title: A striking local esophageal cytokine expression profile in eosinophilic esophagitis.
abstract: BACKGROUND
  Eosinophilic esophagitis (EE) is an emerging worldwide disease that mimics gastroesophageal reflux disease.
  
  
  OBJECTIVE
  Early studies have suggested that esophageal eosinophilia occurs in association with T(H)2 allergic responses, yet the local and systemic expression of relevant cytokines has not been well characterized.
  
  
  METHODS
  A human inflammatory cytokine and receptor PCR array containing 84 genes followed by PCR validation and multiplex arrays were used to quantify cytokine mRNA in esophageal biopsies and blood samples.
  
  
  RESULTS
  Esophageal transcripts of numerous chemokines (eg, chemokine [C-C motif] ligand [CCL] 1, CCL1, CCL23, CCL26 [eotaxin-3], chemokine [C-X-C motif] ligand [CXCL] 1, and CXCL2), cytokines (eg, IL13 and ATP-binding cassette, subfamily F, member 1), and cytokine receptors (eg, IL5 receptor, alpha) were induced at least 4-fold in individuals with EE. Analysis of esophageal biopsies (n = 288) revealed that eotaxin-3 mRNA level alone had 89% sensitivity for distinguishing individuals with and without EE. The presence of allergy was associated with significantly increased esophageal expression of IL4 and IL5 mRNA in patients with active EE. We identified 8 cytokines (IL-4, IL-13, IL-5, IL-6, IL-12p70, CD40 ligand, IL-1α, and IL-17) whose blood levels retrospectively distinguished 12 patients without EE from 13 patients with EE with 100% specificity and 100% sensitivity. When applied to a blind, prospectively recruited group of 36 patients, the cytokine panel scoring system had a 79% positive predictive value, 68% negative predictive value, 61% sensitivity, and 83% specificity for identifying EE.
  
  
  CONCLUSIONS
  Evidence is presented that IL13 and IL5 associate with eosinophil and eotaxin-3 levels, indicating the key role of adaptive T(H)2 immunity in regulating eotaxin-3-driven esophageal eosinophilia in the absence of a consistent systemic change in cytokines.
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
authors.forename: Carine
authors.initials: C
authors.lastname: Blanchard
authors.forename: Emily M
authors.initials: EM
authors.lastname: Stucke
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rodriguez-Jimenez
authors.forename: Karen
authors.initials: K
authors.lastname: Burwinkel
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Collins
authors.forename: Annette
authors.initials: A
authors.lastname: Ahrens
authors.forename: Eileen S
authors.initials: ES
authors.lastname: Alexander
authors.forename: Bridget K Buckmeier
authors.initials: BK
authors.lastname: Butz
authors.forename: Sean C
authors.initials: SC
authors.lastname: Jameson
authors.forename: Ajay
authors.initials: A
authors.lastname: Kaul
authors.forename: James P
authors.initials: JP
authors.lastname: Franciosi
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Kushner
authors.forename: Philip E
authors.initials: PE
authors.lastname: Putnam
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Abonia
authors.forename: Marc E
authors.initials: ME
authors.lastname: Rothenberg
mesh_terms: D016207:Cytokines / Q000096:biosynthesis* / Q000097:blood; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000276:immunology* / Q000378:metabolism*; D004947:Esophagus / Q000276:immunology / Q000378:metabolism; D006801:Humans; D020411:Oligonucleotide Array Sequence Analysis; D012333:RNA, Messenger / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D018418:Th2 Cells
chemical_list: D016207:Cytokines; D012333:RNA, Messenger