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Clinicopathologic Correlations in Eosinophilic Gastrointestinal Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3258-3266. [DOI: 10.1016/j.jaip.2021.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022]
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2
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Wedi B, Gehring M, Kapp A. The pseudoallergen receptor MRGPRX2 on peripheral blood basophils and eosinophils: Expression and function. Allergy 2020; 75:2229-2242. [PMID: 32003863 DOI: 10.1111/all.14213] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Mas-related G protein-coupled receptor X2 (MRGPRX2) is regarded as a mast cell-specific receptor mediating non-IgE-dependent activation. We aimed to investigate whether human basophils and eosinophils express functional MRGPRX2. METHODS Flow cytometry, immunocytochemistry, immunofluorescence, Western blot, and RT-PCR were performed in highly purified peripheral blood basophils and eosinophils of atopic and nonatopic donors. To assess functional activity, fluorescent avidin-based degranulation assay, calcium mobilization, cytokine production in supernatants, assessment of viability/apoptosis, and tricolor granulocyte activation test were used. RESULTS MRGPRX2 was significantly expressed by basophils and eosinophils but not neutrophils. Functional capacity was shown by anti-MRGPRX2 mAb-induced calcium influx and concentration-dependent induction of degranulation. Sequential stimulation in the calcium mobilization assay gave no evidence for desensitization or receptor internalization. Anti-MRGPRX2 mAb significantly promoted survival. Inhibition of apoptosis could be due to released IL-3, IL-5, and GM-CSF found in supernatants. Short-term incubation with IL-3 dose-dependently upregulated MRGPRX2 expression in both, stimulation for 24 hours with anti-IgE, C5a, fMLP, and IL-3 in basophils and by IL-3, IL-5, and IL-33 in eosinophils. Among known mast cell MRGPRX2 agonists ciprofloxacin but not PMX-53 was functional on basophils and eosinophils. In basophils of allergic subjects, tricolor granulocyte activation test using grass pollen demonstrated MRGPRX2 upregulation associated with degranulation and CD63 expression. CONCLUSION Unraveling the regulation and signaling mechanisms of MRGPRX2 on basophils and eosinophils might enable the development of new therapeutic strategies to prevent or inhibit allergic and nonallergic hypersensitivity. Moreover, addressing MRGPRX2 might have potential for diagnostic purposes in (drug) hypersensitivity.
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Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
| | - Manuela Gehring
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
| | - Alexander Kapp
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
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3
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Sallis BF, Erkert L, Moñino-Romero S, Acar U, Wu R, Konnikova L, Lexmond WS, Hamilton MJ, Dunn WA, Szepfalusi Z, Vanderhoof JA, Snapper SB, Turner JR, Goldsmith JD, Spencer LA, Nurko S, Fiebiger E. An algorithm for the classification of mRNA patterns in eosinophilic esophagitis: Integration of machine learning. J Allergy Clin Immunol 2018; 141:1354-1364.e9. [PMID: 29273402 PMCID: PMC6425755 DOI: 10.1016/j.jaci.2017.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/17/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diagnostic evaluation of eosinophilic esophagitis (EoE) remains difficult, particularly the assessment of the patient's allergic status. OBJECTIVE This study sought to establish an automated medical algorithm to assist in the evaluation of EoE. METHODS Machine learning techniques were used to establish a diagnostic probability score for EoE, p(EoE), based on esophageal mRNA transcript patterns from biopsies of patients with EoE, gastroesophageal reflux disease and controls. Dimensionality reduction in the training set established weighted factors, which were confirmed by immunohistochemistry. Following weighted factor analysis, p(EoE) was determined by random forest classification. Accuracy was tested in an external test set, and predictive power was assessed with equivocal patients. Esophageal IgE production was quantified with epsilon germ line (IGHE) transcripts and correlated with serum IgE and the Th2-type mRNA profile to establish an IGHE score for tissue allergy. RESULTS In the primary analysis, a 3-class statistical model generated a p(EoE) score based on common characteristics of the inflammatory EoE profile. A p(EoE) ≥ 25 successfully identified EoE with high accuracy (sensitivity: 90.9%, specificity: 93.2%, area under the curve: 0.985) and improved diagnosis of equivocal cases by 84.6%. The p(EoE) changed in response to therapy. A secondary analysis loop in EoE patients defined an IGHE score of ≥37.5 for a patient subpopulation with increased esophageal allergic inflammation. CONCLUSIONS The development of intelligent data analysis from a machine learning perspective provides exciting opportunities to improve diagnostic precision and improve patient care in EoE. The p(EoE) and the IGHE score are steps toward the development of decision trees to define EoE subpopulations and, consequently, will facilitate individualized therapy.
