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Researchers Identify Potential Non-invasive Biomarkers for EoE
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Patients with eosinophilic esophagitis have significantly higher serum levels of absolute eosinophil count, eosinophil-derived neurotoxin and eosinophil cationic protein, which correlate with esophageal eosinophilia levels, according to the results of a prospective cohort study.
Additionally, absolute eosinophil count (AEC) was predictive of eosinophilia after treatment, and may therefore have a potential role in monitoring disease activity.
“While our understanding of eosinophilic esophagitis (EoE) has grown significantly over the past 10 years, the diagnosis and management still heavily relies on endoscopic evaluation,” Steve B. Min, MD, from the department of pediatric gastroenterology and nutrition at the Walter Reed National Military Medical Center in Bethesda, Md., told Healio Gastroenterology. “Often, patients undergo multiple and ongoing [esophagogastroduodenoscopies (EGD)] to accurately assess their histologic severity and their response to treatment. Determining a reliable and consistent non-invasive marker for disease could significantly aid the clinician in diagnosing and managing this disease.”
Steve B. Min
Min and colleagues evaluated 42 children and adults with EoE (median age, 20.5 years [range, 1.5-59 years]; 79% male; 76% white) and compared them with 53 controls (median age, 14 years [range, 1.5-72 years]; 28% male; 79% white).
All patients received PPI therapy for at least 8 weeks before undergoing EGD for suspected EoE, after which the researchers obtained esophageal mucosal biopsies and performed serum analysis of five biomarkers: AEC, eotaxin-3, eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP) and interleukin (IL)-5.
Among the EoE patients, half were treated with fluticasone and half were treated with budesonide for a mean duration of 9.1 weeks. Then repeat EGD and biomarker measurements were performed.
“We were able to determine that increased levels of serum [AEC] and [ECP] were present in patients with EoE compared with those without,” Min said.
Median baseline AEC levels were 263.5 cu/mm in EoE patients compared with 102 cu/mm in controls (P < .001), median ECP levels were 26.98 ng/mL in EoE patients compared with 5.2 ng/mL in controls (P < .001) and median EDN levels were 31.7 ng/mL in EoE patients compared with 14.18 ng/mL in controls (P = .004). Il-5 levels were lower in EoE patients compared with controls (0 vs. 0.31 pg/mL; P < .001) and eotaxin-3 levels were similar.
AEC levels (OR = 1.79; 95% CI, 1.28-2.64) and ECP levels (OR = 1.61; 95% CI, 1.23-2.36) were associated with an EoE diagnosis. Moreover, AEC, ECP, EDN and IL-5 significantly correlated with esophageal eosinophilia.
“Furthermore, AEC correlated with EoE histologically following treatment,” Min said.
Longitudinal analyses showed only AEC was a significant predictor of tissue eosinophilia after treatment with topical steroids (P = .006).
“While further research certainly needs to be done in this area, our findings were able to demonstrate the potential for these non-invasive biomarkers,” Min said. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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