“For every cross section, I used microscopy to count the number of eosinophil cells along the entire perimeter of the tissue surface in each high-power field of view image," said Saffari, a chemical engineering graduate student. “There were somewhere between 40 and 120 of these images per cross section so it took a lot of time, but it was worth it to extract the information we were looking for. No one has done this type of mapping before."
Saffari’s diligence paid off. With her painstakingly collected data, she and Pease used a statistical simulation technique to determine whether randomly sampling tissue would result in a positive diagnosis of EoE based on eonsinophil density.
“Our analysis shows that with current diagnostic conventions, you are only going to catch the patients with medium-to-high eonsinophil densities, which means we may be misdiagnosing patients as much as one out of every five times," Pease said. “Given this data, clearly endoscopy is not sufficient for a disease this patchy."
Gleich said their findings will inform future revisions of EoE diagnosis guidelines, but biopsies are “currently the standard of care and will not change in the near future."
Building on this study, Pease and Saffari are investigating technologies for labeling and detecting proteins shed by eosinophils in the esophagus, which would help detect EoE at an earlier stage. They have also filed a patent to use radiolabeled antibodies to map eosinophils throughout the entire esophagus, a new technique that would be evaluated with a clinical trial. “We’re optimistic that such a diagnostic tool could be available in the next five years," Pease said.
Saffari added that this is part of the team’s long-term goal to develop new strategies to enhance EoE diagnosis and understand what causes the disease.
Pease, Gleich and Saffari conducted the study with gastroenterologists Kathryn Peterson and John Fang and pathologist Carolin Teman at the University of Utah. This study was funded by the University of Utah, the Utah Governor’s Office of Economic Development and the National Science Foundation.