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Gueguen E, Morsy Y, Mamie C, Schoepfer A, Saner C, Biedermann L, Straumann A, Kreienbühl A, Scharl M, Wawrzyniak M. Novel transcriptomic panel identifies histologically active eosinophilic oesophagitis. Gut 2024:gutjnl-2023-331743. [PMID: 38670631 DOI: 10.1136/gutjnl-2023-331743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND AIMS Eosinophilic oesophagitis (EoE) is characterised by symptoms of oesophageal dysfunction and oesinophil tissue infiltration. The EoE Diagnostic Panel (EDP) can distinguish between active and non-active EoE using a set of 77 genes. Recently, the existence of distinct EoE variants featuring symptoms similar to EoE, such as oesophageal dysfunction but lacking eosinophil infiltration, had been determined. METHODS We used oesophageal biopsies from patients with histologically active (n=10) and non-active EoE (n=9) as well as from healthy oesophageal controls (n=5) participating in the Swiss Eosinophilic Esophagitis Cohort Study (SEECS) and analysed the gene expression profile in these biopsies by total RNA-sequencing (RNA-seq). Moreover, we employed the publicly accessible RNA-seq dataset (series GSE148381) as reported by Greuter et al, encompassing a comprehensive genomic profile of patients presenting with EoE variants. RESULTS A novel, diagnostic gene expression panel that can effectively distinguish patients with histologically active conventional EoE from patients with EoE in histological remission and control individuals, and from three newly discovered EoE variants was identified. Histologically Active EoE Diagnostic Panel (HAEDP) consists of 53 genes that were identified based on differential expression between histologically active EoE, histological remission and controls (p≤0.05). By combining the HAEDP with EDP, we expanded our knowledge about factors that may contribute to the inflammation in EoE and improved our understanding of the underlying mechanisms of the disease. Conversely, we suggested a compact group of genes common to both HAEDP and EDP to create a reliable diagnostic tool that might enhance the accuracy of EoE diagnosis. CONCLUSION We identified a novel set of 53 dysregulated genes that are closely associated with the histological inflammatory activity of EoE. In combination with EDP, our new panel might be a valuable tool for the accurate diagnosis of patients with EoE as well as for monitoring their disease course.
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Affiliation(s)
- Emilie Gueguen
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yasser Morsy
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Céline Mamie
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alain Schoepfer
- Service de gastro-entérologie et d'hépatologie, Centre hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Catherine Saner
- Service de gastro-entérologie et d'hépatologie, Centre hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Kreienbühl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcin Wawrzyniak
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Furuta EJM, Furuta GT, Shandas R. Minimally Invasive Approaches to Diagnose and Monitor Eosinophilic GI Diseases. Curr Allergy Asthma Rep 2024; 24:269-279. [PMID: 38536531 DOI: 10.1007/s11882-024-01142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE OF REVIEW This review seeks to understand novel avenues for eosinophilic GI disease management. Biomarkers offer a unique and non-invasive approach to tracking EoE disease progression. While no biomarkers have definitively met the diagnostic criteria for eosinophilic GI diseases, some biomarkers have been shown to be associated with disease activity. Here, we examine the potential of recently studied biomarkers. RECENT FINDINGS Current research shows advancements in blood, luminal fluid, and breath testing. Particular areas of interest include mRNA analyses, protein fingerprinting, amplicon sequence variants (ASVs), T cells and IgE receptors, eosinophilic cationic proteins, cytokines, and nitric oxide exhalation. Preliminary results showed that mucosal biomarkers, directly captured from the esophagus, may reflect the best representation of biopsy-based results, in contrast to biomarkers obtained from indirect or peripheral (blood, breath) methods. However, this is based on limited clinical studies without sufficient numbers to evaluate true diagnostic accuracy. Large-scale randomized trials are needed to fully ascertain both the optimal sampling technique and the specific biomarkers that reflect diagnostic status of the disease.
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Affiliation(s)
- Ellie J M Furuta
- Department of Public Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, CO, USA.
- Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Robin Shandas
- Department of Bioengineering, University of Colorado Denver|Anschutz Medical Campus, Aurora, CO, USA
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Li D, Li X, Lv J, Li S. Creation of signatures and identification of molecular subtypes based on disulfidptosis-related genes for glioblastoma patients' prognosis and immunological activity. Asian J Surg 2024:S1015-9584(24)00299-9. [PMID: 38462406 DOI: 10.1016/j.asjsur.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/23/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND In recent times, disulfidptosis, an intricate form of cellular demise, has garnered attention due to its impact on prognosis, tumor progression and treatment response. Nevertheless, the exact significance of disulfidptosis-related genes (DisRGs) in glioblastoma (GBM) remains enigmatic. METHODS The GEO and TCGA databases provided transcriptional and clinically relevant data on tumor samples, while the GTEx database provided data on healthy tissues. Disulfidptosis-related genes (DisRGs) were procured from previous scholarly investigations. The expression profile of DisRGs was initially scrutinized among patients diagnosed with GBM, subsequent to which their prognostic value was explored. Through consensus clustering, we constructed DisRGs-related clusters and gene subtypes. Our results established that the DisRG-related clusters had differentially expressed genes, resulting in a DisulfidptosisScore model, which had a positive prognostic value. RESULTS The differential expression profile of 24 DisRGs between GBM samples and healthy samples was acquired. Through consensus cluster analysis, two distinct disulfidptosis subtypes, namely DisRGcluster A and DisRGcluster B, were identified. Then, the DisulfidptosisScore model including 4 characteristic genes was constructed.Notably, patients with GBM assigned with lower score demonstrated a considerably longer overall survival (OS) compared to those with higher score. CONCLUSION We have effectively devised a prognostic model associated with disulfidptosis, presenting autonomous prognostic predictions for patients with GBM. These findings serve as a valuable addition to the current comprehension of disulfidptosis and offer fresh theoretical substantiation for the development of enhanced treatment strategies.
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Affiliation(s)
- Dongjun Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, No.39 Huaxiang Road, Tiexi District, Shenyang, 110000, Liaoning, People's Republic of China
| | - Xiaodong Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, No.39 Huaxiang Road, Tiexi District, Shenyang, 110000, Liaoning, People's Republic of China
| | - Jianfeng Lv
- Department of Neurosurgery, Shengjing Hospital of China Medical University, No.39 Huaxiang Road, Tiexi District, Shenyang, 110000, Liaoning, People's Republic of China
| | - Shaoyi Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, No.39 Huaxiang Road, Tiexi District, Shenyang, 110000, Liaoning, People's Republic of China.
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Jacobse J, Brown R, Revetta F, Vaezi M, Buendia MA, Williams CS, Higginbotham T, Washington MK, Goettel J, Hiremath G, Choksi YA. A synthesis and subgroup analysis of the eosinophilic esophagitis tissue transcriptome. J Allergy Clin Immunol 2024; 153:759-771. [PMID: 37852329 PMCID: PMC10939980 DOI: 10.1016/j.jaci.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic immune mediated inflammatory disorder of the esophagus. It is still unknown why children and adults present differently, and there is little evidence about why it is more common in men than women. OBJECTIVE Our aim was to synthesize published and unpublished esophageal bulk RNA-sequencing (RNA-seq) data to gain novel insights into the pathobiology of EoE and examine the differences in EoE transcriptome by sex and age group. METHODS Esophageal bulk RNA-seq data from 5 published and 2 unpublished studies resulting in 137 subjects (EoE: N = 76; controls: N = 61) were analyzed. For overall analysis, combined RNA-seq data of patients with EoE were compared with those of controls and subgroup analysis was conducted in patients with EoE by age of the patient (children [<18 years] vs adults [≥18 years]) and sex (female vs male). Gene-set enrichment analysis, ingenuity pathway analysis (IPA), cell-type analysis, immunohistochemistry, and T-cell or B-cell receptor analysis were performed. RESULTS Overall analysis identified dysregulation of new genes in EoE compared with controls. IPA revealed that EoE is characterized by a mixed inflammatory response compared with controls. Cell-type analysis showed that cell composition varied with age: children had more mast cells, whereas adults had more macrophages. Finally, gene-set enrichment analysis and IPA revealed pathways that were differentially regulated in adults versus children and male versus female patients with EoE. CONCLUSIONS Using a unique approach to analyze bulk RNA-seq data, we found that EoE is characterized by a mixed inflammatory response, and the EoE transcriptome may be influenced by age and sex. These findings enhance insights into the molecular mechanisms of EoE.
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Affiliation(s)
- Justin Jacobse
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands; Division of Molecular Pathogenesis, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Veterans Affairs Tennessee Valley Health Care System, Nashville, Tenn
| | - Rachel Brown
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tenn; Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Frank Revetta
- Division of Molecular Pathogenesis, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Michael Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthew A Buendia
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tenn
| | - Christopher S Williams
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Veterans Affairs Tennessee Valley Health Care System, Nashville, Tenn; Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tenn; Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Tina Higginbotham
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - M Kay Washington
- Division of Molecular Pathogenesis, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tenn
| | - Jeremy Goettel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Division of Molecular Pathogenesis, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Center for Mucosal Inflammation and Cancer, Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt Institute for Infection Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, Tenn
| | - Girish Hiremath
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tenn
| | - Yash A Choksi
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Veterans Affairs Tennessee Valley Health Care System, Nashville, Tenn; Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tenn.
