The Immune Architecture of Eosinophilic Esophagitis: Mechanisms, Therapeutic Targets, and Precision Management - PubMed
4 hours ago
- #precision medicine
- #eosinophilic esophagitis
- #immune mechanisms
- Eosinophilic esophagitis (EoE) is a chronic, allergen-driven type 2 immune-mediated disease with increasing global prevalence.
- Its pathogenesis involves epithelial alarmin signaling, ILC2 and Th2 immune activation, and an effector network causing barrier disruption and fibrostenotic remodeling.
- The ILC2-amphiregulin-EGFR axis drives structural esophageal remodeling independently of eosinophils, explaining histology-symptom dissociation in some treatments.
- First-line therapies like PPIs, swallowed topical corticosteroids, and dietary elimination achieve histologic remission in 45-90% of patients.
- Dupilumab, the first approved biologic, shows ~59-60% histologic remission vs. 5-6% with placebo at week 24.
- Emerging therapies target IL-13, IL-5R, TSLP, mast cells, and JAK-STAT pathways, along with optimized steroid formulations and oral small molecules.
- Precision medicine strategies incorporate molecular endotyping to optimize outcomes and individualize targeted therapies, preventing fibrostenotic progression.