Potential Noninvasive Biomarker of EoE Disease Activity Identified

Researchers have identified a potential blood-based marker of disease activity for the severe and often painful food allergic disease eosinophilic esophagitis (EoE) – possibly leading to a blood test, which could spare EoE patients, often children, the discomfort and risk of the currently used invasive endoscopic monitoring procedures.

Researchers at the Cincinnati Center for Eosinophilic Disorders (CCED) of Cincinnati Children’s Hospital Medical Center (Cincinnati, OH, USA) led the study. “Adults and children with EoE can be on highly restricted diets of formula alone or only a few foods,” said Patricia C. Fulkerson, MD, PhD, senior study author, “One of the major obstacles to families participating in studies to introduce foods back into the child’s diet is the need for endoscopy after each food is tried to see whether or not it triggers disease activity.”

The disease activity of EoE is currently monitored using peak esophageal eosinophil count, which requires endoscopy to collect esophageal tissue biopsies. People with EoE, a lifelong disease, must continue monitoring disease activity, even after effective treatment with restricted diets or steroids. Treatment changes, such as reintroducing a single food, require additional endoscopic exams to assess for disease flare-ups.

Prior research has demonstrated that testing blood of EoE patients is not a clinically useful indication of active disease because eosinophil levels in blood do not correlate well with levels in the esophagus. This led the team to investigate a precursor cell to eosinophils, a lineage-committed eosinophil progenitor (EoP), as a potential marker. They found elevated EoP levels in the blood of pediatric patients with active EoE disease, suggesting a promising, blood-based marker.

The authors emphasize that additional research is needed to validate the marker before routine clinical use. “This clinical study is the first to investigate EoP levels in patients with EoE and identifies a potential new noninvasive biomarker,” said study author Vincent A. Mukkada, MD, physician at Cincinnati Children’s and CCED member, “This work is an essential step toward improving outcomes for patients with EoE. It will be followed by repeated testing of more patients and with sequential measurements of EoP levels in the same patient during different disease states.”

Allergic diseases have been on the rise over the past 20 years. The CCED team has previously reported that incidence of EoE is estimated at 1 of 1,000 people. Their research has also shown that EoE is caused by a combination of genetic and environmental factors, and is primarily mediated by an immunologic response to foods. The hallmark of EoE is swelling and inflammation in the esophagus, accompanied by high levels of eosinophils.

The study, by Morris DW et al, was published May 16, 2016, in the Journal of Allergy and Clinical Immunology.

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