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Massironi S, Elvevi A, Panceri R, Mulinacci G, Colella G, Biondi A, Invernizzi P, Danese S, Vespa E. Eosinophilic esophagitis: does age matter? Expert Rev Clin Immunol 2024; 20:211-223. [PMID: 37870118 DOI: 10.1080/1744666x.2023.2274940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/20/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus with increasing prevalence worldwide. It is a multifactorial disease caused by a combination of immunologic, genetic, and environmental factors. The clinical presentation of EoE varies largely, especially between different age groups. While diagnostic criteria and therapeutic goals are similar in children and adults, there are differences in treatment, with a more cautious approach in children to avoid growth disturbances. In addition, close monitoring and follow-up are essential in children to ensure uninterrupted growth. AREAS COVERED A search in PubMed/MEDLINE, EMBASE, and SCOPUS databases was conducted to identify relevant studies published between January 2010 and January 2023 to give an overview of the state-of-the-art of EoE epidemiology, diagnosis, and treatment while focusing on similarities and differences between the adult and the pediatric population. EXPERT OPINION The current state of research indicates that while significant progress has been made in understanding and treating EoE, further research and advances are needed to optimize diagnostic strategies, tailored treatment approaches, monitoring, and follow-up, and improve long-term outcomes for patients. With further innovation, the management of EoE can become more precise and tailored, leading to better patient outcomes and improved quality of life.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandra Elvevi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Roberto Panceri
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Giacomo Mulinacci
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Colella
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Andrea Biondi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Pietro Invernizzi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy, and Vita-Salute, San Raffaele University, Milan, Italy
| | - Edoardo Vespa
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy, and Vita-Salute, San Raffaele University, Milan, Italy
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Ridolo E, Barone A, Ottoni M, Peveri S, Montagni M, Nicoletta F. The New Therapeutic Frontiers in the Treatment of Eosinophilic Esophagitis: Biological Drugs. Int J Mol Sci 2024; 25:1702. [PMID: 38338983 PMCID: PMC10855546 DOI: 10.3390/ijms25031702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Eosinophilic esophagitis (EoE) is a multifaceted disease characterized by a wide heterogeneity of clinical manifestations, endoscopic and histopathologic patterns, and responsiveness to therapy. From the perspective of an effective approach to the patient, the different inflammatory mechanisms involved in the pathogenesis of EoE and biologics, in particular monoclonal antibodies (mAbs), targeting these pathways are needed. Currently, the most relevant is dupilumab, which interferes with both interleukin (IL)-4 and IL-13 pathways by binding IL-4 receptor α, and is the only mAb approved by the European Medicine Agency and US Food and Drug Administration for the treatment of EoE. Other mAbs investigated include mepolizumab, reslizumab, and benralizumab (interfering with IL-5 axis), cendakimab and dectrekumab (anti-IL-13s), tezepelumab (anti-TSLP), lirentelimab (anti-SIGLEG-8), and many others. Despite the undeniable economic impact of biologic therapies, in the near future, there will be room for further reflection about the opportunity to prescribe biologic agents, not only as a last-line therapy in selected cases such as patients with comorbidities involving common pathways. Although recent findings are very encouraging, the road to permanent success in the treatment of EoE is still long, and further studies are needed to determine the long-term effects of mAbs and to discover new potential targets.
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Affiliation(s)
- Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Alessandro Barone
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Martina Ottoni
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Silvia Peveri
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Marcello Montagni
- Departmental Unit of Allergology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
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Ferrelli RS, Machado RS, Ogata SK. Oesophageal wall thickness assessment at endoscopic ultrasound in children and adolescents with eosinophilic oesophagitis: a case-control study. J Ultrasound 2023; 26:785-791. [PMID: 36574193 PMCID: PMC10632350 DOI: 10.1007/s40477-022-00742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/06/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disease, and an endosonographic evaluation may help the diagnosis. The main objectives of this study were to measure the thickness of the oesophageal wall using a radial endoscopic ultrasound (EUS), mucosa/submucosa (MSM), muscularis propria (MP) and mucosa to muscularis propria (MMP); to compare these measurements between patients with and without EoE; to correlate them with the Endoscopic Reference Score (EREFS); and to evaluate the diagnostic accuracy of these measurements. METHODS Children and adolescents (aging from 4 to 17 years) were evaluated in this prospective cross-sectional study. A radial EUS at 12 MHz frequency was used, and EREFS was employed to grade macroscopic findings. Accuracy of the measurements for the diagnosis of EoE was assessed by receiver operating characteristics (ROC) curve. RESULTS Twenty-six (19 M/7 F) patients (median age 10.83 years, range 5.65-17.46) were evaluated. EoE was diagnosed in 6 patients. The mean (and SD) oesophageal wall thicknesses in the distal oesophagus in millimetres in groups with and without EoE, respectively, were: MSM 1.07 (0.44) and 1.11 (0.33); MP 0.67 (0.25) and 0.60 (0.19); and MMP 1.73 (0.46) and 1.72 (0.32). Mid-oesophagus: MSM 1.16 (0.34) and 1.15 (0.34); MP 0.63 (0.16) and 0.60 (0.2); and MMP 1.79 (0.41) and 1.74 (0.34). In the ROC curve, the distal MP layer thickness presented better discriminative performance, with an area under the curve of 0.61 (95% CI 0.28-0.93) at 0.73 mm cut-off (66.67% sensitivity, 80% specificity, likelihood ratios of 3.33 for positive and 0.42 for negative test). CONCLUSION The evaluation of oesophageal thickness measurements by EUS is not useful for diagnosing EoE.
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Affiliation(s)
- Regis Schander Ferrelli
- Pediatric Gastroenterology Division, Department of Pediatrics, Escola Paulista de Medicina/Universidade Federal de São Paulo, Rua dos Otonis 839, Vila Clementino, São Paulo, 04025-002, Brazil.
| | - Rodrigo Strehl Machado
- Pediatric Gastroenterology Division, Department of Pediatrics, Escola Paulista de Medicina/Universidade Federal de São Paulo, Rua dos Otonis 839, Vila Clementino, São Paulo, 04025-002, Brazil
| | - Silvio Kazuo Ogata
- Pediatric Gastroenterology Division, Department of Pediatrics, Escola Paulista de Medicina/Universidade Federal de São Paulo, Rua dos Otonis 839, Vila Clementino, São Paulo, 04025-002, Brazil
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Rochman Y, Kotliar M, Ben-Baruch Morgenstern N, Barski A, Wen T, Rothenberg ME. TSLP shapes the pathogenic responses of memory CD4 + T cells in eosinophilic esophagitis. Sci Signal 2023; 16:eadg6360. [PMID: 37699081 PMCID: PMC10602003 DOI: 10.1126/scisignal.adg6360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023]
Abstract
The cytokine thymic stromal lymphopoietin (TSLP) mediates type 2 immune responses, and treatments that interfere with TSLP activity are in clinical use for asthma. Here, we investigated whether TSLP contributes to allergic inflammation by directly stimulating human CD4+ T cells and whether this process is operational in eosinophilic esophagitis (EoE), a disease linked to variants in TSLP. We showed that about 10% of esophageal-derived memory CD4+ T cells from individuals with EoE and less than 3% of cells from control individuals expressed the receptor for TSLP and directly responded to TSLP, as determined by measuring the phosphorylation of STAT5, a transcription factor activated downstream of TSLP stimulation. Accordingly, increased numbers of TSLP-responsive memory CD4+ T cells were present in the circulation of individuals with EoE. TSLP increased the proliferation of CD4+ T cells, enhanced type 2 cytokine production, induced the increased abundance of its own receptor, and modified the expression of 212 genes. The epigenetic response to TSLP was associated with an enrichment in BATF and IRF4 chromatin-binding sites, and these transcription factors were induced by TSLP, providing a feed-forward loop. The numbers of circulating and esophageal CD4+ T cells responsive to TSLP correlated with the numbers of esophageal eosinophils, supporting a potential functional role for TSLP in driving the pathogenesis of EoE and providing the basis for a blood-based diagnostic test based on the extent of TSLP-induced STAT5 phosphorylation in circulating CD4+ T cells. These findings highlight the potential therapeutic value of TSLP inhibitors for the treatment of EoE.
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Affiliation(s)
- Yrina Rochman
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Michael Kotliar
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Netali Ben-Baruch Morgenstern
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Artem Barski
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
- Division of Human Genetics, Department of Pediatrics Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Ting Wen
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Marc E. Rothenberg
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
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Burns GL, Keely S. Targeting type 2 immune responses to treat eosinophilic gastritis. Lancet Gastroenterol Hepatol 2023; 8:773-775. [PMID: 37572672 DOI: 10.1016/s2468-1253(23)00194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Grace L Burns
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; Immune Health Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; NHMRC Centre of Research Excellence in Digestive Health, The University of Newcastle, Callaghan, NSW, Australia.
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; Immune Health Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; NHMRC Centre of Research Excellence in Digestive Health, The University of Newcastle, Callaghan, NSW, Australia
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van Aalst EJ, McDonald CJ, Wylie BJ. Cholesterol Biases the Conformational Landscape of the Chemokine Receptor CCR3: A MAS SSNMR-Filtered Molecular Dynamics Study. J Chem Inf Model 2023; 63:3068-3085. [PMID: 37127541 PMCID: PMC10208230 DOI: 10.1021/acs.jcim.2c01546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Indexed: 05/03/2023]
Abstract
Cholesterol directs the pathway of ligand-induced G protein-coupled receptor (GPCR) signal transduction. The GPCR C-C motif chemokine receptor 3 (CCR3) is the principal chemotactic receptor for eosinophils, with roles in cancer metastasis and autoinflammatory conditions. Recently, we discovered a direct correlation between bilayer cholesterol and increased agonist-triggered CCR3 signal transduction. However, the allosteric molecular mechanism escalating ligand affinity and G protein coupling is unknown. To study cholesterol-guided CCR3 conformational selection, we implement comparative, objective measurement of protein architectures by scoring shifts (COMPASS) to grade model structures from molecular dynamics simulations. In this workflow, we scored predicted chemical shifts against 2-dimensional solid-state NMR 13C-13C correlation spectra of U-15N,13C-CCR3 samples prepared with and without cholesterol. Our analysis of trajectory model structures uncovers that cholesterol induces site-specific conformational restraint of extracellular loop (ECL) 2 and conserved motion in transmembrane helices and ECL3 not observed in simulations of bilayers with only phosphatidylcholine lipids. PyLipID analysis implicates direct cholesterol agency in CCR3 conformational selection and dynamics. Residue-residue contact scoring shows that cholesterol biases the conformational selection of the orthosteric pocket involving Y411.39, Y1133.32, and E2877.39. Lastly, we observe contact remodeling in activation pathway residues centered on the initial transmission switch, Na+ pocket, and R3.50 in the DRY motif. Our observations have unique implications for understanding of CCR3 ligand recognition and specificity and provide mechanistic insight into how cholesterol functions as an allosteric regulator of CCR3 signal transduction.
