Biomarcadores de comprometimento da barreira epitelial esofágica em crianças e adolescentes com esofagite eosinofílica

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation (15 eosinophils / high power field). Other eosinophilic syndromes should be excluded. The recognition of this disease is growing, with increased incidence and prevalence in many continents. Male gender faces a strong risk and there is one peak of incidence in older children. The patients usually suffer from a high number of atopic disorders, especially food allergy. The pathogenesis is not completely understood. Genetic and environmental factors and notably the epithelial barrier proteins of the esophageal epithelium have been considered important to understand the inflammatory process. EoE is a chronic disease and the patients could lose their esophageal function due to remodeling. There is a high impact on quality of life. It is important to understand the role of key proteins in the epithelial barrier to help the patients with EoE - one scientific and health challenge. Objective: to measure the inflammatory activity in fragments of esophageal biopsies of pediatric and adolescent patients with EoE by the expression of E-cadherin and filaggrin proteins. Patients and Methods: 24 patients with EoE and 17 controls were invited to participated in this study. Fragments of esophageal biopsies were collected by upper digestive endoscopy and were analyzed. The number of eosinophils and histological findings were observed. Expression of the E-cadherin and filaggrin proteins was performed by immune-histochemical technique. Symptoms, endoscopic findings, time of diagnosis and treatment were observed in medical records. Results: 62.5% of the patients with EoE were male, with median age of 129.8 months (+ -11.62). The mean of eosinophils was 41.5/HPF (33.03-70.39). 45.8% had food allergy. E-cadherin was altered (subexpressed) in 11 (54.1%) patients with EoE and in 1 (4.1%) of the controls (p <0.05). Filaggrin was not found. Regardless the expression of E-cadherin and filaggrin, there was no significant difference (p <0.05) in the symptoms, endoscopic and histological findings and disease evolution time in patients with EoE. Conclusion: E-cadherin was underexpressed in patients with EoE, indicating epithelial barrier impairment in these patients. Filaggrin expression was unable to signalize barrier impairment in the analyzed patients.