL-8, were produced by TMCs, although at lower levels than in PBMCs. Interestingly, some cytokines (mainly IL-8, but also IL-6, IL-10, and TNFα) were present in larger amount at basal levels. Furthermore, we compared the cytokine produced by isolated TMCs or by tonsillar tissue blocs prepared as described previously6. We measured all types of IFN produced in the supernatant of both cell cultures using the STING-37 cell line reporter assay as described previously17 and showed that we could only measure IFN levels in the isolated TMCs.

Figure 2
Figure 2: TMCs produced cytokines upon stimulation. (A) Purified and isolated TMCs (blue) and PBMCs (green) were stimulated overnight with R848 (5 µg/mL). Supernatants were retrieved and frozen until use. A bead-based immunoassay was performed to quantify multiple soluble cytokines simultaneously using a flow cytometer. The graphs represent the concentration in picograms per milliliter of each measured cytokine. The fold increases are annotated in red on the graphs. Mann-Whitney U test. (B) Purified and isolated TMCs from tonsils (blue) and tonsillar tissue blocs (orange) were stimulated for 24 h with Influenza A virus (IAV). A STING-37 reporter cell line assay was used to measure IFN production in the supernatant. Box and whisker plots with median ± minimum to maximum. Mann-Whitney U test. ***P < 0.001, **P < 0.01, *P < 0.05. NS = non-stimulated. Please click here to view a larger version of this figure.

Finally, we tested the viability of the TMCs. Several techniques are available to measure cell viability. Here, we used a luminescent cell viability assay, an easy and quick two-step assay. As shown in Figure 3, we clearly detected the cytotoxicity induced by compound 1 in TMCs, which was not toxic to PBMCs. Thus, TMCs showed a higher sensitivity to the drug tested.

Figure 3
Figure 3: Compound 1 was toxic to TMCs. Purified and isolated TMCs and PBMCs were preincubated with compound 1 (C1) at various concentrations for 1 h and then stimulated overnight with R848 (5 µg/mL). Supernatants were retrieved, 60 µL of cell viability solution was added, and luminescence was measured. The * represents the statistical analysis comparing C1 to NS. Box and whisker plots with median ± minimum to maximum. Kruskal-Wallis test with Dunn's post hoc correction. ****P < 0.0001, ***P < 0.001, **P < 0.01, *P < 0.05. NS = non-stimulated. Please click here to view a larger version of this figure.

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Human tonsils represent an integrative and physiological ex vivo model to study innate immune responses at the mucosal interface, because they mimic the role of a secondary lymphoid organ. Interestingly, the cellular composition of the TMCs is similar to the PBMCs and includes all the major cell populations, although their percentage can be different from PBMCs from blood (Figure 1). Additional populations can also be found, as all immune responses are initiated in tissues (mucosa or secondary lymphoid organs) and not in blood.

The use of human tissue explants as well as the use of cell culture or blood cells each have their advantages. However, for the of study cytokine secretion and cell activation, tissue explants were not the best model. In fact, we could not detect any IFN production in the supernatant of tissue explants (Figure 2B). We speculate that it is directly consumed by the surrounding cells. On the other hand, stimulation of blood cells (PBMCs) can mimic the primary response to infection but do not mimic what is happening in the tissues, where most of the cytokines are produced and where viruses replicate. Therefore, we set up a protocol to isolate and purify cells arising out of a secondary lymphoid tissue, the tonsil. We purified TMCs from healthy human tonsils, which allows us to investigate immune cell activation upon stimulation. However, one of the limitations of this model is that TMCs do not produce as many pro-inflammatory cytokines as PBMCs ex vivo upon TLR7/8 stimulation, although levels of IFNα, the major antiviral cytokine, is similar in both cultures.

The study of compound toxicity on TMCs versus PBMCs revealed that TMCs are more sensitive to a toxic drug (Figure 3). Thus, the toxicity of new drugs and future treatments should be tested in cells from tissues and not only on cell lines, PBMCs, or tissue explants. Therefore, the use of TMCs for drug testing seems to be a future application of the method described.

Tonsils from adults or children can be obtained and processed as described. However, we recommend obtaining tonsils from children for two main reasons: 1) Children's tonsils contain more cells than the adults'20. Indeed, tonsillar hypertrophy is particularly common in children, because they fight more childhood viruses. Thus, these large tonsils can become obstructive tonsils and need to be removed by a partial tonsillectomy to avoid complications like sleep apnea13; 2) Because adults' tonsils are usually removed after several episodes of ear-nose-throat (ENT) infections, these tonsils are less naïve and contain fewer cells.