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Affiliation(s)
- Evan J. van Aalst
- Department of Chemistry and
Biochemistry, Texas Tech University, Lubbock, Texas 79415, United States
| | - Corey J. McDonald
- Department of Chemistry and
Biochemistry, Texas Tech University, Lubbock, Texas 79415, United States
| | - Benjamin J. Wylie
- Department of Chemistry and
Biochemistry, Texas Tech University, Lubbock, Texas 79415, United States
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Adel-Patient K, Campeotto F, Grauso M, Guillon B, Moroldo M, Venot E, Dietrich C, Machavoine F, Castelli FA, Fenaille F, Molina TJ, Barbet P, Delacourt C, Leite-de-Moraes M, Lezmi G. Assessment of local and systemic signature of eosinophilic esophagitis (EoE) in children through multi-omics approaches. Front Immunol 2023; 14:1108895. [PMID: 37006253 PMCID: PMC10050742 DOI: 10.3389/fimmu.2023.1108895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundEosinophilic oesophagitis (EoE) is a chronic food allergic disorder limited to oesophageal mucosa whose pathogenesis is still only partially understood. Moreover, its diagnosis and follow-up need repeated endoscopies due to absence of non-invasive validated biomarkers. In the present study, we aimed to deeply describe local immunological and molecular components of EoE in well-phenotyped children, and to identify potential circulating EoE-biomarkers.MethodsBlood and oesophageal biopsies were collected simultaneously from French children with EoE (n=17) and from control subjects (n=15). Untargeted transcriptomics analysis was performed on mRNA extracted from biopsies using microarrays. In parallel, we performed a comprehensive analysis of immune components on both cellular and soluble extracts obtained from both biopsies and blood, using flow cytometry. Finally, we performed non-targeted plasma metabolomics using liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS). Uni/multivariate supervised and non-supervised statistical analyses were then conducted to identify significant and discriminant components associated with EoE within local and/or systemic transcriptomics, immunologic and metabolomics datasets. As a proof of concept, we conducted multi-omics data integration to identify a plasmatic signature of EoE.ResultsFrench children with EoE shared the same transcriptomic signature as US patients. Network visualization of differentially expressed (DE) genes highlighted the major dysregulation of innate and adaptive immune processes, but also of pathways involved in epithelial cells and barrier functions, and in perception of chemical stimuli. Immune analysis of biopsies highlighted EoE is associated with dysregulation of both type (T) 1, T2 and T3 innate and adaptive immunity, in a highly inflammatory milieu. Although an immune signature of EoE was found in blood, untargeted metabolomics more efficiently discriminated children with EoE from control subjects, with dysregulation of vitamin B6 and various amino acids metabolisms. Multi-blocks integration suggested that an EoE plasma signature may be identified by combining metabolomics and cytokines datasets.ConclusionsOur study strengthens the evidence that EoE results from alterations of the oesophageal epithelium associated with altered immune responses far beyond a simplistic T2 dysregulation. As a proof of concept, combining metabolomics and cytokines data may provide a set of potential plasma biomarkers for EoE diagnosis, which needs to be confirmed on a larger and independent cohort.
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Affiliation(s)
- Karine Adel-Patient
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), Gif-sur-Yvette, France
- *Correspondence: Karine Adel-Patient, ; Guillaume Lezmi,
| | - Florence Campeotto
- AP-HP, Hôpital Necker-Enfants Malades, Service de Gastro-Entérologie et Nutrition Pédiatriques, Paris, France
- Université de Paris Cité, INSERM UMR1139, Laboratoire de Microbiologie, Faculté de Pharmacie, Paris, France
| | - Marta Grauso
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), Gif-sur-Yvette, France
| | - Blanche Guillon
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), Gif-sur-Yvette, France
| | - Marco Moroldo
- Université Paris Saclay, INRAE, AgroParisTech, GABI, Jouy-en-Josas, France
| | - Eric Venot
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), Gif-sur-Yvette, France
| | - Céline Dietrich
- Université Paris Cité, CNRS UMR 8253, Inserm UMR 1151, Institut Necker Enfants Malades, Equipe Immunorégulation et Immunopathologie, Paris, France
| | - François Machavoine
- Université Paris Cité, CNRS UMR 8253, Inserm UMR 1151, Institut Necker Enfants Malades, Equipe Immunorégulation et Immunopathologie, Paris, France
| | - Florence A. Castelli
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), Gif-sur-Yvette, France
| | - François Fenaille
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), Gif-sur-Yvette, France
| | - Thierry Jo Molina
- Université de Paris, UMRS 1138, INSERM, Sorbonne Paris-Cité, Paris, France
- AP-HP, Centre-Université de Paris, hôpital Necker-Enfant-Malades, Service d'Anatomie et Cytologie Pathologiques, Paris, France
| | - Patrick Barbet
- Université de Paris, UMRS 1138, INSERM, Sorbonne Paris-Cité, Paris, France
- AP-HP, Centre-Université de Paris, hôpital Necker-Enfant-Malades, Service d'Anatomie et Cytologie Pathologiques, Paris, France
| | - Christophe Delacourt
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France
| | - Maria Leite-de-Moraes
- Université Paris Cité, CNRS UMR 8253, Inserm UMR 1151, Institut Necker Enfants Malades, Equipe Immunorégulation et Immunopathologie, Paris, France
| | - Guillaume Lezmi
- Université Paris Cité, CNRS UMR 8253, Inserm UMR 1151, Institut Necker Enfants Malades, Equipe Immunorégulation et Immunopathologie, Paris, France
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et Allergologie Pédiatriques, Paris, France
- *Correspondence: Karine Adel-Patient, ; Guillaume Lezmi,
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12
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Alvarado D, Lu Y, Shoda T, Caldwell JM, Keler T, Rothenberg ME. Strong association of mast cells with eosinophilic esophagitis-specific signatures. Allergy 2023; 78:583-586. [PMID: 36278970 PMCID: PMC10098655 DOI: 10.1111/all.15562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 02/01/2023]
Affiliation(s)
| | - Yufang Lu
- Celldex Therapeutics, Hampton, New Jersey, USA
| | - Tetsuo Shoda
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Julie M Caldwell
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tibor Keler
- Celldex Therapeutics, Hampton, New Jersey, USA
| | - Marc E Rothenberg
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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13
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Dellon ES, Spergel JM. Biologics in eosinophilic gastrointestinal diseases. Ann Allergy Asthma Immunol 2023; 130:21-27. [PMID: 35738437 PMCID: PMC10191215 DOI: 10.1016/j.anai.2022.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
Eosinophilic gastrointestinal diseases are a constellation of conditions categorized by the location of eosinophilic infiltration in the gastrointestinal tract. Symptoms vary based on location of eosinophils and age of the patient. There are no approved medications at the current time with individuals using off-label steroids or dietary therapy. Translational research has identified potential pathways to target in the treatment of eosinophilic esophagitis (EoE), gastritis (EoG), and enteritis (EoN), including type 2 pathways, mast cells, and eosinophils. Preliminary studies found cendakimab (anti-interleukin [IL]-13) and dupilumab (anti-IL-4 receptor alpha) to have an effect on eosinophil count and symptoms with dupilumab recently approved. In addition, mepolizumab (anti-IL-5), reslizumab (anti-IL-5), and lirentelimab (anti-Siglec 8) were found to have reduction in eosinophils without reduction of symptoms. For EoG and EoN, both benralizumab (anti-IL-5 receptor) and lirentelimab were found to have histologic and symptom improvement. There are no agents studied for eosinophilic colitis. Results of ongoing phase 3 trials in EoE and EoG/EoN are also anticipated.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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14
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Underwood B, Troutman TD, Schwartz JT. Breaking down the complex pathophysiology of eosinophilic esophagitis. Ann Allergy Asthma Immunol 2023; 130:28-39. [PMID: 36351516 PMCID: PMC10165615 DOI: 10.1016/j.anai.2022.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic and progressive immune-mediated disease of the esophagus associated with antigen-driven type 2 inflammation and symptoms of esophageal dysfunction. Our understanding of EoE pathophysiology has evolved since its initial recognition more than 20 years ago and has translated into diagnostic and novel therapeutic approaches that are affecting patient care. The mechanisms underlying disease development and progression are influenced by diverse factors, such as genetics, age, allergic comorbidities, and allergen exposures. Central to EoE pathophysiology is a dysregulated feed-forward cycle that develops between the esophageal epithelium and the immune system. Allergen-induced, type 2-biased immune activation by the esophageal epithelium propagates a cycle of impaired mucosal barrier integrity and allergic inflammation, eventually leading to tissue remodeling and progressive organ dysfunction. Herein, we review the current understanding of fundamental pathophysiological mechanisms contributing to EoE pathogenesis.
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Affiliation(s)
- Brynne Underwood
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ty D Troutman
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Justin T Schwartz
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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15
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Dellon ES, Rothenberg ME, Collins MH, Hirano I, Chehade M, Bredenoord AJ, Lucendo AJ, Spergel JM, Aceves S, Sun X, Kosloski MP, Kamal MA, Hamilton JD, Beazley B, McCann E, Patel K, Mannent LP, Laws E, Akinlade B, Amin N, Lim WK, Wipperman MF, Ruddy M, Patel N, Weinreich DR, Yancopoulos GD, Shumel B, Maloney J, Giannelou A, Shabbir A. Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med 2022; 387:2317-2330. [PMID: 36546624 DOI: 10.1056/nejmoa2205982] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dupilumab, a fully human monoclonal antibody, blocks interleukin-4 and interleukin-13 signaling, which have key roles in eosinophilic esophagitis. METHODS We conducted a three-part, phase 3 trial in which patients 12 years of age or older underwent randomization in a 1:1 ratio to receive subcutaneous dupilumab at a weekly dose of 300 mg or placebo (Part A) or in a 1:1:1 ratio to receive 300 mg of dupilumab either weekly or every 2 weeks or weekly placebo (Part B) up to week 24. Eligible patients who completed Part A or Part B continued the trial in Part C, in which those who completed Part A received dupilumab at a weekly dose of 300 mg up to week 52 (the Part A-C group); Part C that included the eligible patients from Part B is ongoing. The two primary end points at week 24 were histologic remission (≤6 eosinophils per high-power field) and the change from baseline in the Dysphagia Symptom Questionnaire (DSQ) score (range, 0 to 84, with higher values indicating more frequent or more severe dysphagia). RESULTS In Part A, histologic remission occurred in 25 of 42 patients (60%) who received weekly dupilumab and in 2 of 39 patients (5%) who received placebo (difference, 55 percentage points; 95% confidence interval [CI], 40 to 71; P<0.001). In Part B, histologic remission occurred in 47 of 80 patients (59%) with weekly dupilumab, in 49 of 81 patients (60%) with dupilumab every 2 weeks, and in 5 of 79 patients (6%) with placebo (difference between weekly dupilumab and placebo, 54 percentage points; 95% CI, 41 to 66 [P<0.001]; difference between dupilumab every 2 weeks and placebo, 56 percentage points; 95% CI, 43 to 69 [not significant per hierarchical testing]). The mean (±SD) DSQ scores at baseline were 33.6±12.41 in Part A and 36.7±11.22 in Part B; the scores improved with weekly dupilumab as compared with placebo, with differences of -12.32 (95% CI, -19.11 to -5.54) in Part A and -9.92 (95% CI, -14.81 to -5.02) in Part B (both P<0.001) but not with dupilumab every 2 weeks (difference in Part B, -0.51; 95% CI, -5.42 to 4.41). Serious adverse events occurred in 9 patients during the Part A or B treatment period (in 7 who received weekly dupilumab, 1 who received dupilumab every 2 weeks, and 1 who received placebo) and in 1 patient in the Part A-C group during the Part C treatment period who received placebo in Part A and weekly dupilumab in Part C. CONCLUSIONS Among patients with eosinophilic esophagitis, subcutaneous dupilumab administered weekly improved histologic outcomes and alleviated symptoms of the disease. (Funded by Sanofi and Regeneron Pharmaceuticals; ClinicalTrials.gov number, NCT03633617.).
