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Show 64 decreased quality of life imposed by endoscopic biopsies, which can cause poor patient compliance [22, 23]. Furthermore, diet elimination trials are not effective for EoE patients with aeroallergen triggers [22]. An improved method to identify antigen triggers in EoE is needed. In Chapter 5, we assess the diagnostic potential of antibodies in esophageal IgG and IgA obtained by brushing. These hypotheses were in part guided by the findings in Chapter 1. Our results suggest that food-specific antibodies (FSAs) secreted by the esophagus are specific to food antigens that trigger EoE and disappear upon successful treatment. FSA testing could be a explored as a novel diagnostic test for predicting food triggers, guiding therapeutic diets, and monitoring treatment response for EoE. Such a test may reduce financial burden and improve quality of life for EoE patients. This method directly addresses the need for improved methods to identify causative antigens for EoE. 6.2 6.2.1 Future work Biomarker validation in a larger cohort Although promising, the findings in Chapters 5 and 6 require validation in a much larger cohort before substantial claims may be made about the diagnostic utility of these biomarkers. We plan to conduct a larger study using esophageal secretions derived from about 250 patients with EoE, gastroesophageal reflux disease, asymptomatic controls, and other gastrointestinal immune diseases. Furthermore, we plan to migrate the food-specific antibody test from the Phadia platform to a Luminex bead-based test. This will allow up to 50-100 different proteins or food-specific antibodies to be simultaneously assayed with high reproducibility using 25µL of patient sample. Ninety-six wells are in a plate, and large numbers of patients could be tested in a single afternoon by a single technician and benchtop device. This method also reduces the cost of diagnosis to about $1.50 per antigen. This test could one day benefit patients immensely by allowing food triggers to be quickly identified, and it could, in theory, be used to identify aeroantigen triggers of EoE. 6.2.2 A generalizable framework for disease research and diagnostic assay development The research framework used in these studies is widely applicable to a plethora of other rare diseases. The combined the skillsets of a proceduralist, pathologist, and compu- |
