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Massey CJ, Oakley GM, Orlandi RR, Ashby S, Alt JA, Smith KA, Pulsipher A. An eosinophil peroxidase activity assay predicts acute exacerbations in post-operative chronic rhinosinusitis. Int Forum Allergy Rhinol 2024; 14:1517-1520. [PMID: 38767584 PMCID: PMC11365801 DOI: 10.1002/alr.23366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
KEY POINTS EPX activity has been correlated with eCRS diagnosis and baseline disease severity. Herein, EPX activity is shown to correlate with post-operative antibiotic and steroid use in CRS. EPX activity has potential to act as a prognostic biomarker of CRS disease severity and control.
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Affiliation(s)
- Conner J. Massey
- Department of Otolaryngology – Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Gretchen M. Oakley
- Department of Otolaryngology – Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Richard R. Orlandi
- Department of Otolaryngology – Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Shaelene Ashby
- Department of Otolaryngology – Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Jeremiah A. Alt
- Department of Otolaryngology – Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Department of Molecular Pharmaceutics, University of Utah College of Pharmacy, Salt Lake City, UT
- Utah Center for Nanomedicine, University of Utah College of Pharmacy, Salt Lake City, UT
- Department of Biomedical Engineering, University of Utah College of Engineering, Salt Lake City, UT
| | - Kristine A. Smith
- Department of Otolaryngology – Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Abigail Pulsipher
- Department of Otolaryngology – Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Department of Molecular Pharmaceutics, University of Utah College of Pharmacy, Salt Lake City, UT
- Utah Center for Nanomedicine, University of Utah College of Pharmacy, Salt Lake City, UT
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2
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Plate J, Bove M, Larsson HM, Norder Grusell E, Chatterjee N, Johansson LE, Bergquist H. Expression of inducible nitric oxide synthase, nitrotyrosine, eosinophilic peroxidase, eotaxin-3, and galectin-3 in patients with gastroesophageal reflux disease, eosinophilic esophagitis, and in healthy controls: a semiquantitative image analysis of 3,3'-diaminobenzidine-stained esophageal biopsies. Dis Esophagus 2024; 37:doae034. [PMID: 38679488 PMCID: PMC11360979 DOI: 10.1093/dote/doae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) share many histopathological features; therefore, markers for differentiation are of diagnostic interest and may add to the understanding of the underlying mechanisms. The nitrergic system is upregulated in GERD and probably also in EoE. Esophageal biopsies of patients with EoE (n = 20), GERD (n = 20), and healthy volunteers (HVs) (n = 15) were exposed to antibodies against inducible nitric oxide synthase (iNOS), nitrotyrosine, eosinophilic peroxidase, eotaxin-3, and galectin-3. The stained object glasses were randomized, digitized, and blindly analyzed regarding the expression of DAB (3,3'-diaminobenzidine) by a protocol developed in QuPath software. A statistically significant overexpression of iNOS was observed in patients with any of the two inflammatory diseases compared with that in HVs. Eotaxin-3 could differentiate HVs versus inflammatory states. Gastroesophageal reflux patients displayed the highest levels of nitrotyrosine. Neither iNOS nor nitrotyrosine alone were able to differentiate between the two diseases. For that purpose, eosinophil peroxidase was a better candidate, as the mean levels increased stepwise from HVs via GERD to EoE. iNOS and nitrotyrosine are significantly overexpressed in patients with EoE and GERD compared with healthy controls, but only eosinophil peroxidase could differentiate the two types of esophagitis. The implications of the finding of the highest levels of nitrotyrosine among gastroesophageal reflux patients are discussed.