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Affiliation(s)
- Evan S Dellon
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Marc E Rothenberg
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Margaret H Collins
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Ikuo Hirano
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Mirna Chehade
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Albert J Bredenoord
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Alfredo J Lucendo
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Jonathan M Spergel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Seema Aceves
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Xian Sun
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Matthew P Kosloski
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Mohamed A Kamal
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Jennifer D Hamilton
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Bethany Beazley
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Eilish McCann
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Kiran Patel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Leda P Mannent
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Elizabeth Laws
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Bolanle Akinlade
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Nikhil Amin
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Wei Keat Lim
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Matthew F Wipperman
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Marcella Ruddy
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Naimish Patel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - David R Weinreich
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - George D Yancopoulos
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Brad Shumel
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Jennifer Maloney
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Angeliki Giannelou
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
| | - Arsalan Shabbir
- From the Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill (E.S.D.); Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati (M.E.R., M.H.C.); Northwestern University Feinberg School of Medicine, Chicago (I.H.); Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York (M.C.), and Regeneron Pharmaceuticals, Tarrytown (X.S., M.P.K., M.A.K., J.D.H., B.B., E.M., B.A., N.A., W.K.L., M.F.W., M.R., D.R.W., G.D.Y., B.S., J.M., A.G., A.S.) - both in New York; Amsterdam University Medical Center, Amsterdam (A.J.B.); Hospital General de Tomelloso, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, and Instituto de Investigación Sanitaria de Castilla-La Mancha, Toledo - both in Spain (A.J.L.); Children's Hospital of Philadelphia, Philadelphia (J.M.S.); University of California, San Diego, La Jolla, and Rady Children's Hospital, San Diego - both in California (S.A.); Sanofi, Bridgewater, NJ (K.P., E.L.); Sanofi, Chilly-Mazarin, France (L.P.M.); and Sanofi, Cambridge, MA (N.P.)
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Maggi E, Parronchi P, Azzarone BG, Moretta L. A pathogenic integrated view explaining the different endotypes of asthma and allergic disorders. Allergy 2022; 77:3267-3292. [PMID: 35842745 DOI: 10.1111/all.15445] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/28/2023]
Abstract
The inflammation of allergic diseases is characterized by a complex interaction between type 2 and type 3 immune responses, explaining clinical symptoms and histopathological patterns. Airborne stimuli activate the mucosal epithelium to release a number of molecules impacting the activity of resident immune and environmental cells. Signals from the mucosal barrier, regulatory cells, and the inflamed tissue are crucial conditions able to modify innate and adaptive effector cells providing the selective homing of eosinophils or neutrophils. The high plasticity of resident T- and innate lymphoid cells responding to external signals is the prerequisite to explain the multiplicity of endotypes of allergic diseases. This notion paved the way for the huge use of specific biologic drugs interfering with pathogenic mechanisms of inflammation. Based on the response of the epithelial barrier, the activity of resident regulatory cells, and functions of structural non-lymphoid environmental cells, this review proposes some immunopathogenic scenarios characterizing the principal endotypes which can be associated with a precise phenotype of asthma. Recent literature indicates that similar concepts can also be applied to the inflammation of other non-respiratory allergic disorders. The next challenges will consist in defining specific biomarker(s) of each endotype allowing for a quick diagnosis and the most effective personalized therapy.
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Affiliation(s)
- Enrico Maggi
- Department of Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Parronchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Lorenzo Moretta
- Department of Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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17
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Khokhar D, Marella S, Idelman G, Chang JW, Chehade M, Hogan SP. Eosinophilic esophagitis: Immune mechanisms and therapeutic targets. Clin Exp Allergy 2022; 52:1142-1156. [PMID: 35778876 PMCID: PMC9547832 DOI: 10.1111/cea.14196] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 01/26/2023]
Abstract
Eosinophilic esophagitis (EoE) is an emerging chronic inflammatory disease of the oesophagus and is clinically characterized by upper gastrointestinal (GI) symptoms including dysphagia and esophageal food impaction. Histopathologic manifestations, which include intraepithelial eosinophilic inflammation and alterations of the esophageal squamous epithelium, such as basal zone hyperplasia (BZH) and dilated intercellular spaces (DIS), are thought to contribute to esophageal dysfunction and disease symptoms. Corroborative clinical and discovery science-based studies have established that EoE is characterized by an underlying allergic inflammatory response, in part, related to the IL-13/CCL26/eosinophil axis driving dysregulation of several key epithelial barrier and proliferative regulatory genes including kallikrein (KLK) serine proteases, calpain 14 (CAPN14) and anoctamin 1 (ANO1). The contribution of these inflammatory and proliferative processes to the clinical and histological manifestations of disease are not fully elucidated. Herein, we discuss the immune molecules and cells that are thought to underlie the clinical and pathologic manifestations of EoE and the emerging therapeutics targeting these processes for the treatment of EoE.
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Affiliation(s)
- Dilawar Khokhar
- Division of Allergy and ImmunologyUniversity of MichiganAnn ArborMichiganUSA
- Mary H Weiser Food Allergy CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Sahiti Marella
- Mary H Weiser Food Allergy CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of PathologyUniversity of MichiganAnn ArborMichiganUSA
| | - Gila Idelman
- Mary H Weiser Food Allergy CenterUniversity of MichiganAnn ArborMichiganUSA
| | - Joy W. Chang
- Division of Gastroenterology, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic DisordersIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Simon P. Hogan
- Mary H Weiser Food Allergy CenterUniversity of MichiganAnn ArborMichiganUSA
- Department of PathologyUniversity of MichiganAnn ArborMichiganUSA
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18
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Franceschini L, Farsi A. Eosinophilic oesophagitis and type 2 inflammation multimorbidity: an opportunity for biologic treatment. Lancet Gastroenterol Hepatol 2022; 7:787-788. [PMID: 35932768 DOI: 10.1016/s2468-1253(22)00177-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Laura Franceschini
- Allergology and Clinical Immunology Unit, Santo Stefano Hospital, Prato 59100, Italy
| | - Alessandro Farsi
- Allergology and Clinical Immunology Unit, Santo Stefano Hospital, Prato 59100, Italy.
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19
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Disease Burden and Unmet Need in Eosinophilic Esophagitis. Am J Gastroenterol 2022; 117:1231-1241. [PMID: 35417421 DOI: 10.14309/ajg.0000000000001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/04/2022] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory disease of increasing prevalence, characterized by symptoms of dysphagia and reduced quality of life. A dysregulated type 2 immune response to food and aeroallergen leads to barrier dysfunction, chronic esophageal inflammation, remodeling, and fibrosis. Patients with EoE have impaired quality of life because of dysphagia and other symptoms. They may also suffer social and psychological implications of food-related illness and expensive out-of-pocket costs associated with treatment. Disease burden in EoE is often compounded by the presence of comorbid type 2 inflammatory diseases. Current conventional treatments include elimination diet, proton pump inhibitors, and swallowed topical corticosteroids, as well as esophageal dilation in patients who have developed strictures. These treatments demonstrate variable response rates and may not always provide long-term disease control. There is an unmet need for long-term histologic, endoscopic, and symptomatic disease control; for targeted therapies that can normalize the immune response to triggers, reduce chronic inflammation, and limit or prevent remodeling and fibrosis; and for earlier diagnosis, defined treatment outcomes, and a greater understanding of patient perspectives on treatment. In addition, healthcare professionals need a better understanding of the patient perspective on disease burden, the disconnect between symptoms and disease activity, and the progressive nature of EoE and the need for continuous monitoring and maintenance treatment. In this review, we explore the progression of disease over the patient's lifespan, highlight the patient perspective on disease, and discuss the unmet need for effective long-term treatments.
