Do mast cells—a type of white blood cell that plays a part in immune and allergic responses—contribute to the development of eosinophilic esophagitis (EoE)? In the past, eosinophils (another type of white blood cell) have been implicated, which is clear given the disease’s name. However, more medical literature has been suggesting that mast cells could also be a driving force behind this condition. As a result, more research has centered around identifying treatments that could overcome these inflammatory responses and provide more relief to people living with EoE.
According to Yahoo! Finance, barzolvolimab could offer this benefit. Barzolvolimab was developed by clinical-stage biotechnology company Celldex Therapeutics, Inc. (“Celldex”). This subcutaneously administered humanized monoclonal antibody binds to KIT, a receptor tyrosine kinase that is responsible for mast cell activity and survival. When mast cells become overactive, they drive diseases like EoE or chronic spontaneous urticaria (in fact, Celldex released results of a study evaluating barzolvolimab for CSU earlier this year). The therapy works by obstructing KIT’s activity and stopping mast cells from activating.
Celldex believes this will help people with EoE as mast cells have been found in some biopsy tissues. The company also announced recently that the first participant with EoE was dosed in a Phase 2 study evaluating barzolvolimab as a potential therapy. Altogether, 60 patients will enroll. During the trial, they will receive either 300mg barzolvolimab or a placebo every eight week, followed by 300mg barzolvolimab for everyone on the same dosing schedule.
Ultimately, the goal of the study is understanding how this treatment reduces mast cell numbers, activation, and symptoms like difficulty swallowing.
About Eosinophilic Esophagitis (EoE)
This chronic digestive system disorder is characterized by the accumulation of excess eosinophils in the esophagus. Doctors believe that it is immune-mediated and may result from immune hypersensitivity to certain foods and allergens. Some research has also suggested a genetic predisposition to EoE, resulting from unusually high eotaxin-3 gene expression. Many people with eosinophilic esophagitis also have other allergic conditions. EoE causes esophageal inflammation and can lead to symptoms such as:
- Dysphagia (difficulty swallowing)
- Nausea and vomiting
- Food impaction (a medical emergency in which food becomes stuck in the esophagus)
- Appetite loss and/or a poor appetite
- Malnutrition
- Unintentional weight loss
- Recurrent abdominal pain
- Failure to thrive (in infants)
Proton pump inhibitor therapy, as well as nutritional modifications to remove certain foods from the diet, can provide some comfort to people with this condition. Oftentimes, milk, fish, eggs, wheat, soy, and nuts are removed from the diet. Some individuals may require a liquid formula diet. Another treatment, which was just approved in 2022, is dupilumab (Dupixent); this therapy blocks inflammatory cytokines.