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Affiliation(s)
- Benjamin F. Sallis
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Medicine, Harvard Medical School, Medical
University of Vienna
| | - Lena Erkert
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna
| | - Sherezade Moñino-Romero
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Pediatrics and Adolescent Medicine, Medical
University of Vienna
| | - Utkucan Acar
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Medicine, Harvard Medical School, Medical
University of Vienna
| | - Rina Wu
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna
| | - Liza Konnikova
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Medicine, Harvard Medical School, Medical
University of Vienna
| | - Willem S. Lexmond
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Medicine, Harvard Medical School, Medical
University of Vienna
| | - Matthew J. Hamilton
- Department of Medicine, Harvard Medical School, Medical
University of Vienna.,Department of Pathology, Medical University of
Vienna.,Division of Gastroenterology, Hepatology, and Endoscopy,
Brigham and Women’s Hospital; Medical University of Vienna
| | - W. Augustine Dunn
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Medicine, Harvard Medical School, Medical
University of Vienna
| | - Zsolt Szepfalusi
- Department of Pediatrics and Adolescent Medicine, Medical
University of Vienna
| | - Jon A. Vanderhoof
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna
| | - Scott B. Snapper
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Medicine, Harvard Medical School, Medical
University of Vienna
| | - Jerrold R. Turner
- Department of Pathology, Medical University of
Vienna.,Division of Gastroenterology, Hepatology, and Endoscopy,
Brigham and Women’s Hospital; Medical University of Vienna
| | - Jeffrey D. Goldsmith
- Department of Pathology, Boston Children’s Hospital,
Medical University of Vienna
| | - Lisa A. Spencer
- Department of Medicine, Harvard Medical School, Medical
University of Vienna.,Department of Medicine, Division of Allergy and
Inflammation, Beth Israel Deaconess Medical Center, Boston, Medical University of
Vienna
| | - Samuel Nurko
- Department of Pediatrics, Division of Gastroenterology,
Hepatology and Nutrition, Medical University of Vienna.,Department of Medicine, Harvard Medical School, Medical
University of Vienna
| | - Edda Fiebiger
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
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4
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Uppal V, Kreiger P, Kutsch E. Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:175-88. [PMID: 26054822 DOI: 10.1007/s12016-015-8489-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Eosinophilic gastrointestinal disorders, including eosinophilic esophagitis, gastroenteritis, and colitis, refer to a spectrum of clinical diseases that present with variable degrees of infiltration of the gastrointestinal tract by eosinophils in the absence of other known causes of tissue eosinophilia. Clinical symptoms and laboratory findings are usually non-specific and may or may not be accompanied by peripheral blood eosinophilia. The extent of eosinophilic infiltration of the gastrointestinal wall varies from mucosal to transmural and serosal involvement. Diagnosis requires presence of gastrointestinal symptoms, demonstration of gastrointestinal eosinophilia by biopsy, and exclusion of other known causes of tissue eosinophilia. Many studies have pointed toward the eosinophil as the major offender; however, the exact functional role of the eosinophil in the pathogenesis of eosinophilic gastrointestinal disorders remains unclear. The roles of T-helper-2 cytokines and other mediators, such as eotaxin-1 and interleukin-5, have gained significant importance in the pathobiology of eosinophilic gastrointestinal disorders. Current understanding of treatment is based on case reports and a few case series, as there is a lack of large prospective studies. Steroids are currently the mainstay of therapy, but the roles of other drugs such as leukotriene inhibitors, mast cell stabilizers, interleukin-5 inhibitors, and anti-immunoglobulin E, along with other targets in the immune pathway, are currently being explored.