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Affiliation(s)
- John Plate
- Department of Otorhinolaryngology, Head and Neck Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mogens Bove
- Department of Otorhinolaryngology, Head and Neck Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen M Larsson
- Department of Otorhinolaryngology, Head and Neck Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Norder Grusell
- Department of Otorhinolaryngology, Head and Neck Surgery, Kungsbacka Hospital, Region Halland, Kungsbacka, Sweden
| | - Nabanita Chatterjee
- Core Facilities, Centre for Cellular Imaging (CCI), University of Gothenburg, Gothenburg, Sweden
| | - Leif E Johansson
- Department of ENT, Head and Neck Surgery, Skövde County Hospital, Region Västra Götaland, Skövde, Sweden
| | - Henrik Bergquist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Smith KA, Gill AS, Pollard CE, Sumsion JS, Saffari H, Ashby S, Witt BL, Shipman PA, Gabrielsen DA, Yim MT, Levy JM, Oakley GM, Orlandi RR, Gleich GJ, Alt JA, Pulsipher A. An eosinophil peroxidase activity assay accurately predicts eosinophilic chronic rhinosinusitis. J Allergy Clin Immunol 2023; 152:400-407. [PMID: 37148919 PMCID: PMC10524284 DOI: 10.1016/j.jaci.2023.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND A definitive diagnosis of eosinophilic chronic rhinosinusitis (eCRS) requires invasive surgical tissue sampling and histologic enumeration of intact eosinophils. Eosinophil peroxidase (EPX) is an accurate biomarker of sinonasal tissue eosinophilia in CRS regardless of polyp status. A less invasive and rapid method that accurately identifies tissue eosinophilia would be of great benefit to patients. OBJECTIVE We sought to evaluate a new clinical tool that uses a nasal swab and colorimetric EPX activity assay to predict a diagnosis of eCRS. METHODS A prospective, observational cohort study was conducted using nasal swabs and sinonasal tissue biopsies obtained from patients with CRS electing endoscopic sinus surgery. Patients were classified as non-eCRS (n = 19) and eCRS (n = 35) on the basis of pathologically determined eosinophil counts of less than 10 or greater than or equal to 10 eosinophils/HPF, respectively. Swab-deposited EPX activity was measured and compared with tissue eosinophil counts, EPX levels, and CRS-specific disease metrics. RESULTS EPX activity was significantly increased in patients with eCRS than in patients without eCRS (P < .0001). With a relative absorbance unit cutoff value of greater than or equal to 0.80, the assay demonstrated high sensitivity (85.7%) and moderate specificity (79.0%) for confirming eCRS. Spearman correlations between EPX activity and tissue eosinophil counts (rs = 0.424), EPX levels (rs = 0.503), and Lund-Kennedy endoscopy scores (rs = 0.440) in eCRS were significant (P < .05). CONCLUSIONS This investigation evaluates a nasal swab sampling method and EPX activity assay that accurately confirms eCRS. This method could potentially address the unmet need to identify sinonasal tissue eosinophilia at the point-of-care, as well as to longitudinally monitor eosinophil activity and treatment response.
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Affiliation(s)
- Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Chelsea E Pollard
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jorgen S Sumsion
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Hedieh Saffari
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Shaelene Ashby
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Benjamin L Witt
- Cytopathology Section, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paige A Shipman
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - David A Gabrielsen
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael T Yim
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah; Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Shreveport, Shreveport, La
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Gretchen M Oakley
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Richard R Orlandi
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Gerald J Gleich
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah; Department of Molecular Pharmaceutics, University of Utah College of Pharmacy, Salt Lake City, Utah; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah.
| | - Abigail Pulsipher
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, University of Utah School of Medicine, Salt Lake City, Utah; Department of Molecular Pharmaceutics, University of Utah College of Pharmacy, Salt Lake City, Utah; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah.
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Ammann NL, Schwietzer YF, Mess C, Stadler JC, Geidel G, Kött J, Pantel K, Schneider SW, Utikal J, Bauer AT, Gebhardt C. Activated Eosinophils Predict Longer Progression-Free Survival under Immune Checkpoint Inhibition in Melanoma. Cancers (Basel) 2022; 14:cancers14225676. [PMID: 36428768 PMCID: PMC9688620 DOI: 10.3390/cancers14225676] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Immune checkpoint inhibition (ICI) has yielded remarkable results in prolonging survival of metastatic melanoma patients but only a subset of individuals treated respond to therapy. Success of ICI treatment appears to depend on the number of tumor-infiltrating effector T-cells, which are known to be influenced by activated eosinophils. To verify the co-occurrence of activated eosinophils and T-cells in melanoma, immunofluorescence was performed in 285 primary or metastatic tumor tissue specimens from 118 patients. Moreover, eosinophil counts and activity markers such as eosinophil cationic protein (ECP) and eosinophil peroxidase (EPX) were measured in the serum before therapy start and before the 4th infusion of ICI in 45 metastatic unresected melanoma patients. We observed a positive correlation between increased tumor-infiltrating eosinophils and T-cells associated with delayed melanoma progression. High baseline levels of eosinophil count, serum ECP and EPX were linked to prolonged progression-free survival in metastatic melanoma. Our data provide first indications that activated eosinophils are related to the T-cell-inflamed tumor microenvironment and could be considered as potential future prognostic biomarkers in melanoma.