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Dellon ES, Khoury P, Muir AB, Liacouras CA, Safroneeva E, Atkins D, Collins MH, Gonsalves N, Falk GW, Spergel JM, Hirano I, Chehade M, Schoepfer AM, Menard-Katcher C, Katzka DA, Bonis PA, Bredenoord AJ, Geng B, Jensen ET, Pesek RD, Feuerstadt P, Gupta SK, Lucendo AJ, Genta RM, Hiremath G, McGowan EC, Moawad FJ, Peterson KA, Rothenberg ME, Straumann A, Furuta GT, Aceves SS. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology 2022; 163:59-76. [PMID: 35606197 PMCID: PMC9233087 DOI: 10.1053/j.gastro.2022.03.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Disease activity and severity of eosinophilic esophagitis (EoE) dictate therapeutic options and management, but the decision-making process for determining severity varies among practitioners. To reduce variability in practice patterns and help clinicians monitor the clinical course of the disease in an office setting, we aimed to create an international consensus severity scoring index for EoE. METHODS A multidisciplinary international group of adult and pediatric EoE researchers and clinicians, as well as non-EoE allergy immunology and gastroenterology experts, formed 3 teams to review the existing literature on histology, endoscopy, and symptoms of EoE in the context of progression and severity. A steering committee convened a 1-day virtual meeting to reach consensus on each team's opinion on salient features of severity across key clinicopathologic domains and distill features that would allow providers to categorize disease severity. RESULTS Symptom features and complications and inflammatory and fibrostenotic features on both endoscopic and histologic examination were collated into a simplified scoring system-the Index of Severity for Eosinophilic Esophagitis (I-SEE)-that can be completed at routine clinic visits to assess disease severity using a point scale of 0-6 for mild, 7-14 for moderate, and ≥15 for severe EoE. CONCLUSIONS A multidisciplinary team of experts iteratively created a clinically usable EoE severity scoring system denominated "I-SEE" to guide practitioners in EoE management by standardizing disease components reflecting disease severity beyond eosinophil counts. I-SEE should be validated and refined using data from future clinical trials and routine clinical practice to increase its utilization and functionality.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Amanda B Muir
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris A Liacouras
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Eosinophilic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Margaret H Collins
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nirmala Gonsalves
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gary W Falk
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ikuo Hirano
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alain M Schoepfer
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Calies Menard-Katcher
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | | | | | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Bob Geng
- University of California San Diego, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Elizabeth T Jensen
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert D Pesek
- Division of Allergy/Immunology, University of Arkansas for Medicine Sciences, Little Rock, Arkansas; Arkansas Children's Hospital, Little Rock, Arkansas
| | - Paul Feuerstadt
- Division of Gastroenterology, Yale-New Haven Hospital, New Haven, Connecticut; Physicians Alliance of Connecticut, Gastroenterology Center, Hamden, Connecticut
| | - Sandeep K Gupta
- Section of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis, Indiana; Riley Hospital for Children, Indianapolis, Indiana; Community Health Network, Indianapolis, Indiana
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Ciudad Real, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | | - Girish Hiremath
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Emily C McGowan
- Allergy and Clinical Immunology, University of Virginia, Charlottesville, Virginia
| | - Fouad J Moawad
- Division of Gastroenterology, Scripps Clinic, La Jolla, California
| | - Kathryn A Peterson
- Division of Gastroenterology, University of Utah Health, Salt Lake City, Utah
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program and Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Seema S Aceves
- Rady Children's Hospital, San Diego, California; Division of Allergy, Immunology, University of California-San Diego, San Diego, California
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21
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Dellon ES, Khoury P, Muir AB, Liacouras CA, Safroneeva E, Atkins D, Collins MH, Gonsalves N, Falk GW, Spergel JM, Hirano I, Chehade M, Schoepfer AM, Menard-Katcher C, Katzka DA, Bonis PA, Bredenoord AJ, Geng B, Jensen ET, Pesek RD, Feuerstadt P, Gupta SK, Lucendo AJ, Genta RM, Hiremath G, McGowan EC, Moawad FJ, Peterson KA, Rothenberg ME, Straumann A, Furuta GT, Aceves SS. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. J Allergy Clin Immunol 2022; 150:33-47. [PMID: 35606166 PMCID: PMC9549868 DOI: 10.1016/j.jaci.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Disease activity and severity of eosinophilic esophagitis (EoE) dictate therapeutic options and management, but the decision-making process for determining severity varies among practitioners. To reduce variability in practice patterns and help clinicians monitor the clinical course of the disease in an office setting, we aimed to create an international consensus severity scoring index for EoE. METHODS A multidisciplinary international group of adult and pediatric EoE researchers and clinicians, as well as non-EoE allergy immunology and gastroenterology experts, formed 3 teams to review the existing literature on histology, endoscopy, and symptoms of EoE in the context of progression and severity. A steering committee convened a 1-day virtual meeting to reach consensus on each team's opinion on salient features of severity across key clinicopathologic domains and distill features that would allow providers to categorize disease severity. RESULTS Symptom features and complications and inflammatory and fibrostenotic features on both endoscopic and histologic examination were collated into a simplified scoring system-the Index of Severity for Eosinophilic Esophagitis (I-SEE)-that can be completed at routine clinic visits to assess disease severity using a point scale of 0-6 for mild, 7-14 for moderate, and ≥15 for severe EoE. CONCLUSIONS A multidisciplinary team of experts iteratively created a clinically usable EoE severity scoring system denominated "I-SEE" to guide practitioners in EoE management by standardizing disease components reflecting disease severity beyond eosinophil counts. I-SEE should be validated and refined using data from future clinical trials and routine clinical practice to increase its utilization and functionality.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill.
| | - Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda
| | - Amanda B Muir
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Philadelphia
| | - Chris A Liacouras
- Division of Gastroenterology, Hepatology, and Nutrition, Perelman School of Medicine, University of Pennsylvania, Philadelphia; The Children's Hospital of Philadelphia, Philadelphia; Center for Pediatric Eosinophilic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora; Children's Hospital Colorado, Aurora
| | - Margaret H Collins
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati; Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Nirmala Gonsalves
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Gary W Falk
- The Children's Hospital of Philadelphia, Philadelphia; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jonathan M Spergel
- The Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ikuo Hirano
- Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York
| | - Alain M Schoepfer
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
| | - Calies Menard-Katcher
- Department of Pediatrics, University of Colorado School of Medicine, Aurora; Digestive Health Institute, Children's Hospital Colorado, Aurora
| | | | | | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam
| | - Bob Geng
- University of California San Diego, San Diego; Rady Children's Hospital, San Diego
| | - Elizabeth T Jensen
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem
| | - Robert D Pesek
- Division of Allergy/Immunology, University of Arkansas for Medicine Sciences, Little Rock; Arkansas Children's Hospital, Little Rock
| | - Paul Feuerstadt
- Division of Gastroenterology, Yale-New Haven Hospital, New Haven; Physicians Alliance of Connecticut, Gastroenterology Center, Hamden
| | - Sandeep K Gupta
- Section of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis; Riley Hospital for Children, Indianapolis; Community Health Network, Indianapolis
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Ciudad Real; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid; Instituto de Investigación Sanitaria La Princesa, Madrid
| | | | - Girish Hiremath
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Emily C McGowan
- Allergy and Clinical Immunology, University of Virginia, Charlottesville
| | | | | | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | | | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora; Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program and Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora
| | - Seema S Aceves
- Rady Children's Hospital, San Diego; Division of Allergy, Immunology, University of California-San Diego, San Diego
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Shoda T, Collins MH, Rochman M, Wen T, Caldwell JM, Mack LE, Osswald GA, Besse JA, Haberman Y, Aceves SS, Arva NC, Capocelli KE, Chehade M, Davis CM, Dellon ES, Falk GW, Gonsalves N, Gupta SK, Hirano I, Khoury P, Klion A, Menard-Katcher C, Leung J, Mukkada VA, Putnam PE, Spergel JM, Wechsler JB, Yang GY, Furuta GT, Denson LA, Rothenberg ME. Evaluating Eosinophilic Colitis as a Unique Disease Using Colonic Molecular Profiles: A Multi-Site Study. Gastroenterology 2022; 162:1635-1649. [PMID: 35085569 PMCID: PMC9038694 DOI: 10.1053/j.gastro.2022.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Colonic eosinophilia, an enigmatic finding often referred to as eosinophilic colitis (EoC), is a poorly understood condition. Whether EoC is a distinct disease or a colonic manifestation of eosinophilic gastrointestinal diseases (EGIDs) or inflammatory bowel disease (IBD) is undetermined. METHODS Subjects with EoC (n = 27) and controls (normal [NL, n = 20], Crohn's disease [CD, n = 14]) were enrolled across sites associated with the Consortium of Eosinophilic Gastrointestinal Disease Researchers. EoC was diagnosed as colonic eosinophilia (ascending ≥100, descending ≥85, sigmoid ≥65 eosinophils/high-power field) with related symptoms. Colon biopsies were subjected to RNA sequencing. Associations between gene expression and histologic features were analyzed with Spearman correlation; operational pathways and cellular constituents were computationally derived. RESULTS We identified 987 differentially expressed genes (EoC transcriptome) between EoC and NL (>1.5-fold change, P < .05). Colonic eosinophil count correlated with 31% of EoC transcriptome, most notably with CCL11 and CLC (r = 0.78 and 0.77, P < .0001). Among EoC and other EGIDs, there was minimal transcriptomic overlap and minimal evidence of a strong allergic type 2 immune response in EoC compared with other EGIDs. Decreased cell cycle and increased apoptosis in EoC compared with NL were identified by functional enrichment analysis and immunostaining using Ki-67 and cleaved caspase-3. Pericryptal circumferential eosinophil collars were associated with the EoC transcriptome (P < .001). EoC transcriptome-based scores were reversible with disease remission and differentiated EoC from IBD, even after controlling for colonic eosinophil levels (P < .0001). CONCLUSIONS We established EoC transcriptomic profiles, identified mechanistic pathways, and integrated findings with parallel IBD and EGID data. These findings establish EoC as a distinct disease compared with other EGIDs and IBD, thereby providing a basis for improving diagnosis and treatment.
