Interplay of adaptive th2 immunity with eotaxin-3/c-C chemokine receptor 3 in eosinophilic esophagitis

J Pediatr Gastroenterol Nutr. 2007 Jul;45(1):22-31. doi: 10.1097/MPG.0b013e318043c097.


Background: Pediatric eosinophilic esophagitis (EE) is a recently described disorder associated with atopy. Although studies of esophageal tissue suggest that Th2 cytokines and eotaxin-3 may be crucial in disease pathogenesis, little is known about the systemic immunological phenotypes of children with EE.

Objectives: To define the phenotypes of peripheral blood eosinophils and lymphocytes in EE and to examine for correlations between these parameters and tissue eosinophil numbers and disease severity.

Patients and methods: Blood was collected from children with EE, atopic control children without EE, and nonatopic control children without EE. Flow cytometry was used to measure eosinophil expression of chemokine receptor 3 (CCR3) and interleukin-5 receptor-alpha (IL-5Ralpha), and intracellular lymphocyte expression of IL-4, IL-5, IL-13, interferon-gamma, and tumor necrosis factor-alpha. Eosinophil numbers and eotaxin-3 mRNA levels were quantitated in esophageal biopsy specimens.

Results: Compared with nonatopic control children, EE patients with active disease had increased peripheral blood eosinophil percentages, mean channel of fluorescence (MCF) of CCR3 on eosinophils, and percentage of CD4+ T cells expressing IL-5. Notably, these parameters positively correlated with esophageal eosinophil numbers. Eotaxin-3 tissue expression positively correlated with esophageal eosinophil numbers and peripheral blood eosinophil CCR3 MCF. The percentage of peripheral blood eosinophils, eosinophil CCR3 MCF, and CD4+ T cell expression of IL-5 were lower in EE patients in disease remission than in patients with active disease.

Conclusions: Collectively, these studies demonstrate cooperation between systemic CD4+ Th2-cell-mediated immunity and an enhanced eosinophil-CCR3/eotaxin-3 pathway in EE pathogenesis. Furthermore, the imbalanced Th2 immunity and increased CCR3 expression are reversible with disease remission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antigens, Surface
  • Chemokine CCL26
  • Chemokines, CC / biosynthesis
  • Chemokines, CC / immunology*
  • Child
  • Cytokines / biosynthesis
  • Eosinophilia / immunology*
  • Eosinophils / immunology
  • Eosinophils / metabolism*
  • Esophagitis / immunology*
  • Humans
  • Hypersensitivity, Immediate / immunology
  • Immunity, Cellular
  • RNA, Messenger / biosynthesis
  • Receptors, CCR3
  • Receptors, Chemokine / biosynthesis
  • Receptors, Chemokine / immunology*
  • Th2 Cells / immunology*


  • Antigens, Surface
  • CCL26 protein, human
  • CCR3 protein, human
  • Chemokine CCL26
  • Chemokines, CC
  • Cytokines
  • RNA, Messenger
  • Receptors, CCR3
  • Receptors, Chemokine