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Affiliation(s)
- Nadine L. Ammann
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Yasmin F. Schwietzer
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Christian Mess
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Julia-Christina Stadler
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Glenn Geidel
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Julian Kött
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Klaus Pantel
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Stefan W. Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), 69121 Heidelberg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, 68167 Mannheim, Germany
| | - Alexander T. Bauer
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany
| | - Christoffer Gebhardt
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Fleur Hiege Center for Skin Cancer Research, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Correspondence: ; Tel.: +49-(0)-40-7410-53263
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Khan A, Khan A, Shal B, Aziz A, Ahmad S, Amin MU, Ahmed MN, Zia-Ur-Rehman, Khan S. Ameliorative effect of two structurally divergent hydrazide derivatives against DSS-induced colitis by targeting Nrf2 and NF-κB signaling in mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2022; 395:1167-1188. [PMID: 35851927 DOI: 10.1007/s00210-022-02272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
The environmental factors and genetic vulnerability trigger the inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn's disease. Furthermore, the oxidative stress and inflammatory cytokines have been implicated in the aggravation of the IBDs. The aim of the present study was to investigate the effect of N-(benzylidene)-2-((2-hydroxynaphthalen-1-yl)diazenyl)benzohydrazides (NCHDH and NTHDH) compounds against the DSS-induced colitis in mice. The colitis was induced by 5% dextran sulfate sodium (DSS) dissolved in normal saline for 5 days. The effect of the NCHDH and NTHDH on the behavioral, biochemical, histological, and immunohistological parameters was assessed. The NCHDH and NTHDH treatment improved the behavioral parameters such as food intake, disease activity index, and diarrhea score significantly compared to DSS control. The NCHDH and NTHDH treatments significantly increased the antioxidant enzymes, whereas oxidative stress markers were markedly reduced. Similarly, the NCHDH and NTHDH treatments significantly suppressed the activity of nitric oxide (NO), myeloperoxidase (MPO), and eosinophil peroxidase (EPO). The histological studies showed a significant reduction in inflammation, immune cell infiltration, and fibrosis in the NCHDH- and NTHDH-treated groups. The immunohistochemical results demonstrated that NCHDH and NTHDH treatments markedly increase the expression level of Nrf2, HO-1 (hemeoxygenase-1), TRX (thioredoxin reductase), and IκB compared to the DSS-induced group. In the same way, the NCHDH and NTHDH significantly reduced the NF-κB and COX-2 (cyclooxygenase-2) expression levels. The NCHDH and NTHDH treatment significantly improved the symptoms associated with colitis via inducing antioxidants and attenuating oxidative stress markers.
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Affiliation(s)
- Ashrafullah Khan
- Pharmacological Sciences Research Laboratory, Department of Pharmacy, Faculty of Biological Sciences, Quaid-I-Azam University, Islamabad, 45320, Pakistan
- Faculty of Pharmaceutical Sciences, Abasyn University, Peshawar, 25000, KPK, Pakistan
| | - Adnan Khan
- Pharmacological Sciences Research Laboratory, Department of Pharmacy, Faculty of Biological Sciences, Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | - Bushra Shal
- Pharmacological Sciences Research Laboratory, Department of Pharmacy, Faculty of Biological Sciences, Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | - Abdul Aziz
- Department of Chemistry, The University of Azad Jammu and Kashmir, Muzaffarabad, 13100, Pakistan
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar, 25000, Pakistan
| | - Muhammad Usman Amin
- Faculty of Pharmaceutical Sciences, Abasyn University, Peshawar, 25000, KPK, Pakistan
| | - Muhammad Naeem Ahmed
- Department of Chemistry, The University of Azad Jammu and Kashmir, Muzaffarabad, 13100, Pakistan
| | - Zia-Ur-Rehman
- Department of Chemistry, Quaid-I-Azam University, Islamabad, Pakistan
| | - Salman Khan
- Pharmacological Sciences Research Laboratory, Department of Pharmacy, Faculty of Biological Sciences, Quaid-I-Azam University, Islamabad, 45320, Pakistan.
