Chehade Mirna, Falk Gary W, Aceves Seema, Lee Jason K, Mehta Vinay, Leung John, Shumel Brad, Jacob-Nara Juby A, Deniz Yamo, Rowe Paul J, Cunoosamy Danen, Khodzhayev Angela
Deparment of Pediatrics and Medicine, Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Gastro Hep Adv. 2022 May 21;1(5):720-732. doi: 10.1016/j.gastha.2022.05.004. eCollection 2022.
Eosinophilic esophagitis (EoE) is a chronic type 2 inflammatory disease characterized by an eosinophilic inflammatory infiltrate in the esophagus, leading to remodeling, stricture formation, and fibrosis. Triggered by food and aeroallergens, type 2 cytokines interleukin (IL)-4, IL-13, IL-5 produced by CD4+ T helper 2 cells (Th2), eosinophils, mast cells, basophils, and type 2 innate lymphoid cells alter the esophageal epithelial barrier and increase inflammatory cell tissue infiltration. Clustering analysis based on the expression of type 2 inflammatory genes demonstrated the diversity of EoE endotypes. Despite the availability of treatment options for patients with EoE, which include dietary restriction, proton pump inhibitors, swallowed topical steroids, and esophageal dilation, there are still no Food and Drug Administration-approved medications for this disease; as such, there are clear unmet medical needs for these patients. A number of novel biologic therapies currently in clinical trials represent a promising avenue for targeted therapeutic approaches in EoE. This review summarizes our current knowledge on the role of type 2 inflammatory cells and mediators in EoE disease pathogenesis, as well as the future treatment landscape targeting underlying inflammation in EoE.
嗜酸性粒细胞性食管炎（EoE）是一种慢性2型炎症性疾病，其特征为食管出现嗜酸性粒细胞炎性浸润，进而导致重塑、狭窄形成和纤维化。由食物和空气过敏原触发，CD4 +辅助性T细胞2型（Th2）、嗜酸性粒细胞、肥大细胞、嗜碱性粒细胞和2型固有淋巴细胞产生的2型细胞因子白细胞介素（IL）-4、IL-13、IL-5会改变食管上皮屏障并增加炎性细胞组织浸润。基于2型炎症基因表达的聚类分析显示了EoE内型的多样性。尽管有针对EoE患者的治疗选择，包括饮食限制、质子泵抑制剂、吞咽局部类固醇和食管扩张，但目前仍没有美国食品药品监督管理局批准用于该疾病的药物；因此，这些患者存在明显未满足的医疗需求。目前一些正在进行临床试验的新型生物疗法是EoE靶向治疗方法的一个有前景的途径。本综述总结了我们目前对2型炎症细胞和介质在EoE疾病发病机制中的作用的认识，以及针对EoE潜在炎症的未来治疗前景。