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Affiliation(s)
- Vikas Uppal
- Division of Pediatric Gastroenterology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Portia Kreiger
- Department of Pathology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Erika Kutsch
- Division of Pediatric Gastroenterology and Nutrition, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
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5
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Prussin C. Allergic Inflammatory Diseases of the Gastrointestinal Tract. Mucosal Immunol 2015. [DOI: 10.1016/b978-0-12-415847-4.00083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Messingham KN, Holahan HM, Frydman AS, Fullenkamp C, Srikantha R, Fairley JA. Human eosinophils express the high affinity IgE receptor, FcεRI, in bullous pemphigoid. PLoS One 2014; 9:e107725. [PMID: 25255430 PMCID: PMC4177878 DOI: 10.1371/journal.pone.0107725] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/17/2014] [Indexed: 01/21/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering disease mediated by autoantibodies targeting BP180 (type XVII collagen). Patient sera and tissues typically have IgG and IgE autoantibodies and elevated eosinophil numbers. Although the pathogenicity of the IgE autoantibodies is established in BP, their contribution to the disease process is not well understood. Our aims were two-fold: 1) To establish the clinical relationships between total and BP180-specific IgE, eosinophilia and other markers of disease activity; and 2) To determine if eosinophils from BP patients express the high affinity IgE receptor, FcεRI, as a potential mechanism of action for IgE in BP. Our analysis of 48 untreated BP patients revealed a correlation between BP180 IgG and both BP180 IgE and peripheral eosinophil count. Additionally, we established a correlation between total IgE concentration and both BP180 IgE levels and eosinophil count. When only sera from patients (n = 16) with total IgE ≥ 400 IU/ml were analyzed, BP180 IgG levels correlated with disease severity, BP230 IgG, total circulating IgE and BP180 IgE. Finally, peripheral eosinophil count correlated more strongly with levels of BP180 IgE then with BP180 IgG. Next, eosinophil FcεRI expression was investigated in the blood and skin using several methods. Peripheral eosinophils from BP patients expressed mRNA for all three chains (α, β and γ) of the FcεRI. Surface expression of the FcεRIα was confirmed on both peripheral and tissue eosinophils from most BP patients by immunostaining. Furthermore, using a proximity ligation assay, interaction of the α- and β-chains of the FcεRI was observed in some biopsy specimens, suggesting tissue expression of the trimeric receptor form in some patients. These studies provide clinical support for the relevance of IgE in BP disease and provide one mechanism of action of these antibodies, via binding to the FcεRI on eosinophils.
