Comparing the relative efficacy of therapeutics for eosinophilic oesophagitis: is counting eosinophils the right target?

Eosinophilic oesophagitis (EoE) is characterised by an abundance of oesophageal epithelial eosinophils.1 There is strong rationale that supports the eosinophil as central to the pathophysiology of EoE. In histology, the eosinophil is numerically the dominant inflammatory cell. Moreover, the eosinophil is capable of producing inflammation and tissue remodelling in human tissue. On degranulation, multiple destructive mediators are released that can invoke a robust inflammatory response. These include eosinophil proinflammatory cationic proteins (MBP, EDN, EPO, ECP), chemokines and cytokines (IL-4, IL-5, IL-13, TGF-β, etc) that regulate cell chemoattraction and activation, perpetuate inflammation, and instigate epithelial mesenchymal transition associated with subepithelial fibrosis.2 Indeed, first-line therapies in EoE include swallowed topical corticosteroids and elimination diets that concomitantly improve oesophageal eosinophilia as well as endoscopic disease activity and EoE-related symptoms.3 4 Further supporting an important role for the eosinophil in EoE is its importance in...
Source: Gut - Category: Gastroenterology Authors: Tags: Gut Commentary Source Type: research