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Uchida AM, Ro G, Garber JJ, Peterson KA, Round JL. Models and Tools for Investigating Eosinophilic Esophagitis at the Bench. Front Immunol 2022; 13:943518. [PMID: 35874718 PMCID: PMC9296852 DOI: 10.3389/fimmu.2022.943518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is an increasingly common food allergy disease of the esophagus that received its medical designation code in 2008. Despite this recency, great strides have been made in the understanding of EoE pathophysiology and type 2 immunity through basic and translational scientific investigations conducted at the bench. These advances have been critical to our understanding of disease mechanisms and generating new hypotheses, however, there currently is only one very recently approved FDA-approved therapy for EoE, leaving a great deal to be uncovered for patients with this disease. Here we review some of the innovative methods, models and tools that have contributed to the advances in EoE discovery and suggest future directions of investigation to expand upon this foundation.
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Affiliation(s)
- Amiko M. Uchida
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, UT, United States
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
- *Correspondence: Amiko M. Uchida,
| | - Gabrielle Ro
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, UT, United States
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - John J. Garber
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston MA, United States
| | - Kathryn A. Peterson
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - June L. Round
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
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7
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Saffari H, Peterson KA, Leiferman KM, Stabin MG, Krstyen JJ, Clayton FC, Pease LF, Yap JT, Hoffman JM, Gleich GJ. Oral Administration of 99mTechnetium-Labeled Heparin in Eosinophilic Esophagitis. Mayo Clin Proc 2020; 95:449-458. [PMID: 32138878 DOI: 10.1016/j.mayocp.2019.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/01/2019] [Accepted: 12/16/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine if heparin labeled with 99mTechnetium (99mTc) could be an imaging probe to detect eosinophil-related inflammation in eosinophilic esophagitis and to determine the biodistribution and radiation dosimetry of 99mTc-heparin oral administration using image-based dosimetry models with esophageal modeling. METHODS Freshly prepared 99mTc-heparin was administered orally to 5 research subjects. Radioactivity was measured by whole-body scintigraphy and single-photon emission computed tomography during the 24 hours postadministration. Following imaging, endoscopic examination was performed. The biodistribution of esophageal radioactivity was compared with endoscopic findings, eosinophil counts in biopsy tissues, and immunostaining for eosinophil granule major basic protein-1 (eMBP1). These studies were conducted from July 1, 2013, until April 22, 2017. RESULTS Oral administration of 99mTc-heparin was well tolerated in all 5 subjects. The entire esophagus could be visualized dynamically during oral administration. Bound esophageal radioactivity marked areas of inflammation as judged by endoscopy scores, by eosinophils per high power field and by localization of eMBP1 using immunostaining. Ninety percent of the radioactivity did not bind to the esophagus and passed through the gastrointestinal tract. CONCLUSION The biodistribution of ingested 99mTc-heparin is almost exclusively localized to the gastrointestinal tract. Radiation exposure was highest in the lower gastrointestinal tract and was comparable with other orally administered diagnostic radiopharmaceuticals. The use of swallowed 99mTc-heparin may aid in assessing eosinophil-related inflammation in the esophagus.