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Affiliation(s)
- Tetsuo Shoda
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margaret H Collins
- Division of Pathology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Rochman
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ting Wen
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah
| | - Julie M Caldwell
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lydia E Mack
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Garrett A Osswald
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John A Besse
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yael Haberman
- Division of Gastroenterology, Hepatology, and Nutrition, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, Sheba Medical Center, Tel-HaShomer, affiliated with the Tel-Aviv University, Israel
| | - Seema S Aceves
- Division of Allergy Immunology, Departments of Pediatrics and Medicine, University of California, San Diego, Rady Children's Hospital, San Diego, California
| | - Nicoleta C Arva
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carla M Davis
- Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine & Texas Children's Hospital, Houston, Texas
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gary W Falk
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nirmala Gonsalves
- Division of Gastroenterology & Hepatology, Northwestern University, Chicago, Illinois
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children/Indiana University, and Community Health Network, Indianapolis, Indiana
| | - Ikuo Hirano
- Division of Gastroenterology & Hepatology, Northwestern University, Chicago, Illinois
| | - Paneez Khoury
- Human Eosinophil Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Amy Klion
- Human Eosinophil Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Calies Menard-Katcher
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - John Leung
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology, and Nutrition, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology, and Nutrition, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan M Spergel
- Division of Allergy and Immunology, University of Pennsylvania Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua B Wechsler
- Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Guang-Yu Yang
- Department of Pathology and Laboratory Medicine, Northwestern University, Chicago, Illinois
| | - Glenn T Furuta
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Lee A Denson
- Division of Gastroenterology, Hepatology, and Nutrition, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marc E Rothenberg
- Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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23
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Dellon ES, Simon D, Wechsler ME. Controversies in Allergy: The Potential Role of Biologics as First-Line Therapy in Eosinophilic Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1169-1176. [PMID: 35167955 PMCID: PMC9086115 DOI: 10.1016/j.jaip.2022.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 01/11/2023]
Abstract
With advances in understanding the role of eosinophils in disease pathogenesis, particularly in the airways, gastrointestinal tract, and skin, targeting eosinophils or the cytokines that lead to their production, activation, and survival has become an increasingly pursued therapeutic approach. Newly developed biologic agents target eosinophils directly, other cells interacting with or activating eosinophils, or cytokines in the type 2 inflammatory pathway with specific antibodies. Current treatment paradigms reserve therapy with biologics for patients refractory to or intolerant of corticosteroids or immunosuppressants. Given accumulating data for safety and efficacy of these biologics, however, there is the question of whether targeted treatments should be used earlier in the treatment algorithm. In this article, we discuss the pros and cons of using biologics as first-line therapy for eosinophilic diseases of the airways, gastrointestinal tract, and skin. We highlight emerging biologic agents and future directions for research, as well as a rationale for the early use of some biologics to prevent tissue damage, disease progression, and organ dysfunction in selected conditions.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Diseases, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael E Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo
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24
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Maggi E, Azzarone BG, Canonica GW, Moretta L. What we know and still ignore on COVID-19 immune pathogenesis and a proposal based on the experience of allergic disorders. Allergy 2022; 77:1114-1128. [PMID: 34582050 PMCID: PMC8652765 DOI: 10.1111/all.15112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic started in March 2020 and caused over 5 million confirmed deaths worldwide as far August 2021. We have been recently overwhelmed by a wide literature on how the immune system recognizes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and contributes to COVID-19 pathogenesis. Although originally considered a respiratory viral disease, COVID-19 is now recognized as a far more complex, multi-organ-, immuno-mediated-, and mostly heterogeneous disorder. Though efficient innate and adaptive immunity may control infection, when the patient fails to mount an adequate immune response at the start, or in advanced disease, a high innate-induced inflammation can lead to different clinical outcomes through heterogeneous compensatory mechanisms. The variability of viral load and persistence, the genetic alterations of virus-driven receptors/signaling pathways and the plasticity of innate and adaptive responses may all account for the extreme heterogeneity of pathogenesis and clinical patterns. As recently applied to some inflammatory disorders as asthma, rhinosinusitis with polyposis, and atopic dermatitis, herein we suggest defining different endo-types and the related phenotypes along COVID-19. Patients should be stratified for evolving symptoms and tightly monitored for surrogate biomarkers of innate and adaptive immunity. This would allow to preventively identify each endo-type (and its related phenotype) and to treat patients precisely with agents targeting pathogenic mechanisms.
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Affiliation(s)
- Enrico Maggi
- Department of ImmunologyBambino Gesù Children’s HospitalIRCCSRomeItaly
| | | | | | - Lorenzo Moretta
- Department of ImmunologyBambino Gesù Children’s HospitalIRCCSRomeItaly
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25
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Dunn JLM, Rothenberg ME. 2021 year in review: Spotlight on eosinophils. J Allergy Clin Immunol 2021; 149:517-524. [PMID: 34838883 DOI: 10.1016/j.jaci.2021.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
This review highlights recent advances in the understanding of eosinophils and eosinophilic diseases, particularly eosinophilic gastrointestinal diseases during the last year. The increasing incidence of diseases marked by eosinophilia has been documented and highlighted the need to understand eosinophil biology and eosinophilic contributions to disease. Significant insight into the nature of eosinophilic diseases has been achieved using next-generation sequencing technologies, proteomic analysis, and machine learning to analyze tissue biopsies. These technologies have elucidated mechanistic underpinnings of eosinophilic inflammation, delineated patient endotypes, and identified patient responses to therapeutic intervention. Importantly, recent clinical studies using mAbs that interfere with type 2 cytokine signaling or deplete eosinophils point to multiple and complex roles of eosinophils in tissues. Several studies identified distinct activation features of eosinophils in different tissues and disease states. The confluence of these studies supports a new paradigm of tissue-resident eosinophils that have pro- and anti-inflammatory immunomodulatory roles in allergic disease. Improved understanding of unique eosinophil activation states is now poised to identify novel therapeutic targets for eosinophilic diseases.
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Affiliation(s)
- Julia L M Dunn
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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26
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Barni S, Arasi S, Mastrorilli C, Pecoraro L, Giovannini M, Mori F, Liotti L, Saretta F, Castagnoli R, Caminiti L, Cianferoni A, Novembre E. Pediatric eosinophilic esophagitis: a review for the clinician. Ital J Pediatr 2021; 47:230. [PMID: 34809686 PMCID: PMC8609874 DOI: 10.1186/s13052-021-01178-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic clinical-pathologic disease characterized by eosinophilic infiltration of the esophageal epithelium with esophageal dysfunction symptoms.EoE can occur at any age and has different clinical manifestations depending on the age onset.To date, esophago-gastroduodenal endoscopy (EGD) with biopsy is the gold-standard for EoE diagnosis.According to the recent consensus guidelines, proton pump inhibitors, corticosteroids and elimination diets could be a first-line therapy option. The aim of the treatment is clinical and histological remission for preventing long-lasting untreatable fibrosis.A multidisciplinary approach (allergist, gastroenterology, dietitian, and pathologist) is recommended for managing patients affected by EoE, given the complexity of its treatment.This review will provide a practical guide to assist pediatricians treating children with EoE.Moreover, it highlights the unmet needs in diagnosis and treatment that require urgent attention from the scientific community in the aim of improving the management of patients with EoE.
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Affiliation(s)
- Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
| | - Stefania Arasi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Pediatric Allergy Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Pecoraro
- Department of Medicine, University of Verona, Policlinico GB Rossi, Verona, Italy
- Pediatric Unit, ASST Mantua, Mantua, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
| | - Lucia Liotti
- Pediatric Unit, Senigallia Hospital, Senigallia, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age “Gaetano Barresi”, Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Antonella Cianferoni
- Pediatrics Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Allergy and Immunology Division, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
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27
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van Aalst E, Wylie BJ. Cholesterol Is a Dose-Dependent Positive Allosteric Modulator of CCR3 Ligand Affinity and G Protein Coupling. Front Mol Biosci 2021; 8:724603. [PMID: 34490352 PMCID: PMC8417553 DOI: 10.3389/fmolb.2021.724603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/14/2021] [Indexed: 01/14/2023] Open
Abstract
Cholesterol as an allosteric modulator of G protein-coupled receptor (GPCR) function is well documented. This quintessential mammalian lipid facilitates receptor–ligand interactions and multimerization states. Functionally, this introduces a complicated mechanism for the homeostatic modulation of GPCR signaling. Chemokine receptors are Class A GPCRs responsible for immune cell trafficking through the binding of endogenous peptide ligands. CCR3 is a CC motif chemokine receptor expressed by eosinophils and basophils. It traffics these cells by transducing the signal stimulated by the CC motif chemokine primary messengers 11, 24, and 26. These behaviors are close to the human immunoresponse. Thus, CCR3 is implicated in cancer metastasis and inflammatory conditions. However, there is a paucity of experimental evidence linking the functional states of CCR3 to the molecular mechanisms of cholesterol–receptor cooperativity. In this vein, we present a means to combine codon harmonization and a maltose-binding protein fusion tag to produce CCR3 from E. coli. This technique yields ∼2.6 mg of functional GPCR per liter of minimal media. We leveraged this protein production capability to investigate the effects of cholesterol on CCR3 function in vitro. We found that affinity for the endogenous ligand CCL11 increases in a dose-dependent manner with cholesterol concentration in both styrene:maleic acid lipid particles (SMALPs) and proteoliposomes. This heightened receptor activation directly translates to increased signal transduction as measured by the GTPase activity of the bound G-protein α inhibitory subunit 3 (Gαi3). This work represents a critical step forward in understanding the role of cholesterol-GPCR allostery in regulation of signal transduction.
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Affiliation(s)
- Evan van Aalst
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, United States
| | - Benjamin J Wylie
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, United States
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28
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Proper SP, Azouz NP, Mersha TB. Achieving Precision Medicine in Allergic Disease: Progress and Challenges. Front Immunol 2021; 12:720746. [PMID: 34484229 PMCID: PMC8416451 DOI: 10.3389/fimmu.2021.720746] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Allergic diseases (atopic dermatitis, food allergy, eosinophilic esophagitis, asthma and allergic rhinitis), perhaps more than many other traditionally grouped disorders, share several overlapping inflammatory pathways and risk factors, though we are still beginning to understand how the relevant patient and environmental factors uniquely shape each disease. Precision medicine is the concept of applying multiple levels of patient-specific data to tailor diagnoses and available treatments to the individual; ideally, a patient receives the right intervention at the right time, in order to maximize effectiveness but minimize morbidity, mortality and cost. While precision medicine in allergy is in its infancy, the recent success of biologics, development of tools focused on large data set integration and improved sampling methods are encouraging and demonstrates the utility of refining our understanding of allergic endotypes to improve therapies. Some of the biggest challenges to achieving precision medicine in allergy are characterizing allergic endotypes, understanding allergic multimorbidity relationships, contextualizing the impact of environmental exposures (the “exposome”) and ancestry/genetic risks, achieving actionable multi-omics integration, and using this information to develop adequately powered patient cohorts and refined clinical trials. In this paper, we highlight several recently developed tools and methods showing promise to realize the aspirational potential of precision medicine in allergic disease. We also outline current challenges, including exposome sampling and building the “knowledge network” with multi-omics integration.
