From Pathogenesis to Treatment: Targeting Type-2 Inflammation in Eosinophilic Esophagitis
Alberto Barchi, Francesco Vito Mandarino, Mona‐Rita Yacoub, Luca Albarello, Luca Massimino, Edoardo Savarino, Federica Ungaro, Sandro Passaretti, Gwen Masclee, Silvio Danese, Albert J. Bredenoord, Edoardo Vespa
Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus. EoE shares a common pathogenetic mechanism with other chronic disorders pertaining to the type 2 inflammatory spectrum, such as atopic dermatitis (AD), allergic rhinitis (AR), asthma, and chronic rhinosinusitis with nasal polyps (CRSwNP). The recent advancements in EoE pathogenesis understanding have unveiled new molecular targets implied within the "atopic march" picture as well as specific to EoE. These discoveries have led to the clinical evaluation of several novel drugs (monoclonal antibodies and immune modulators), specifically aimed at the modulation of Th2 inflammation. In this comprehensive review, we have focused on the subtle mechanisms of type 2 inflammatory disorders, highlighting the similarities and differences with EoE, taking a deeper look into the evolving field of biologic therapies, already approved or under current investigation.