title: Peripheral blood eosinophils and other non-invasive biomarkers can monitor treatment response in eosinophilic oesophagitis.
abstract: BACKGROUND
  Monitoring of the treatment response in eosinophilic oesophagitis (EoE) requires structured endoscopical and histological examination of the oesophagus. Less invasive methods would be highly desirable.
  
  
  OBJECTIVE
  To evaluate the utility of several EoE-associated blood and serum markers in order to non-invasively monitor the response to treatment with swallowed topical corticosteroids in adult EoE patients.
  
  
  METHODS
  In a randomised, controlled double-blind trial blood samples of EoE patients (n = 69) were collected at baseline and after 14 days of treatment with budesonide (n = 51) or placebo (n = 18) respectively. Absolute blood eosinophil count (AEC) as well as serum levels of CCL-17, CCL-18, CCL-26, eosinophil-cationic-protein (ECP) and mast cell tryptase (MCT) were determined and correlated with oesophageal eosinophil density and with symptom and endoscopy scores.
  
  
  RESULTS
  Histological remission, defined as mean number of <16 eos/mm(2) hpf at end-of-treatment, was achieved in 98% of the budesonide and 0% of the placebo recipients. AEC [380.2 vs. 214.7/mm(3) (P = 0.0001)], serum-CCL-17 [294.3 vs. 257.9 pg/mL (P = 0.0019)], -CCL-26 [26.7 vs. 16.2 pg/mL (P = 0.0058)], -ECP [45.5 ± 44.7 vs. 27.5 ± 25.0 μg/L (P = 0.0016)] and -MCT [5.3 ± 2.9 vs. 4.5 ± 2.6 μg/L (P = 0.0019)] significantly decreased under budesonide but not under placebo. AEC significantly correlated with oesophageal eosinophil density before (r = 0.28, P = 0.0236) and after (r = 0.42, P = 0.0004) budesonide treatment. In ROC-AUC analyses post-treatment values of AEC were significantly associated with histological remission (ROC-AUC 0.754; 95% CI: 0.617-0.891; P = 0.0003).
  
  
  CONCLUSIONS
  The budesonide-induced treatment response in EoE is mirrored by several blood and serum markers, and the absolute blood eosinophil count is the most valuable as it shows correlation with the oesophageal eosinophil density.
authors: 2nd Medical Department, Technische Universität München, Munich, Germany.
authors: C
authors: C
authors: Schlag
authors: Center for Digestive Diseases Eppendorf, Hamburg, Germany.
authors: S
authors: S
authors: Miehlke
authors: Institute for Immunology, Ludwig-Maximillian-Universität München, Munich, Germany.
authors: A
authors: A
authors: Heiseke
authors: Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany.
authors: K
authors: K
authors: Brockow
authors: Institute for Immunology, Ludwig-Maximillian-Universität München, Munich, Germany.
authors: A
authors: A
authors: Krug
authors: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany.
authors: U
authors: U
authors: von Arnim
authors: Swiss EoE Research Network, Olten, Switzerland.
authors: A
authors: A
authors: Straumann
authors: Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany.
authors: M
authors: M
authors: Vieth
authors: Institute for Pathology, Kantonsspital Luzern, Luzern, Switzerland.
authors: C
authors: C
authors: Bussmann
authors: Dr Falk Pharma GmbH, Freiburg, Germany.
authors: R
authors: R
authors: Mueller
authors: Dr Falk Pharma GmbH, Freiburg, Germany.
authors: R
authors: R
authors: Greinwald
authors: 2nd Medical Department, Technische Universität München, Munich, Germany.
authors: M
authors: M
authors: Bajbouj
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D019819:Budesonide / Q000627:therapeutic use*; D019742:Chemokines, CC / Q000097:blood; D004311:Double-Blind Method; D016903:Drug Monitoring; D047150:Eosinophil Cationic Protein / Q000097:blood; D057765:Eosinophilic Esophagitis / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D004804:Eosinophils; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012074:Remission Induction; D053802:Tryptases / Q000097:blood
chemical_list: D015415:Biomarkers; D019742:Chemokines, CC; D005938:Glucocorticoids; D019819:Budesonide; D047150:Eosinophil Cationic Protein; C479220:RNASE3 protein, human; D053802:Tryptases