Role of Vasoactive Intestinal Peptide in Promoting the Pathogenesis of Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) is associated with eosinophil and mast cell accumulation, which promotes dysphagia and esophageal dysmotility. Cytokines and chemokines implicated in eosinophil-, mast cell–, and basophil-mediated EoE pathogenesis include interleukin (IL)-5, IL-13, thymic stromal lymphopoietin, and eotaxin-3. A correlation between IL-5 and eotaxin-3 expression and eosinophil infiltration has been observed. Nevertheless, it is not clear if eotaxin-3 is the only chemokine, or one of several, that directs eosinophil accumulation in EoE. Herein, we present evidence that a neuroimmune pathway is involved in eosinophil and mast cell accumulation and degranulation in human EoE. Morphologically, eosinophils accumulate near nerves within the muscular mucosa of the esophagus (Figure 1A). This spatial association suggests that nerve cells may release