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Involvement of mast cells in eosinophilic esophagitis - 07/08/11

Doi : 10.1016/j.jaci.2010.04.009 
J. Pablo Abonia, MD a, Carine Blanchard, PhD a, Bridget Buckmeier Butz, MHSA a, Heather F. Rainey, BS a, Margaret H. Collins, MD c, Keith Stringer, MD c, Philip E. Putnam, MD b, Marc E. Rothenberg, MD, PhD a,
a Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 
b Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 
c Division of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 

Reprint requests: Marc E. Rothenberg, MD, PhD, Cincinnati Children’s Hospital Medical Center, Division of Allergy and Immunology, 3333 Burnet Ave, ML7028, Cincinnati, OH 45229.

Abstract

Background

Eosinophilic esophagitis (EE) is an emerging disorder with poorly understood pathogenesis.

Objective

Whereas prior studies have primarily focused on the role of eosinophils in disease diagnosis and pathogenesis, this study investigates the involvement of mast cells.

Methods

Total and degranulated mast cell counts were correlated to microarray and RT-PCR data to generate transcriptome expression profiles related to mast cell number and degranulation in patients with EE and healthy control subjects.

Results

Esophageal mastocytosis and mast cell degranulation were readily apparent in patients with EE compared with control subjects (P < .01), as assessed by staining for total mast cells and the presence of extracellular mast cell tryptase (P < .01). Microarray analysis revealed that mast cell levels correlated with the dysregulation of 0.8% (301 genes) of the genome, which was partially distinct from the genes that correlated with tissue eosinophilia. The expression of transcripts for the mast cell proteases carboxypeptidase A3 and tryptase, but not chymase, correlated with mast cell levels and distinguished patients with EE from control subjects. Suprabasilar mast cell counts (P < .01) and degranulation (P < .01) were proportional with KIT ligand mRNA expression. Treatment of patients with EE with swallowed fluticasone propionate normalized levels of mast cells and the mast cell–related transcriptome in responder patients.

Conclusion

Herein we have identified local mastocytosis and mast cell degranulation in the esophagi of patients with EE; identified an esophageal mast cell–associated transcriptome that is significantly divergent from the eosinophil-associated transcriptome, with carboxypeptidase A3 mRNA levels serving as the best mast cell surrogate marker; and provided evidence for the involvement of KIT ligand in the pathogenesis of EE.

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Key words : Mast cells/basophils, eosinophils, human

Abbreviations used : CCL26, CE, CPA3, CXCL1, CXCL6, EE, FP, GERD, H&E, HPF, HPRT, IHC, KITLG, NL, PPP2R2C


Plan


 Supported by National Institutes of Health grants 12HD028827 and AI057991 to J.P.A. and grants AI070235, AI045898, P30 DK078392, and DK076893; the Food Allergy Project; the Campaign Urging Research for Eosinophilic Disorders (CURED); and the Buckeye Foundations to M.E.R.
 Disclosure of potential conflict of interest: J. P. Abonia has received research support from the National Institutes of Health, Ception Therapeutics, and the Children’s Digestive Health and Nutrition Foundation. M. H. Collins has consulted for GlaxoSmithKline, Ception Therapeutics, and Meritage Pharma. M. E. Rothenberg has consulted for and is a speaker for Merck; has consulted for Centocor, Ception Therapeutics, Nycomed, Array Biopharma, Biocrystal Pharmaceuticals, Endo Pharmaceuticals, and Pieres A; has received research support from the National Institutes of Health, the Food Allergy and Anaphylaxis Network, and the Dana Foundation; is on the medical advisory board of the American Partnership for Eosinophilic Disorders; and is on the executive council of the International Eosinophil Society. The rest of the authors have declared they have no conflict of interest.


© 2010  American Academy of Allergy, Asthma & Immunology. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 126 - N° 1

P. 140-149 - juillet 2010 Retour au numéro
Article précédent Article précédent
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