Adult Eosinophilic Esophagitis Registry Atlas

Eosinophilic esophagitis (EoE) arises in the setting of type 2 cytokine-driven inflammation, is characterized by the infiltration of eosinophils in the esophageal mucosa, and is associated with dysphagia and fibrostenotic complications. Disease development and progression involve complex interactions between epithelial cells, stromal cells and immune cells. Indeed, increased epithelial permeability is consistently found in EoE, potentially leading to increased antigen exposure and inflammation. Persistent inflammation can in turn lead to fibroblast activation and fibrosis, which, together with the mediators produced by eosinophils and mast cells, leads to dysmotility. To decipher the interactions between these cell types across distinct disease states, we obtained biopsies from 7 healthy controls and 15 EoE subjects, including both active disease and clinical remission, to perform single cell RNA-sequencing (scRNA-seq).Each biopsy sample was enzymatically digested within 3 hours of collection with collagenase/dispase to generate a single cell suspension. Suspensions were then loaded on a 10x Chromium controller, and libraries were generated with the 3' Chemistry pipeline (v2 or v3) before sequencing on an Illumina sequencer. The resulting sequence data was demultiplexed and analyzed with the CellRanger pipeline to generate raw fastq files and processed gene-count matrices for each sample. Altogether, our study generated transcriptomic profiles from 421,312 individual cells after quality control and filtering.Our analyses reveal 60 cell subsets and functional alterations in cell states, compositions, and interactions that highlight previously unknown features of EoE. Active disease displayed enrichment of ALOX15+ macrophages, novel PRDM16+ dendritic cells expressing the EoE risk gene ATP10A, and cycling mast cells, with concomitant reduction of TH17 cells. Receptor–ligand expression uncovered eosinophil recruitment programs, increased fibroblast interactions in disease, and IL-9+IL-4+IL-13+TH2 and endothelial cells as potential mast cell interactors. Resolution of inflammation-associated signatures included mast and CD4+ Tissue-resident memory T (TRM) cell contraction and cell type-specific downregulation of eosinophil chemoattractant, growth, and survival factors. ]]>
Adult subjects undergoing a clinically-indicated upper endoscopy were enrolled after informed written consent. Separate biopsies were collected for pathological evaluation and single-cell processing and pathological reports were used to determine inclusion/exclusion.EoE subjects were enrolled based on a diagnosis of EoE (either pre-existing or determined after endoscopy), and classified as active disease based on the presence of ≥15 eosinophils per high-powered field (eos/hpf) in at least one biopsy from the proximal or distal esophagus. Subjects were classified as remission if they had a history of EoE but both proximal and distal biopsies had <15 eos/hpf for the visit where samples were collected.Healthy controls were included based on an absence of EoE history and underwent an endoscopy for unrelated diagnoses. Subjects with abnormal histological findings in the esophagus were excluded from this control group.]]>