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Affiliation(s)
- Steven P Proper
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nurit P Azouz
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Tesfaye B Mersha
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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29
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Bidirectional crosstalk between eosinophils and esophageal epithelial cells regulates inflammatory and remodeling processes. Mucosal Immunol 2021; 14:1133-1143. [PMID: 33972688 PMCID: PMC8380647 DOI: 10.1038/s41385-021-00400-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 02/04/2023]
Abstract
Eosinophils accumulate adjacent to epithelial cells in the mucosa of patients with eosinophilic esophagitis (EoE), yet the bidirectional communication between these cells is not well understood. Herein, we investigated the crosstalk between human eosinophils and esophageal epithelial cells. We report that blood-derived eosinophils have prolonged survival when cocultured with epithelial cells; 96 ± 1% and 30 ± 6% viability was observed after 7 and 14 days of coculture, respectively, compared with 1 ± 0% and 0 ± 0% of monoculture. In the presence of IL-13 and epithelial cells, eosinophils had greater survival (68 ± 1%) at 14 days compared with cocultures lacking IL-13. Prolonged eosinophil viability did not require cellular contact and was observed when eosinophils were cultured in conditioned media from esophageal epithelial cells; neutralizing GM-CSF attenuated eosinophil survival. The majority of eosinophil transcripts (58%) were dysregulated in cocultured eosinophils compared with freshly isolated cells. Analysis of epithelial cell transcripts indicated that exposure to eosinophils induced differential expression of a subset of genes that were part of the EoE esophageal transcriptome. Collectively, these results uncover a network of crosstalk between eosinophils and esophageal epithelial cells involving epithelial mediated eosinophil survival and reciprocal changes in cellular transcripts, events likely to occur in EoE.
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30
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van Aalst E, Koneri J, Wylie BJ. In Silico Identification of Cholesterol Binding Motifs in the Chemokine Receptor CCR3. MEMBRANES 2021; 11:570. [PMID: 34436333 PMCID: PMC8401243 DOI: 10.3390/membranes11080570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/14/2023]
Abstract
CC motif chemokine receptor 3 (CCR3) is a Class A G protein-coupled receptor (GPCR) mainly responsible for the cellular trafficking of eosinophils. As such, it plays key roles in inflammatory conditions, such as asthma and arthritis, and the metastasis of many deadly forms of cancer. However, little is known about how CCR3 functionally interacts with its bilayer environment. Here, we investigate cholesterol binding sites in silico through Coarse-Grained Molecular Dynamics (MD) and Pylipid analysis using an extensively validated homology model based on the crystal structure of CCR5. These simulations identified several cholesterol binding sites containing Cholesterol Recognition/Interaction Amino Acid Consensus motif (CRAC) and its inversion CARC motifs in CCR3. One such site, a CARC site in TM1, in conjunction with aliphatic residues in TM7, emerged as a candidate for future investigation based on the cholesterol residency time within the binding pocket. This site forms the core of a cholesterol binding site previously observed in computational studies of CCR2 and CCR5. Most importantly, these cholesterol binding sites are conserved in other chemokine receptors and may provide clues to cholesterol regulation mechanisms in this subfamily of Class A GPCRs.
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Affiliation(s)
| | | | - Benjamin J. Wylie
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX 79423, USA; (E.v.A.); (J.K.)
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31
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Ruffner MA, Zhang Z, Maurer K, Muir AB, Cianferoni A, Sullivan KE, Spergel JM. RNA sequencing identifies global transcriptional changes in peripheral CD4 + cells during active oesophagitis and following epicutaneous immunotherapy in eosinophilic oesophagitis. Clin Transl Immunology 2021; 10:e1314. [PMID: 34322233 PMCID: PMC8296633 DOI: 10.1002/cti2.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 04/28/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE There are no disease-modifying therapies for the treatment of eosinophilic oesophagitis (EoE), which is driven by non-IgE-mediated allergic inflammation. A recent clinical trial of milk epicutaneous immunotherapy (EPIT) has shown initial promise, with 47% of treated EoE patients tolerating milk without recurrence of disease. Mechanisms of EPIT in EoE have not been studied in humans. Here, we identify transcriptional changes in the peripheral CD4+ T-cell compartment during active EoE and following EPIT. METHODS RNA isolation, sequencing and integrative data analysis were performed on peripheral CD4+ T cells isolated from 15 of 20 patients enrolled in a clinical trial of EPIT for EoE. Gene expression changes in peripheral CD4+ T cells were examined during diet therapy and following trial of milk antigen EPIT. RESULTS We identify 244 differentially expressed genes in peripheral blood CD4+ cells of EoE patients consuming versus those eliminating milk, and 129 DEGs in CD4+ cells were isolated after EPIT versus after placebo (FDR ≤ 0.05). Gene set enrichment analysis identifies enrichment of hallmark interferon-α and interferon-γ response pathways in peripheral CD4+ T cells from EoE patients during active disease on a milk-containing diet. We demonstrate overlap of this gene signature with the altered gene expression signature seen in EoE patient biopsy tissue. EPIT therapy response is associated with significant enrichment in pathways related to T-cell receptor signalling (P = 1.16 × 10-14), antigen presentation and costimulation, and cytokine signalling (P = 1.11 × 10-16), as well as upregulation of genes associated with regulatory T-cell function. CONCLUSIONS EoE is associated with distinct global transcriptional changes in CD4+ T cells, one feature of which is an IFN response signature. Clinically favorable response to EPIT is likely multifactorial but is associated with a distinct transcriptional profile in peripheral CD4+ cells supporting the hypothesis that EPIT alters peripheral CD4+ responses in EoE patients.
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Affiliation(s)
- Melanie A Ruffner
- Division of Allergy and ImmunologyThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsThe Perelman School of Medicine at University of PennsylvaniaPhiladelphiaPAUSA
| | - Zhe Zhang
- Department of Biomedical and Health InformaticsThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Kelly Maurer
- Division of Allergy and ImmunologyThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Amanda B Muir
- Department of PediatricsThe Perelman School of Medicine at University of PennsylvaniaPhiladelphiaPAUSA
- Division of Gastroenterology, Hepatology, and NutritionThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Antonella Cianferoni
- Division of Allergy and ImmunologyThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsThe Perelman School of Medicine at University of PennsylvaniaPhiladelphiaPAUSA
| | - Kathleen E Sullivan
- Division of Allergy and ImmunologyThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsThe Perelman School of Medicine at University of PennsylvaniaPhiladelphiaPAUSA
| | - Jonathan M Spergel
- Division of Allergy and ImmunologyThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsThe Perelman School of Medicine at University of PennsylvaniaPhiladelphiaPAUSA
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32
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Yamamoto M, Nagashima S, Yamada Y, Murakoshi T, Shimoyama Y, Takahashi S, Seki H, Kobayashi T, Hara Y, Tadaki H, Ishimura N, Ishihara S, Kinoshita Y, Morita H, Ohya Y, Saito H, Matsumoto K, Nomura I. Comparison of Nonesophageal Eosinophilic Gastrointestinal Disorders with Eosinophilic Esophagitis: A Nationwide Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3339-3349.e8. [PMID: 34214704 DOI: 10.1016/j.jaip.2021.06.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) has increased rapidly and has been well characterized. However, no nationwide survey has been conducted regarding non-esophageal eosinophilic gastrointestinal disorders (non-EoE EGIDs), and they remain poorly understood. OBJECTIVE To compare the clinical features and natural histories of non-EoE EGIDs and EoE by using the same questionnaire, for all ages. METHODS We conducted a nationwide hospital-based survey of patients who visited hospitals from January 2013 through December 2017. We randomly selected 10,000 hospitals that perform endoscopy. We analyzed the demographics, symptoms, gastrointestinal histology, treatments, and natural histories of EoE and non-EoE EGIDs. RESULTS A total of 2906 hospitals responded to the questionnaire. We identified 1542 patients and obtained detailed data for 786 patients, consisting of 39% EoE and 61% non-EoE EGIDs. The clinical characteristics were analyzed for patients who met the "definite" criteria that excluded comorbidities. Non-EoE EGIDs showed no gender difference, whereas EoE was male-predominant. Tissue eosinophilia was often seen in the small intestine (62%) and stomach (49%). The frequency of hypoproteinemia was high (27%) in childhood. Children also had more serious symptoms and complications than adults: restriction of daily life activity (P = .009), failure to grow/weight loss (P = .008), and surgery (P = .01). For both diseases, the most common natural history was the continuous type: 66% (95% confidence interval [CI]: 58-74) in EoE and 64% (95% CI: 55-72) in non-EoE EGIDs. CONCLUSIONS The percentage of persistent patients with non-EoE EGIDs was almost the same as those with EoE. Complications were more frequent in children than in adults.
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Affiliation(s)
- Mayu Yamamoto
- Division of Eosinophilic Gastrointestinal Disorders, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Saori Nagashima
- Division of Eosinophilic Gastrointestinal Disorders, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yoshiyuki Yamada
- Division of Allergy and Immunology, Gunma Children's Medical Center, Gunma, Japan
| | - Takatsugu Murakoshi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yasuyuki Shimoyama
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Sakuma Takahashi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Hideyuki Seki
- Department of Gastroenterology, KKR Sapporo Medical Center, Hokkaido, Japan
| | - Takashi Kobayashi
- Department of Gastroenterology, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Yuichi Hara
- Department of Gastroenterology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Hiromi Tadaki
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, Kanagawa, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology, Shimane University Hospital, Shimane, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Shimane University Hospital, Shimane, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology, Shimane University Hospital, Shimane, Japan; Department of Medicine, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hirohisa Saito
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
| | - Ichiro Nomura
- Division of Eosinophilic Gastrointestinal Disorders, National Research Institute for Child Health and Development, Tokyo, Japan; Allergy Center, National Center for Child Health and Development, Tokyo, Japan.
