Original articles—alimentary tractA Novel Histologic Scoring System to Evaluate Mucosal Biopsies From Patients With Eosinophilic Esophagitis
Section snippets
Development of an Anti-Eosinophil Peroxidase Monoclonal Antibody and Diagnostic Scoring Algorithm to Evaluate Esophageal Patients
For a complete explanation of this process, see Supplementary Materials and Methods.
Human Subjects
Adult esophageal patients were identified retrospectively by gastroenterologists at Mayo Clinic Arizona. These patients were divided into 4 groups. Group I were patients diagnosed with EoE by virtue of (1) clinical symptoms at presentation (eg, dysphagia, vomiting, and/or food impaction); (2) GERD was ruled out with pretreatment with proton pump inhibition, a normal pH/impedance monitor, and/or response to
Anti-Eosinophil Peroxidase Monoclonal Antibody–Based Immunohistochemistry: Pathology Assessments of Eosinophilic Esophagitis Patients, Including the Detection of Eosinophil Activation (the Release of Granule Proteins [Degranulation])
EPX-mAb–based immunohistochemistry provided a strategy for the rapid detection of infiltrating eosinophils in esophageal biopsies. More important, this strategy also provided a method with which to identify quickly areas of biopsies that are likely to contain the focus of ≥15 eosinophils/40× HPF needed to meet the histologic guidelines for a diagnosis of EoE. The photomicrographs of Figure 1 demonstrated the ease of identifying eosinophils within tissue sections by using EPX-mAb–based
Discussion
The EPX-mAb–based immunohistochemical assay described in this report represents a novel tool and systematic method to assess esophageal tissues for evidence of eosinophilic inflammation in both children and adults. The previously limited availability of eosinophil-specific antibody staining options for immunohistochemical assays that are sensitive, reproducible, and useful in the most commonly available format (ie, archived formalin-fixed paraffin-embedded tissues) had prevented the development
Acknowledgments
The authors are grateful to all of their Mayo Clinic Arizona (MCA) and Children's Hospital Denver (CHD) clinical colleagues and their patients. The authors are grateful for the invaluable insight provided by their pathology colleagues, including Drs K. Leslie (MCA), R. Valdez (MCA), C. Conley (MCA), J. Sweeney (MCA), Mark Lovell (CHD), and Kelley Capocelli (CHD). The authors would also like to thank Wendy Moore (CHD), S. Montgomery (MCA), and C. Sinclair (MCA). The authors are indebted to Media
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To view this article's video abstract, go to the AGA's YouTube Channel.
Conflicts of interest The authors disclose no conflicts.
Funding The studies presented regarding the use of these antibodies in the diagnosis of human disease were supported by the Mayo Foundation and research grants from the NIH to J.J.L. (HL065228, CA112442, and K26-RR019709), N.A.L. (HL058723), and G.T.F. (DK62245 and CURED). The creation/production of EPX-reactive mouse monoclonal antibodies was supported in part by a sponsored research grant from Schering-Plough.