Type 2 Inflammation in Eosinophilic Esophagitis: From Pathophysiology to Therapeutic Targets

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation, whose incidence is rising. It significantly affects patients’ quality of life and, if...

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Published inFrontiers in physiology Vol. 12; p. 815842
Main Authors Racca, Francesca, Pellegatta, Gaia, Cataldo, Giuseppe, Vespa, Edoardo, Carlani, Elisa, Pelaia, Corrado, Paoletti, Giovanni, Messina, Maria Rita, Nappi, Emanuele, Canonica, Giorgio Walter, Repici, Alessandro, Heffler, Enrico
Format Journal Article
LanguageEnglish
Published Switzerland Frontiers Media S.A 12.01.2022
Subjects
eosinophilic esophagitis
pathophysiology
Physiology
precision medicine
therapeutic targets
type 2 inflammation
precision medicine
therapeutic targets
type 2 inflammation
eosinophilic esophagitis
pathophysiology
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Abstract Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation, whose incidence is rising. It significantly affects patients’ quality of life and, if left untreated, results in fibrotic complications. Although broad consensus has been achieved on first-line therapy, a subset of patients remains non-responder to standard therapy. The pathogenesis of EoE is multifactorial and results from the complex, still mostly undefined, interaction between genetics and intrinsic factors, environment, and antigenic stimuli. A deep understanding of the pathophysiology of this disease is pivotal for the development of new therapies. This review provides a comprehensive description of the pathophysiology of EoE, starting from major pathogenic mechanisms (genetics, type 2 inflammation, epithelial barrier dysfunction, gastroesophageal reflux, allergens, infections and microbiota) and subsequently focusing on the single protagonists of type 2 inflammation (involved cells, cytokines, soluble effectors, surface proteins and transcription factors) that could represent present and future therapeutic targets, while summarizing previous therapeutic approaches in literature.
AbstractList Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation, whose incidence is rising. It significantly affects patients' quality of life and, if left untreated, results in fibrotic complications. Although broad consensus has been achieved on first-line therapy, a subset of patients remains non-responder to standard therapy. The pathogenesis of EoE is multifactorial and results from the complex, still mostly undefined, interaction between genetics and intrinsic factors, environment, and antigenic stimuli. A deep understanding of the pathophysiology of this disease is pivotal for the development of new therapies. This review provides a comprehensive description of the pathophysiology of EoE, starting from major pathogenic mechanisms (genetics, type 2 inflammation, epithelial barrier dysfunction, gastroesophageal reflux, allergens, infections and microbiota) and subsequently focusing on the single protagonists of type 2 inflammation (involved cells, cytokines, soluble effectors, surface proteins and transcription factors) that could represent present and future therapeutic targets, while summarizing previous therapeutic approaches in literature.
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation, whose incidence is rising. It significantly affects patients' quality of life and, if left untreated, results in fibrotic complications. Although broad consensus has been achieved on first-line therapy, a subset of patients remains non-responder to standard therapy. The pathogenesis of EoE is multifactorial and results from the complex, still mostly undefined, interaction between genetics and intrinsic factors, environment, and antigenic stimuli. A deep understanding of the pathophysiology of this disease is pivotal for the development of new therapies. This review provides a comprehensive description of the pathophysiology of EoE, starting from major pathogenic mechanisms (genetics, type 2 inflammation, epithelial barrier dysfunction, gastroesophageal reflux, allergens, infections and microbiota) and subsequently focusing on the single protagonists of type 2 inflammation (involved cells, cytokines, soluble effectors, surface proteins and transcription factors) that could represent present and future therapeutic targets, while summarizing previous therapeutic approaches in literature.Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation, whose incidence is rising. It significantly affects patients' quality of life and, if left untreated, results in fibrotic complications. Although broad consensus has been achieved on first-line therapy, a subset of patients remains non-responder to standard therapy. The pathogenesis of EoE is multifactorial and results from the complex, still mostly undefined, interaction between genetics and intrinsic factors, environment, and antigenic stimuli. A deep understanding of the pathophysiology of this disease is pivotal for the development of new therapies. This review provides a comprehensive description of the pathophysiology of EoE, starting from major pathogenic mechanisms (genetics, type 2 inflammation, epithelial barrier dysfunction, gastroesophageal reflux, allergens, infections and microbiota) and subsequently focusing on the single protagonists of type 2 inflammation (involved cells, cytokines, soluble effectors, surface proteins and transcription factors) that could represent present and future therapeutic targets, while summarizing previous therapeutic approaches in literature.
Author Pellegatta, Gaia
Paoletti, Giovanni
Heffler, Enrico
Carlani, Elisa
Pelaia, Corrado
Vespa, Edoardo
Nappi, Emanuele
Canonica, Giorgio Walter
Racca, Francesca
Messina, Maria Rita
Cataldo, Giuseppe
Repici, Alessandro
AuthorAffiliation 4 Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro , Catanzaro , Italy
1 Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital , Rozzano , Italy
3 Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital , Rozzano , Italy
2 Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy
AuthorAffiliation_xml – name: 3 Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital , Rozzano , Italy
– name: 1 Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital , Rozzano , Italy
– name: 4 Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro , Catanzaro , Italy
– name: 2 Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy
Author_xml – sequence: 1
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  fullname: Racca, Francesca
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  fullname: Heffler, Enrico
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35095572$$D View this record in MEDLINE/PubMed
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Copyright Copyright © 2022 Racca, Pellegatta, Cataldo, Vespa, Carlani, Pelaia, Paoletti, Messina, Nappi, Canonica, Repici and Heffler.
Copyright © 2022 Racca, Pellegatta, Cataldo, Vespa, Carlani, Pelaia, Paoletti, Messina, Nappi, Canonica, Repici and Heffler. 2022 Racca, Pellegatta, Cataldo, Vespa, Carlani, Pelaia, Paoletti, Messina, Nappi, Canonica, Repici and Heffler
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Keywords precision medicine
therapeutic targets
type 2 inflammation
eosinophilic esophagitis
pathophysiology
Language English
License Copyright © 2022 Racca, Pellegatta, Cataldo, Vespa, Carlani, Pelaia, Paoletti, Messina, Nappi, Canonica, Repici and Heffler.
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Reviewed by: Darío Antolín-Amérigo, Ramón y Cajal University Hospital, Spain; Jill Johnson, Aston University, United Kingdom
This article was submitted to Clinical and Translational Physiology, a section of the journal Frontiers in Physiology
Edited by: Gilda Varricchi, University of Naples Federico II, Italy
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Snippet Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and...
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SubjectTerms eosinophilic esophagitis
pathophysiology
Physiology
precision medicine
therapeutic targets
type 2 inflammation
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Title Type 2 Inflammation in Eosinophilic Esophagitis: From Pathophysiology to Therapeutic Targets
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