Scientists Show How With an Existing Drug They Completely Sent Eosiniphilic Esophagitis into Remission

Food allergies can trigger a chronic immune system disease that inhibits a child’s ability to eat, but recent research might point toward an effective treatment.

Eosinophilic esophagitis (EoE) was not recognized as a distinct illness until the 1990s. However, significant progress has been made since, with a potential remedy now on the horizon.

Researchers from Tulane University have uncovered a new treatment for EoE, a chronic immune system disorder that impedes children’s ability to consume food.

What is Eosinophilic Esophagitis?

EoE is activated by food or airborne allergens that lead to an accumulation of a specific white blood cell, known as eosinophils, in the esophagus lining.

This build-up results in the shortening of the esophagus and thickening of its wall, thereby obstructing swallowing and leading to the lodging of food in the throat.

The condition, though it affects about 1 in 2,000 adults, is more prevalent in children (1 in 1,500), where it poses a higher risk due to the challenges in diagnosis.

The difficulty in feeding can contribute to malnutrition, weight loss, and stunted growth.

How is Eosinophilic Esophagitis caused by food allergies?

The ground-breaking study, published in the Communications Biology journal by Nature, discovered that EoE is caused by Interleukin-18 (IL-18), a protein engaged in the innate immune response that triggers inflammation when overproduced.

The entry of a food allergen in the body sets off a regulatory pathway in the innate immune system, leading to the discharge of proinflammatory proteins like IL-18, which in turn produce the eosinophils that harm the esophagus.

The research found that effectively blocking this NLRP3 pathway, along with the release of IL-18, halted the onset of EoE due to both food and airborne allergens.

“Parents and doctors may not be aware of this, but this is a very prominent and serious disease in the pediatric population, and it is increasing in number because it is directly related to food allergens, which are also on the rise,” added Dr. Anil Mishra, the study’s lead author and director of the Eosinophilic Disorder Center at the Tulane University School of Medicine. “In this study, we show that after treating the disease in animals, the disease is gone and completely in remission.”

How to treat Eosinophilic Esophagitis in children?

This finding is particularly significant for a disease that remained unidentified until the last decade of the 20th century.

For a long time, EoE was erroneously diagnosed as Gastroesophageal Reflux Disease (GERD), despite the ineffectiveness of GERD medications in treating EoE. Furthermore, this study challenges the long-held belief that Th2 cells are major contributors to EoE.

“Given the paucity of mechanistic information and treatment strategies for EoE, we feel the proposed studies are highly relevant and are poised to have a major impact on establishing the significance of NLRP3-IL-18 pathway in the initiation of EoE pathogenesis,” commented Mishra.

The team identified an existing drug, VX-765, which acts as an inhibitor and could potentially be a treatment option for humans.

Notably, this inhibitor would only eradicate pathogenic eosinophils produced and transformed by IL-18, without affecting white blood cells produced by IL-5, a protein vital for maintaining innate immunity.

Source: 10.1038/s42003-023-05130-4 

Image Credit: Getty