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Affiliation(s)
- Kelly N. Messingham
- Department of Dermatology, University of Iowa, Iowa City, Iowa, United States of America
| | - Heather M. Holahan
- Department of Dermatology, University of Iowa, Iowa City, Iowa, United States of America
| | - Alexandra S. Frydman
- Department of Dermatology, University of Iowa, Iowa City, Iowa, United States of America
| | - Colleen Fullenkamp
- Department of Dermatology, University of Iowa, Iowa City, Iowa, United States of America
| | - Rupasree Srikantha
- Department of Dermatology, University of Iowa, Iowa City, Iowa, United States of America
| | - Janet A. Fairley
- Department of Dermatology, University of Iowa, Iowa City, Iowa, United States of America
- Veterans Administration Medical Center, Iowa City, Iowa, United States of America
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7
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Wechsler JB, Schwartz S, Amsden K, Kagalwalla AF. Elimination diets in the management of eosinophilic esophagitis. J Asthma Allergy 2014; 7:85-94. [PMID: 24920928 PMCID: PMC4043711 DOI: 10.2147/jaa.s47243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Eosinophilic esophagitis, an increasingly recognized chronic inflammatory disorder isolated to the esophagus, is triggered by an abnormal allergic response to dietary antigens. Current treatment includes swallowed topical steroids and dietary modification, which aim to resolve symptoms and prevent long-term complications such as formation of strictures. The dietary approach has become more widely accepted because long-term steroid therapy is associated with potential risks. Dietary treatment includes elemental and elimination diets. An exclusive elemental diet, which requires replacement of all intact protein with amino acid-based formula, offers the best response of all available therapies, with remission in up to 96% of subjects proving it to be superior to all other available therapies including topical steroids. However, compliance with this approach is challenging because of poor taste and monotony. The high cost of formula and the associated psychosocial problems are additional drawbacks of this approach. Empiric and allergy test-directed elimination diets have gained popularity given that elimination of a limited number of foods is much easier and as such is more readily acceptable. There is a growing body of literature supporting this type of therapy in both children and adults. This paper reviews the evidence for all types of dietary therapy in eosinophilic esophagitis.
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Affiliation(s)
- Joshua B Wechsler
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Sally Schwartz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Katie Amsden
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Amir F Kagalwalla
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
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8
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Bates AWH. Diagnosing eosinophilic colitis: histopathological pattern or nosological entity? SCIENTIFICA 2013; 2012:682576. [PMID: 24278727 PMCID: PMC3820477 DOI: 10.6064/2012/682576] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/06/2012] [Indexed: 06/02/2023]
Abstract
Reports of "eosinophilic colitis"-raised colonic mucosal eosinophil density in patients with lower gastrointestinal symptoms-have increased markedly over the last fifteen years, though it remains a rarity. There is no consensus over its diagnosis and management, and uncertainty is compounded by the use of the same term to describe an idiopathic increase in colonic eosinophils and an eosinophilic inflammatory reaction to known aetiological agents such as parasites or drugs. In patients with histologically proven colonic eosinophilia, it is important to seek out underlying causes and careful clinicopathological correlation is advised. Because of the variability of eosinophil density in the normal colon, it is recommended that histological reports of colonic eosinophilia include a quantitative morphometric assessment of eosinophil density, preferably across several sites. Few reported cases of "eosinophilic colitis" meet these criteria. As no correlation has been shown between colonic eosinophil density and symptoms in older children or adults, it is suggested that treatment should be directed towards alleviation of symptoms and response to treatment assessed clinically rather than by histological estimates of intramucosal eosinophils.
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Affiliation(s)
- Alan W. H. Bates
- Research Department of Pathology, University College London, London WC1E 6BT, UK
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9
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Laxa BU, Bouchard A, De Petris G, Heigh R, Heppell J. Eosinophilic enteritis confined to an ileostomy site. Case Rep Gastroenterol 2011; 5:422-7. [PMID: 21960943 PMCID: PMC3180657 DOI: 10.1159/000329990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Eosinophilic enteritis is a rather rare condition that can manifest anywhere from esophagus to rectum. Its description in the literature is sparse, but associations have been made with collagen vascular disease, malignancy, food allergy, parasitic or viral infections, inflammatory bowel disease, and drug sensitivity. We present the case of a 41-year-old male diagnosed with ulcerative colitis who underwent proctocolectomy with ileal pouch anal anastomosis and loop ileostomy formation utilizing Seprafilm®, who later developed eosinophilic enteritis of the loop ileostomy site. This is the first report of eosinophilic enteritis and its possible link to the use of bioabsorbable adhesion barriers.
