Immune privilege and inflammation of the testis

Immune cells are found in considerable numbers within the normal, unaffected testes of mammals, including humans. Located in the interstitial compartment, they are implicated in the mechanisms that make the testis an immunologically privileged site where germ cells are protected from autoimmune attack and foreign tissue grafts may survive for extended periods of time. With regard to normal development and function of the testis, both pro- and antiinflammatory cytokines have been shown to play an important regulatory role. The testicular environment, however, does not preclude immune activation resulting in inflammatory reactions and potential damage. In experimental animals, active immunization with testicular tissue or adoptive transfer of specific T lymphocytes causes autoimmune orchitis. In men, infection and inflammation of the reproductive tract including the testes are widely accepted as important etiological factors of infertility. Whereas symptomatic orchitis due to bacterial or viral infections is considered to be rare, a high prevalence of asymptomatic testicular inflammatory reactions could be demonstrated among infertile males. Despite the patchy distribution of the lesions, inflammation is associated with disruption of testicular function, i.e. spermatogenesis. The pattern of lymphocyte infiltration and concomitant damage of seminiferous tubules supports the concept that activation of autoreactive T cells is involved.