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Affiliation(s)
- Hedieh Saffari
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Kathryn A Peterson
- Department of Medicine, Division of Gastroenterology, University of Utah, Salt Lake City, Utah
| | | | - Michael G Stabin
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
| | - Jeffrey J Krstyen
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | | | - Leonard F Pease
- Departments of Chemical Engineering, Internal Medicine, and Pharmaceutical and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah
| | - Jeffrey T Yap
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah; Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, Utah
| | - John M Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah; Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Gerald J Gleich
- Departments of Dermatology and Medicine, University of Utah, Salt Lake City, Utah.
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8
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Saffari H, Condie RM, Watson BR, Krstyen JJ, Peterson KA, Hoffman JM, Gleich GJ, Pease LF. Biodistribution of orally administered 99mTc-heparin to assess eosinophilic esophagitis associated inflammation. CHEMICAL ENGINEERING SCIENCE: X 2019. [DOI: 10.1016/j.cesx.2019.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Schroeder S, Ochkur SI, Shim KP, Galvin KM, Bauer CS, Lee JJ, Wright BL. Throat-derived eosinophil peroxidase is not a reliable biomarker of pediatric eosinophilic esophagitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 5:1804-1805. [PMID: 29122165 DOI: 10.1016/j.jaip.2017.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Kelly P Shim
- Phoenix Children's Hospital, Phoenix, Ariz; Mayo Clinic Arizona, Scottsdale, Ariz
| | - Katie M Galvin
- University of Arizona College of Medicine, Phoenix, Ariz
| | - Cindy S Bauer
- Phoenix Children's Hospital, Phoenix, Ariz; Mayo Clinic Arizona, Scottsdale, Ariz; University of Arizona College of Medicine, Phoenix, Ariz
| | | | - Benjamin L Wright
- Phoenix Children's Hospital, Phoenix, Ariz; Mayo Clinic Arizona, Scottsdale, Ariz; University of Arizona College of Medicine, Phoenix, Ariz.
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10
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Choi Y, Jeon H, Yang EA, Yoon JS, Kim HH. Nasal eosinophilia and eosinophil peroxidase in children and adolescents with rhinitis. KOREAN JOURNAL OF PEDIATRICS 2019; 62:353-359. [PMID: 31096743 PMCID: PMC6753315 DOI: 10.3345/kjp.2019.00318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/24/2019] [Indexed: 01/21/2023]
Abstract
Background Researchers have shown that eosinophil peroxidase (EPO) is a relatively accurate marker of eosinophilia and eosinophil activity. However, its use as a marker of eosinophilic inflammation in nasal secretions is limited because the diagnostic cutoff values of EPO for use as a one-time test for allergic diseases such as allergic rhinitis have not been established. Purpose To identify the correlation between nasal eosinophil count and EPO in children and adolescents with rhinitis. Methods We recruited patients <18 years of age with rhinitis for more than 2 weeks or more than 2 episodes a year whose nasal eosinophil and EPO were measured at a single allergy clinic. The eosinophil percentage was calculated by dividing the eosinophil count by the number of total cells under light microscopy at ×1,000 magnification. EPO and protein were measured from nasal secretions. We retrospectively analyzed the correlation between nasal eosinophils and protein-corrected EPO (EPO/protein) value. Results Of the 67 patients enrolled, 41 were male (61.2%); the mean age was 8.2±4.0 years. The median nasal eosinophil count was 1 and percentage was 1%. The median protein-corrected EPO value was 12.5 ng/μg (range, 0–31 ng/μg). There was a statistically significant correlation between eosinophil count and percentage (P<0.001). However, the eosinophil percentage and EPO did not correlate. The eosinophil count and EPO had a statistically significant correlation (P =0.01). The EPO cutoff value examined for nasal eosinophil counts of 2, 5, 10, and 20 was 17.57 ng/μg regardless of the reference count. The largest area under the curve value was obtained when the receiver operating characteristic curve was drawn using the eosinophil count of 2. Conclusion Nasal eosinophil count was significantly associated with protein-corrected EPO.
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Affiliation(s)
- Yeonu Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Haeun Jeon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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11
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Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus associated with an atopic predisposition which appears to be increasing in prevalence over the last few decades. Symptoms stem from fibrosis, swelling, and smooth muscle dysfunction. In the past two decades, the etiology of EoE has been and is continuing to be revealed. This review provides an overview of the effects of genetics, environment, and immune function including discussions that touch on microbiome, the role of diet, food allergy, and aeroallergy. The review further concentrates on the pathophysiology of the disease with particular focus on the important concepts of the molecular etiology of EoE including barrier dysfunction and allergic hypersensitivity.