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Affiliation(s)
- Bernadette U Laxa
- Department of Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Ariz., USA
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10
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Platzer B, Ruiter F, van der Mee J, Fiebiger E. Soluble IgE receptors--elements of the IgE network. Immunol Lett 2011; 141:36-44. [PMID: 21920387 DOI: 10.1016/j.imlet.2011.08.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 08/15/2011] [Accepted: 08/27/2011] [Indexed: 12/22/2022]
Abstract
Soluble isoforms of three human IgE Fc receptors, namely FcεRI, FcεRII, and galectin-3, can be found in serum. These soluble IgE receptors are a diverse family of proteins unified by the characteristic of interacting with IgE in the extracellular matrix. A truncated form of the alpha-chain of FcεRI, the high affinity IgE receptor, has recently been described as a soluble isoform (sFcεRI). Multiple soluble isoforms of CD23 (sCD23), the low affinity IgE receptor also known as FcεRII, are generated via different mechanisms of extracellular and intracellular proteolysis. The second low affinity IgE receptor, galectin-3, only exists as a secretory protein. We here discuss the physiological roles of these three soluble IgE receptors as elements of the human IgE network. Additionally, we review the potential and current use of sFcεRI, sCD23, and galectin-3 as biomarkers in human disease.
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Affiliation(s)
- Barbara Platzer
- Division of Gastroenterology and Nutrition, Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
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11
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Lexmond W, der Mee JV, Ruiter F, Platzer B, Stary G, Yen EH, Dehlink E, Nurko S, Fiebiger E. Development and validation of a standardized ELISA for the detection of soluble Fc-epsilon-RI in human serum. J Immunol Methods 2011; 373:192-9. [PMID: 21903095 DOI: 10.1016/j.jim.2011.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/22/2011] [Accepted: 08/22/2011] [Indexed: 11/30/2022]
Abstract
The aim of this study was to develop a standardized enzyme-linked immunosorbent assay (ELISA) for detection of human soluble Fc-epsilon-RI (sFcεRI), a serum isoform of the high affinity IgE receptor. A recombinant version of sFcεRI was produced in baculovirus and used as standard. ELISA plates were coated with anti-mouse IgG followed by incubation with the monoclonal capture antibody CRA1. This FcεRI-alpha-specific antibody binds to the stalk region of the protein and does not inhibit IgE-binding. After incubation with standards or serum samples, plates were incubated with chimeric IgE followed by detection with horseradish peroxidase conjugated anti-human IgE. Enzymatic activity was visualized with (3,3',5,5')-tetramethylbenzidine. Specificity was demonstrated by omission of capture or detection reagents. Units (U) of detection were established and the dynamic range of the assay was defined as 10-640 U/ml for a 1/5 serum dilution. Parameters of linearity (R(2)>0.999), matrix interference test (recovery of 70-110%), intra-assay variability (coefficient of variation (CV) <20%) and inter-assay variability (CV <20%) met acceptance criteria for immunoassay validation. Correlation analysis of serum units of sFcεRI measured with the new ELISA and serum IgE levels confirmed earlier published data describing a weak correlation of the two parameters in patients with elevated serum IgE while no correlation in patients with normal serum IgE or the total patient group was found. In summary, we established and validated a standardized ELISA for the detection of sFcεRI. This novel method now allows for comparative analysis of sFcεRI levels in health and disease.
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Affiliation(s)
- Willem Lexmond
- Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA, USA
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12
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Dehlink E, Platzer B, Baker AH, LaRosa J, Pardo M, Dwyer P, Yen EH, Szépfalusi Z, Nurko S, Fiebiger E. A soluble form of the high affinity IgE receptor, Fc-epsilon-RI, circulates in human serum. PLoS One 2011; 6:e19098. [PMID: 21544204 PMCID: PMC3081330 DOI: 10.1371/journal.pone.0019098] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 03/16/2011] [Indexed: 01/03/2023] Open
Abstract
Soluble IgE receptors are potential in vivo modulators of
IgE-mediated immune responses and are thus important for our basic understanding
of allergic responses. We here characterize a novel soluble version of the
IgE-binding alpha-chain of Fc-epsilon-RI (sFcεRI), the high affinity
receptor for IgE. sFcεRI immunoprecipitates as a protein of ∼40 kDa and
contains an intact IgE-binding site. In human serum, sFcεRI is found as a
soluble free IgE receptor as well as a complex with IgE. Using a newly
established ELISA, we show that serum sFcεRI levels correlate with serum IgE
in patients with elevated IgE. We also show that serum of individuals with
normal IgE levels can be found to contain high levels of sFcεRI. After
IgE-antigen-mediated crosslinking of surface FcεRI, we detect sFcεRI in
the exosome-depleted, soluble fraction of cell culture supernatants. We further
show that sFcεRI can block binding of IgE to FcεRI expressed at the cell
surface. In summary, we here describe the alpha-chain of FcεRI as a
circulating soluble IgE receptor isoform in human serum.