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33
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Nelson M, Zhang X, Genta RM, Turner K, Podgaetz E, Paris S, Cardenas J, Gu J, Leeds S, Ward M, Nguyen A, Konda V, Furuta GT, Pan Z, Souza RF, Spechler SJ. Lower esophageal sphincter muscle of patients with achalasia exhibits profound mast cell degranulation. Neurogastroenterol Motil 2021; 33:e14055. [PMID: 33280206 DOI: 10.1111/nmo.14055] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/23/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Eosinophils and mast cells are key effectors of allergy. When they accumulate in the esophagus, their myoactive, pro-inflammatory, and cytotoxic products potentially could cause achalasia-like motility abnormalities and neuronal degeneration. We hypothesized that there is an allergy-mediated form of achalasia. METHODS LES muscle samples obtained during Heller myotomy from patients with achalasia or EGJ outflow obstruction (EGJOO) and from organ donor controls were immunostained for tryptase. Eosinophil and mast cell density, and mast cell degranulation were assessed. LES muscle was evaluated by qPCR for genes mediating smooth muscle Ca2+ handling and contraction. KEY RESULTS There were 13 patients (7 men, median age 59; 10 achalasia, 3 EGJOO) and 7 controls (4 men, median age 42). Eosinophils were infrequent in LES muscle, but mast cells were plentiful. Patients and controls did not differ significantly in LES mast cell density. However, 12 of 13 patients exhibited profound LES mast cell degranulation involving perimysium and myenteric plexus nerves, while only mild degranulation was seen in 2 of 7 controls. Hierarchical clustering analysis of qPCR data revealed two "mototype" LES gene expression patterns, with all type II patients in one mototype, and type I and III patients in the other. CONCLUSIONS & INFERENCES LES muscle of patients with achalasia or EGJOO exhibits striking mast cell degranulation, and patients with different achalasia manometric phenotypes exhibit different LES patterns of expression for genes mediating Ca2+ handling and muscle contraction. Although these findings are not definitive, they support our hypothesis that achalasia can be allergy-driven.
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Affiliation(s)
- Melissa Nelson
- Department of Medicine, Center forEsophageal Diseases/Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Xi Zhang
- Department of Medicine, Center forEsophageal Diseases/Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Robert M Genta
- Inform Diagnostics, Irving, TX, USA.,Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | | | - Eitan Podgaetz
- Center for Thoracic Surgery, Center for Esophageal Diseases, Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Shere Paris
- Department of Medicine, Center forEsophageal Diseases/Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Jacob Cardenas
- Biostatistics Core, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Jinghua Gu
- Biostatistics Core, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Steven Leeds
- Department of Surgery, Center for Esophageal Diseases, Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Marc Ward
- Department of Surgery, Center for Esophageal Diseases, Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Anh Nguyen
- Department of Medicine, Center forEsophageal Diseases/Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Vani Konda
- Department of Medicine, Center forEsophageal Diseases/Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Glenn T Furuta
- Department of Pediatrics and Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Zui Pan
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Rhonda F Souza
- Department of Medicine, Center forEsophageal Diseases/Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Stuart Jon Spechler
- Department of Medicine, Center forEsophageal Diseases/Baylor University Medical Center, Center for Esophageal Research/Baylor Scott & White Research Institute, Dallas, TX, USA
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34
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Odiase E, Zhang X, Chang Y, Nelson M, Balaji U, Gu J, Zhang Q, Pan Z, Jon Spechler S, Souza RF. In Esophageal Squamous Cells From Eosinophilic Esophagitis Patients, Th2 Cytokines Increase Eotaxin-3 Secretion Through Effects on Intracellular Calcium and a Non-Gastric Proton Pump. Gastroenterology 2021; 160:2072-2088.e6. [PMID: 33581123 PMCID: PMC9013281 DOI: 10.1053/j.gastro.2021.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In upper airway cells, T helper 2 cytokines that signal through interleukin-4 (IL-4) receptor-α have been shown to stimulate eotaxin-3 secretion via a nongastric proton pump (ngH+,K+ATPase). To seek novel targets for eosinophilic esophagitis (EoE) treatments, we evaluated ngH+,K+ATPase expression in EoE squamous cells, and explored molecular pathways involved in eotaxin-3 secretion by IL-4 receptor-α signaling. METHODS ngH+,K+ATPase expression in EoE cells was evaluated by quantitative real-time polymerase chain reaction and Western blotting. IL-4-stimulated eotaxin-3 secretion was measured by enzyme-linked immunosorbent assay after treatment with omeprazole, SCH 28080 (potassium-competitive acid blocker), ethylene glycol-bis(β-aminoethyl)-N,N,N',N'-tetraacetoxymethyl ester (calcium chelator), 2-aminoethoxydiphenyl borate (inhibitor of endoplasmic reticulum calcium release), verapamil, and diltiazem (L-type calcium channel inhibitors). Intracellular calcium transients were measured by Fluo-4 fluorescence. Key experiments were confirmed in EoE primary cells and in RNA sequencing datasets from mucosal biopsies of patients with EoE and controls. RESULTS EoE cells expressed ngH+,K+ATPase messenger RNA and protein. Omeprazole and SCH 28080 decreased IL-4-stimulated eotaxin-3 secretion. IL-4 increased intracellular calcium transients, and IL-4-stimulated eotaxin-3 secretion was blocked by ethylene glycol-bis(β-aminoethyl)-N,N,N',N'-tetraacetoxymethyl ester, 2-aminoethoxydiphenyl borate, verapamil, and diltiazem. The combination of omeprazole and verapamil suppressed IL-4-stimulated eotaxin-3 secretion more than either agent alone. EoE biopsies expressed higher ngH+,K+ATPase and exhibited more calcium signaling than controls. CONCLUSIONS EoE cells express a nongastric proton pump that mediates T helper 2 cytokine-stimulated eotaxin-3 secretion. IL-4 induces calcium release from the endoplasmic reticulum and calcium entry via L-type calcium channels, increasing intracellular calcium that contributes to eotaxin-3 secretion by EoE cells. L-type calcium channel inhibitors block T helper 2 cytokine-stimulated eotaxin-3 secretion, suggesting a potential role for these agents in EoE treatment.
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Affiliation(s)
- Eunice Odiase
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas,Department of Pediatrics, Children’s Hospital of Colorado, Aurora, Colorado
| | - Xi Zhang
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
| | - Yan Chang
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Melissa Nelson
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
| | - Uthra Balaji
- Biostatistics Core, Baylor Scott & White Research Institute, Dallas, Texas
| | - Jinghua Gu
- Biostatistics Core, Baylor Scott & White Research Institute, Dallas, Texas
| | - Qiuyang Zhang
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
| | - Zui Pan
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Stuart Jon Spechler
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
| | - Rhonda F. Souza
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
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Intestinal eosinophils: multifaceted roles in tissue homeostasis and disease. Semin Immunopathol 2021; 43:307-317. [PMID: 33772336 DOI: 10.1007/s00281-021-00851-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
Intestinal eosinophils are largely considered to be one of the central immune effector cells during helminth infection and disorders such as eosinophilic oesophagitis and food allergies. Given the abundance of these cells present in the gastrointestinal tract at homeostasis, emerging studies now reveal novel roles for eosinophils in the development and regulation of immunity, and during tissue repair. In addition, the identification of distinct eosinophil subsets indicates that we must consider the heterogeneity of these cells and how they differentially participate in mucosal immunity at steady state and during disease. Here, we summarise the literature on intestinal eosinophils, and how they contribute to mucosal homeostasis through immune regulation and interactions with the microbiome. We then explore the divergent roles of eosinophils in the context of eosinophilic gastrointestinal disorders and during helminth infection, whereby we discuss key observations and differences that have emerged from animal models and human studies. Lastly, we consider the possible interactions of eosinophils with the enteric nervous system, and how this represents an exciting area for future research which may inform future therapeutic targets.
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36
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Doyle AD, Masuda MY, Kita H, Wright BL. Eosinophils in Eosinophilic Esophagitis: The Road to Fibrostenosis is Paved With Good Intentions. Front Immunol 2020; 11:603295. [PMID: 33335531 PMCID: PMC7736408 DOI: 10.3389/fimmu.2020.603295] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is an antigen-driven disease associated with epithelial barrier dysfunction and chronic type 2 inflammation. Eosinophils are the defining feature of EoE histopathology but relatively little is known about their role in disease onset and progression. Classically defined as destructive, end-stage effector cells, eosinophils (a resident leukocyte in most of the GI tract) are increasingly understood to play roles in local immunity, tissue homeostasis, remodeling, and repair. Indeed, asymptomatic esophageal eosinophilia is observed in IgE-mediated food allergy. Interestingly, EoE is a potential complication of oral immunotherapy (OIT) for food allergy. However, we recently found that patients with peanut allergy may have asymptomatic esophageal eosinophilia at baseline and that peanut OIT induces transient esophageal eosinophilia in most subjects. This is seemingly at odds with multiple studies which have shown that EoE disease severity correlates with tissue eosinophilia. Herein, we review the potential role of eosinophils in EoE at different stages of disease pathogenesis. Based on current literature we suggest the following: (1) eosinophils are recruited to the esophagus as a homeostatic response to epithelial barrier disruption; (2) eosinophils mediate barrier-protective activities including local antibody production, mucus production and epithelial turnover; and (3) when type 2 inflammation persists, eosinophils promote fibrosis.
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Affiliation(s)
- Alfred D Doyle
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, United States
| | - Mia Y Masuda
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, United States
| | - Hirohito Kita
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, United States.,Department of Immunology, Mayo Clinic Arizona, Scottsdale, AZ, United States
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, United States.,Division of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, United States
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Slack IF, Schwartz JT, Mukkada VA, Hottinger S, Abonia JP. Eosinophilic Esophagitis: Existing and Upcoming Therapies in an Age of Emerging Molecular and Personalized Medicine. Curr Allergy Asthma Rep 2020; 20:30. [PMID: 32506181 DOI: 10.1007/s11882-020-00928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Recent research efforts have spurred great progress in the diagnosis and management of eosinophilic esophagitis (EoE). Nonetheless, challenges remain in addressing disease burden and impairment in the growing EoE population. We highlight work from the Cincinnati Center for Eosinophilic Disorders, the Consortium of Eosinophilic Gastrointestinal Disease Researchers, and others that address these ongoing challenges. RECENT FINDINGS New tools for characterizing EoE disease activity include the EoE Histology Scoring System (EoEHSS), endoscopic alternatives, validated patient-reported outcome (PRO) questionnaires, and investigational biomarkers. These diagnostic and monitoring strategies have been complemented by advances in EoE therapy. Treatment modalities have refined the traditional approaches of dietary elimination, swallowed steroids, and proton pump inhibitors (PPI), and biologics offer promise for future treatment. This review summarizes EoE advances in disease management and newly defined EoE endotypes that may serve as the foundation for EoE-personalized medicine.
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Affiliation(s)
- Ian F Slack
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA
| | - Justin T Schwartz
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shawna Hottinger
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA
| | - J Pablo Abonia
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH, 45229, USA.
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