EoE表现为一种独特的Th2疾病:叙述性回顾。

IF 3 4区 医学 Q1 Medicine Translational gastroenterology and hepatology Pub Date : 2023-01-01 DOI:10.21037/tgh-22-15
Simon S Rabinowitz, Liwei Yu, Patrick Geraghty
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引用次数: 1

摘要

背景与目的:强调并解释嗜酸性粒细胞性食管炎(EoE),一种2型辅助细胞(Th2)疾病,以及其他三种具有代表性的Th2疾病之间的两个显著差异。EoE、哮喘、特应性皮炎(AD)、慢性鼻窦炎(CRS)和其他Th2疾病利用上皮警报器识别诱因,共享一个典型的炎症级联,并对糖皮质激素做出反应。然而,EoE也有几个不同的特征,这些特征可以用不同的病理生理机制来解释。方法:以下报告由四个相关的叙述性评论组成,这些评论结合了综合PubMed和Google搜索。我们进行了两项综述,以确定和对比所有描述EoE与哮喘、AD和CRS的血清学标志物的符合条件的研究。另外两篇综述比较了EoE和同样具有代表性的Th2疾病对肠外生物治疗的反应。关键内容和发现:综合文献检索明确区分了EoE中血清学标志物的缺失,而不是其他代表性Th2疾病中血清学标志物的缺失。同样,治疗试验的总结表明,虽然EoE不能对各种肠外生物疗法产生临床反应,但哮喘、AD和CRS可以用同样的方法非常有效地治疗。提出了一种新的EoE病理生理学,并总结了支持其存在的新兴文献。结论:如果EoE采用了一种独特的Th2通路应用,那么本文中描述的关于EoE血清学信号传导和肠外治疗反应的基本特性可以得到解释。与这些观察结果一致的一个潜在机制是,EoE仅利用食管粘膜成分来启动和产生典型的Th2级联以及随后的纤维狭窄改变。
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EoE behaves as a unique Th2 disease: a narrative review.

Background and objective: To highlight and interpret two significant differences between eosinophilic esophagitis (EoE), a type 2 helper cell (Th2) disease, and three other representative Th2 diseases. EoE, asthma, atopic dermatitis (AD), chronic rhinosinusitis (CRS) and other Th2 diseases employ epithelial alarmins to recognize triggers, share a prototypical inflammatory cascade, and respond to glucocorticoids. However, EoE also has several distinguishing characteristics which may be explained by a distinct pathophysiologic mechanism.

Methods: The following report consist of four related narrative reviews which combine comprehensive PubMed and Google searches. Two reviews were performed to identify and contrast all eligible studies describing serologic markers in EoE compared to asthma, AD, and CRS. Two additional reviews then compare the responses to parenteral biological therapies in EoE and in the same representative Th2 diseases.

Key content and findings: Comprehensive literature searches definitively differentiate the absence of serologic markers in EoE compared to their identification in the other representative Th2 diseases. Similarly, a summary of therapeutic trials demonstrates that while EoE is unable to clinically respond to a variety of parenteral biological therapies, asthma, AD and CRS are very effectively treated with this same approach. A novel pathophysiology for EoE is proposed, and the emerging literature that support its existence is summarized.

Conclusions: The fundamental properties described in this narrative regarding serologic signaling and response to parenteral therapy in EoE could be explained if EoE employs a unique application of the Th2 pathway. One potential mechanism consistent with these observations is that EoE employs exclusively esophageal mucosal constituents to initiate and generate the prototypical Th2 cascade and the fibrostenotic changes that follow.

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来源期刊
CiteScore
8.20
自引率
0.00%
发文量
1
期刊介绍: Translational Gastroenterology and Hepatology (Transl Gastroenterol Hepatol; TGH; Online ISSN 2415-1289) is an open-access, peer-reviewed online journal that focuses on cutting-edge findings in the field of translational research in gastroenterology and hepatology and provides current and practical information on diagnosis, prevention and clinical investigations of gastrointestinal, pancreas, gallbladder and hepatic diseases. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to gastrointestinal and hepatic diseases. Contributions pertinent to gastroenterology and hepatology are also included from related fields such as nutrition, surgery, public health, human genetics, basic sciences, education, sociology, and nursing.
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