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Affiliation(s)
- Benjamin P Davis
- Department of Internal Medicine, Division of Immunology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52246, USA.
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12
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Saffari H, Baer K, Boynton KK, Gleich GJ, Peterson KA. Reply. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1805. [PMID: 29122166 DOI: 10.1016/j.jaip.2017.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Hedieh Saffari
- Department of Dermatology, University of Utah, Salt Lake City, Utah.
| | - Krista Baer
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Kathleen K Boynton
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Gerald J Gleich
- Department of Dermatology and Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Kathryn A Peterson
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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13
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Hiremath G, Gupta SK. Promising Modalities to Identify and Monitor Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2017; 15:1655-1664. [PMID: 28501533 DOI: 10.1016/j.cgh.2017.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/21/2017] [Accepted: 05/01/2017] [Indexed: 12/13/2022]
Abstract
Eosinophilic esophagitis (EoE) is an allergen-mediated condition characterized by symptoms of esophageal dysfunction and histologic evidence of intense eosinophilic inflammation involving the esophagus in the absence of overlapping conditions such as gastroesophageal reflux disease. Since the initial description as a distinct entity approximately 2 decades ago, there has been a remarkable increase in the recognition of this clinicopathologic entity. The current approach to diagnose and monitor EoE requires repeated esophagogastroduodenoscopies, with associated sedation/anesthesia, to visualize mucosal abnormalities, and to obtain multiple biopsy specimens for histologic assessment and to evaluate treatment response. Frequent esophagogastroduodenoscopies with multiple biopsies can increase the risk of procedural complications, place significant financial burden on families, and escalate health care costs. In addition, this burdensome approach may contribute toward delayed diagnosis and suboptimal monitoring, thereby increasing the likelihood of complications such as esophageal narrowing and stricture formation, which may require escalation of care including endoscopic interventions. Clinical progression and complications associated with EoE can be attenuated through early identification and optimal management. Therefore, developing reliable, safe, less-cumbersome, and cost-effective modalities for early diagnosis and effective monitoring of EoE is an area of active research. These efforts have been substantially supported by the development of new biomaterials, analytic methodologies, and the application of novel concepts. Herein, we summarize modalities that have shown promise to advance the diagnosis and monitoring of EoE and could improve the care of affected individuals and advance the field.
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Affiliation(s)
- Girish Hiremath
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine, Peoria, Illinois.
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14
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Eosinophils and eosinophil-associated diseases: An update. J Allergy Clin Immunol 2017; 141:505-517. [PMID: 29045815 DOI: 10.1016/j.jaci.2017.09.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 01/01/2023]
Abstract
The goal of this series is to offer a survey of the latest literature for clinicians and scientists alike, providing a list of important recent advances relevant to the broad field of allergy and immunology. This particular assignment was to cover the topic of eosinophils. In an attempt to highlight major ideas, themes, trends, and advances relevant to basic and clinical aspects of eosinophil biology, a search of articles published since 2015 in the Journal of Allergy and Clinical Immunology and other high-impact journals was performed. Articles were then reviewed and organized, and then key findings were summarized. Given space limitations, many outstanding articles could not be included, but the hope is that what follows provides a succinct overview of recently published work that has significantly added to our knowledge of eosinophils and eosinophil-associated diseases.
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15
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Saffari H, Baer K, Boynton KK, Gleich GJ, Peterson KA. Pharyngeal mucosa brushing does not correlate with disease activity in patients with eosinophilic esophagitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1455-1456. [PMID: 28478919 DOI: 10.1016/j.jaip.2017.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/23/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Hedieh Saffari
- Department of Dermatology, University of Utah, Salt Lake City, Utah.
| | - Krista Baer
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Kathleen K Boynton
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Gerald J Gleich
- Department of Dermatology and Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Kathryn A Peterson
- Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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