Molecular Mechanisms of Eosinophilic Esophagitis

Food hypersensitivity is a group of diseases arising from a specific immune response that reproduces on exposure to a given food. The current understanding of molecular mechanisms and immunopathology of non-IgE-mediated/mixed food hypersensitivity, e.g., eosinophilic esophagitis, contains many gaps in knowledge. This review aims to provide a modern classification and identify the primary diseases of non-IgE-mediated/mixed food hypersensitivity reactions, delineate the distinctive molecular features, and discuss recent findings in the immunopathology of eosinophilic esophagitis that may become a basis to develop valid biomarkers and novel therapies for this disease. Eosinophilic esophagitis is a recently recognized allergic-mediated disease with eosinophil-predominant esophagus inflammation. Its pathogenesis is a complicated network of interactions and signaling between epithelial, mesenchymal, and immune cells on molecular and intercellular levels. Alterations produced by overactivation of some cytokine signaling pathways, e.g., IL-13 or thymic stromal lymphopoietin (TSLP), were evolved and observed in this review from the viewpoints of molecular, genetic, epigenetic, and transcriptomic changes. Despite substantial experimental data, the reliable and representative mechanism of eosinophilic esophagitis pathogenesis has yet to show itself. So, the place of esophagitis between mixed and non-IgE-mediated allergic disorders and between eosinophilic gastrointestinal disorders currently seems vague and unclear.

Automated summary

Food hypersensitivity encompasses diseases driven by specific immune responses to certain foods, with conditions like eosinophilic esophagitis posing challenges in understanding their molecular mechanisms. Researchers aim to classify and identify primary diseases of non-IgE-mediated/mixed food hypersensitivity, exploring distinctive molecular features and discussing potential biomarkers and therapies for eosinophilic esophagitis. The pathogenesis of eosinophilic esophagitis involves complex interactions and signaling at molecular and cellular levels, with alterations in cytokine signaling pathways observed, although a definitive mechanism remains elusive. The position of esophagitis within allergic disorders and eosinophilic gastrointestinal disorders is currently ambiguous.