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Expansion of activated eosinophils in infants with severe atopic dermatitis
Tomoko Toma1, Kazunori Mizuno, Hiroyuki Okamoto
1Department of Pediatrics, Graduate School of Medical Science, Faculty of Medicine, Kanazawa University, Kanazawa 920-0942, Japan.
Insights
Eosinophil activation, indicated by CD69 expression, is linked to severe systemic complications in infant atopic dermatitis (AD). Early evaluation and intervention for eosinophil activation are crucial for treating severe infant AD.
Area of Science:
- Immunology
- Dermatology
- Pediatrics
Background:
- Infants with atopic dermatitis (AD) in Japan exhibit severe systemic complications like hypoproteinemia and developmental delays.
- These severe cases often correlate with significantly elevated eosinophil counts, but the clinical impact remains unclear.
Purpose of the Study:
- To investigate the significance of eosinophilia and eosinophil activation in infant AD.
- To compare clinical parameters, eosinophil activation markers, and serum cytokine levels in infants with and without eosinophil CD69 expression.
Main Methods:
- Assessed CD69 expression on eosinophils via flow cytometry.
- Graded AD severity using the SCORing of atopic dermatitis (SCORAD) index.
- Measured serum levels of eosinophil-derived neurotoxin (EDN) and various interleukins (IL-4, IL-5, IL-12, IL-18) and interferon-gamma (IFN-γ).
Main Results:
- Patients with CD69-positive eosinophils showed higher eosinophil and platelet counts, elevated total IgE, and increased eosinophil nuclear lobes.
- This group also exhibited growth failure, developmental delay, low serum albumin, and electrolyte disturbances.
- Significantly increased EDN and IL-18 levels were observed in CD69-positive eosinophil group.
Conclusions:
- Surface CD69 expression on eosinophils signifies intense systemic allergic inflammation in severe infant AD.
- Evaluating eosinophil activation and implementing early therapeutic interventions are essential for managing severe AD in infants.
Background:
There is increasing concern in Japan over infants with atopic dermatitis (AD) who present with severe systemic complications, such as hypoproteinemia, electrolyte disturbances, and delayed growth and development. They are often associated with extremely increased numbers of circulating eosinophils. However, the clinical significance of eosinophil expansion has not been thoroughly investigated.
Methods:
This study attempted to determine the significance of eosinophilia and eosinophil activation in infant cases of AD by comparing multiple clinical parameters, indexes of eosinophil activation, and levels of serum cytokines. CD69 expression was determined by flow cytometry. The clinical severity of AD was graded by the severity SCORing of atopic dermatitis (SCORAD) method. Patients were classified into two groups, with and without CD69 on eosinophils. Nuclear lobes were evaluated under a microscopy. Serum levels of eosinophil-derived neurotoxin (EDN), interleukin (IL)-12, IL-18, IL-4, IL-5 and interferon (IFN)-gamma were determined by enzyme-linked immunosorbent assay.
Results:
Patients with CD69-positive eosinophils had significantly higher numbers of eosinophils and platelets, total IgE, and eosinophil nuclear lobes. They also showed growth failure, developmental delay, low serum albumin, and electrolyte disturbances. EDN and IL-18 levels were significantly increased in this group, but the levels of IL-4, IL-5 and IL-12 were not significantly different between the two groups. IFN-gamma was not detectable in all patients with AD. Surface expression of CD69 indicates intense systemic allergic inflammation induced in severe cases of AD.
Conclusions:
Evaluation of eosinophil activation and early therapeutic intervention is mandatory for the treatment of severe AD during infancy.
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