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Affiliation(s)
- Eleonora Dehlink
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
- Department of Pediatrics and Adolescent Medicine, Medical University of
Vienna, Vienna, Austria
| | - Barbara Platzer
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
| | - Alexandra H. Baker
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
| | - Jessica LaRosa
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
| | - Michael Pardo
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
| | - Peter Dwyer
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
| | - Elizabeth H. Yen
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
| | - Zsolt Szépfalusi
- Department of Pediatrics and Adolescent Medicine, Medical University of
Vienna, Vienna, Austria
| | - Samuel Nurko
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
| | - Edda Fiebiger
- Division of Gastroenterology and Nutrition, Department of Pediatrics,
Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts,
United States of America
- * E-mail:
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13
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Comparative analysis of FcεRI expression patterns in patients with eosinophilic and reflux esophagitis. J Pediatr Gastroenterol Nutr 2010; 51:584-92. [PMID: 20808250 PMCID: PMC2965300 DOI: 10.1097/mpg.0b013e3181de7685] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Eosinophilic esophagitis (EoE) is an allergic disease of the esophagus. The IgE receptors on immune cells that infiltrate the esophagus are poorly defined. The high-affinity receptor for IgE, FcεRI, may play a role in EoE. The objective of the present study is to identify and compare the IgE receptors in the esophageal epithelium of patients with EoE, reflux esophagitis (RE), and normal controls. PATIENTS AND METHODS A retrospective case-control study of 62 patients (19 EoE, 22 RE, 21 normal controls) was conducted. Biopsies were immunostained for FcεRI, CD23, galectin-3, c-kit, CD1a, and langerin. RESULTS FcεRI was the only IgE receptor present in the esophageal epithelium of patients with EoE. The FcεRI-positive cell count varied by diagnosis (proximal biopsies EoE 32.6 ± 19.0 cells/high-power field, RE 26.7 ± 16.6, controls 15.6 ± 8.3, ANOVA P = 0.005; distal biopsies EoE 24.2 ± 16.2, RE 35.7 ± 27.6, controls 15.3 ± 8.4, P = 0.006). In the proximal esophagus, the FcεRI count was higher in EoE than in controls (P = 0.006); in the distal esophagus, the FcεRI count was higher in RE than in controls (P = 0.004). EoE and RE had similar FcεRI-positive cell counts. A subset of FcεRI-positive cells was similar in morphology and distribution to Langerhans cells (CD1a and langerin positive). CONCLUSIONS The presence of FcεRI-positive cells in high numbers in the esophageal epithelium implies this receptor must be critical in the IgE-mediated activation of immune cells in the esophagus. Langerhans cells in the esophageal epithelium appear to express FcεRI. The role of Langerhans cells in the pathophysiology of EoE needs to be elucidated.
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Abstract
Eosinophilic esophagitis (EoE) is a chronic esophageal inflammatory disease of undetermined pathophysiology that results in dense mucosal eosinophilia and esophageal dysfunction. In childhood, vague symptoms associated with GERD and feeding difficulties are the first manifestations of EoE. Adults typically present with dysphagia and food impaction. No pathognomonic features have been identified for EoE and, therefore, its diagnosis must be made on both clinical and histological grounds. Effective treatments rely on steroids and dietary exclusions.
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