It is critical to work on the tonsils as soon as possible after the removal surgery, ideally <3 h after collection. Indeed, right after removal and until dissection, the tonsils from each side are kept together in a 50 mL sterile vial containing around 20 mL of PBS, so that they are totally submerged.

Interdonor variability can represent a major issue for reproducibility. Indeed, variability in cellular composition between donors can be significant. Our protocol, using TMCs and not tissue explants, limits this variability because the cells from the whole tonsils are mixed before being plated and placed in culture, while tissue explants bring intradonor variability in cellular composition because the pieces come from different areas within the same specimen. Partial tonsillectomy can only be performed on noninflamed tonsils, which limits the inflammatory status variability between patients. We also recommend collecting tonsils surgically removed on different days. We have clearly noticed that inter-surgeon and inter-day variabilities are higher than interdonor variability (data not shown).

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The authors have nothing to disclose.


This work was supported by the Agence National de la Recherche sur le SIDA et les Hépatites ANRS (J-P.H) for the experiments and N.B. fellowship (AAP 2017 166). N.S. acknowledges support from the ANRS for fellowship (AAP 2016 1), the European Molecular Biology Organization EMBO for Fellowship (LT 834 2017), the startup funding program "Baustein" of the Medical Faculty of Ulm University (LSBN.0147) and the Deutsche Forschungsgemeinschaft DFG (SM 544/1 1).


Name Company Catalog Number Comments
10 meshes steel grid - 1910 µm Dutscher 198586 To put in the cell strainer Cellector
60 meshes steel grid - 230 µm Dutscher 198591 To put in the cell strainer Cellector
70 µm white ClearLine cell strainers Dutscher 141379C
Anios Excell D detergent Dutscher 59852 Detergent
Antibiotic solution, 100x Thermo Fisher 15140122 100 U/mL Penicilium and 100 μg/mL Streptomycin - to add to culture media
BD FalconTM Round-Bottom Tubes, 5 mL BD Biosciences 352063 FACS Tubes
Cell strainer Cellector, 85 mL and 37 mm diameter Dutscher 198585
CellTiter-Glo (CTG) Luminescent Cell Viability Assay Promega G7572 Viability assay
Centrifuge 5810 R Eppendorf
Conical tubes Falcon 50 mL Dutscher 352070
Curved tweezers Dutscher 711200
Dimethyl sulfoxide (DMSO) Sigma-Aldrich D2650
Dulbecco's Phosphate Buffered Saline (PBS) Sigma-Aldrich D8537 Without calcium and magnesium
EnVision PerkinElmer Measures the luminescence
Fetal Bovine Serum (FBS) To add to culture media
Fluorescence labeles antibodies See Table 1
Glass Pestle Dutscher 198599
Hepes (1 M) Thermo Fisher 15630056 Use at 20 mM
LEGENDplex Human Anti-Virus Response Panel BioLegend 740390 Bead-based immunoassay
Lymphoprep StemCell 7801 Density gradient medium
Mr. Frosty container Thermo Fisher 5100-0001 Slow freezing container
Pierce 16% Formaldehyde (w/v), Methanol-free Thermo Fisher 28908
Resiquimod (R848) InvivoGen tlrl-r848 TLR7/8 agonist
RPMI-1640 Medium Sigma-Aldrich R8758
SPL Cell Culture Dish, 150 mm x 25 mm (SPL150) Dutscher 330009
Surgical blade sterile N°23 Dutscher 132523
UltraComp eBeads Compensation Beads Thermo Fisher 01-2222-41
UltraPure 0.5 M EDTA, pH 8.0 Thermo Fisher 15575020 To make wash buffer in PBS



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Isolation of Tonsillar Mononuclear Cells to Study Ex Vivo Innate Immune Responses in a Human Mucosal Lymphoid Tissue
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Cite this Article

Smith, N., Bekaddour, N., Leboulanger, N., Richard, Y., Herbeuval, J. P. Isolation of Tonsillar Mononuclear Cells to Study Ex Vivo Innate Immune Responses in a Human Mucosal Lymphoid Tissue. J. Vis. Exp. (160), e60914, doi:10.3791/60914 (2020).More

Smith, N., Bekaddour, N., Leboulanger, N., Richard, Y., Herbeuval, J. P. Isolation of Tonsillar Mononuclear Cells to Study Ex Vivo Innate Immune Responses in a Human Mucosal Lymphoid Tissue. J. Vis. Exp. (160), e60914, doi:10.3791/60914 (2020).

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