Abstract

Usefulness of Measurement of Soluble Interleukin-2 Receptor (sIL-2R) and Interleukin 6 to Monitor Efficacy of Specific Immunotherapy in Eosinophilic Esophagitis

Background: Eosinophilic esophagitis is considered a hypersensitivity reaction. We have successfully treated patients who suffered from eosinophilic esophagitis with Allergen Specific Immunotherapy (AIT). Monitoring this efficacy has been carried out with clinical parameters and serial endoscopies, but it would be useful to find a serological marker with a good response to the AIT that would obviate them. Soluble Interleukin-2 Receptor (sIL-2R) can be useful for monitoring many active eosinophilic inflammatory diseases (autoimmune, neoplastic, and infectious), but it has not been measured in Eosinophilic Esophagitis (EoE). IL-6 has a great inflammatory activity more associated with rheumatoid arthritis but could measure the lymphocytic and fibrotic response that occurs in the remodeling of the mucosa in this pathology. Objective: We carried out measurements of sIL-2Ry IL-6 after 3 years of AIT in patients with EoE and two years of suspension of this treatment without relapse of disease, to evaluate the usefulness of this measurement as objective markers of improvement of the esophagitis. Methods: One hundred and twenty-nine patients with EoE were tested for environmental and food allergens. CRD, histological and botanical analysis was performed. Clinical scores and endoscopic biopsies were performed every six months for five years. Fifteen healthy patients and 34 asthmatics due to pollen were included as control groups. CRD-directed Allergen Immunotherapy (AIT) was administered in 91 EoE patients and conventional treatment (proton pump inhibitors, empiric diet, corticosteroids) in the rest of the patients (n=38). Sera of all patients were collected before de therapy and after the suppression of the treatment. Randomized blind analysis of IL-2R and IL-6 was performed in all samples of treated (AIT/conventional) and controls subjects and correlated with clinical and endoscopic findings. Results: Higher sIL-2Rlevels were measured in patients with EoE for pollen asthma and higher in both processes than in healthy patients (p<0.0001). In patients treated with AIT, a marked decrease in sIL-2R was observed, significantly higher than in patients with conventional therapy (p<0.0001). This improvement was significantly correlated with clinical and endoscopic findings of good evolution of the disease (p<0.001). The measure of IL-6 was not useful for monitoring the effect of AIT. Conclusion: Measurement of sIL-2R can be useful in monitoring efficacy of specific immunotherapy in EoE as can be used also as a marker of the activity of the disease, but it is not valid as a diagnostic test, while IL-6 is not valid neither for monitoring nor as a diagnostic test.

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