Eosinophils, sometimes called eosinophiles or, less commonly, acidophils, are a variety

of white blood cells and one of the immune system components responsible for combating
multicellular parasites and certain infections in vertebrates.[2] Along with mast cells and basophils,
they also control mechanisms associated with allergy and asthma. They are granulocytes that
develop during hematopoiesis in the bone marrow before migrating into blood, after which they
are terminally differentiated and do not multiply.[3] They form about 2 to 3% of white blood cells in
the body.

These cells are eosinophilic or "acid-loving" due to their large acidophilic cytoplasmic granules,
which show their affinity for acids by their affinity to coal tar dyes: Normally transparent, it is this
affinity that causes them to appear brick-red after staining with eosin, a red dye, using
the Romanowsky method.[4] The staining is concentrated in small granules within the
cellular cytoplasm, which contain many chemical mediators, such as eosinophil
peroxidase, ribonuclease (RNase), deoxyribonucleases (DNase), lipase, plasminogen, and major
basic protein. These mediators are released by a process called degranulation following
activation of the eosinophil, and are toxic to both parasite and host tissues.

In normal individuals, eosinophils make up about 1–3% of white blood cells, and are about 12–
17 micrometres in size with bilobed nuclei.[3][5] While eosinophils are released into the
bloodstream, they reside in tissue.[4] They are found in the medulla and the junction between
the cortex and medulla of the thymus, and, in the
lower gastrointestinal tract, ovaries, uterus, spleen, and lymph nodes, but not in
the lungs, skin, esophagus, or some other internal organs[vague] under normal conditions. The
presence of eosinophils in these latter organs is associated with disease. For instance, patients
with eosinophilic asthma have high levels of eosinophils that lead to inflammation and tissue
damage, making it more difficult for patients to breathe.[6][7] Eosinophils persist in the circulation for
8–12 hours, and can survive in tissue for an additional 8–12 days in the absence of stimulation.
[8]
Pioneering work in the 1980s elucidated that eosinophils were unique granulocytes, having the
capacity to survive for extended periods of time after their maturation as demonstrated by ex-vivo
culture experiments.[9]

Development[edit]

Blood cell lineage

TH2 and ILC2 cells both express the transcription factor GATA-3, which promotes the production
of TH2 cytokines, including the interleukins (ILs).[6] IL-5 controls the development of eosinophils in
the bone marrow, as they differentiate from myeloid precursor cells.[6][10][11][12] Their lineage fate is
determined by transcription factors, including GATA and C/EBP.[3] Eosinophils produce and store
many secondary granule proteins prior to their exit from the bone marrow. After maturation,
eosinophils circulate in blood and migrate to inflammatory sites in tissues, or to sites
of helminth infection in response to chemokines like CCL11 (eotaxin-1), CCL24 (eotaxin-2), CCL5
(RANTES), 5-hydroxyicosatetraenoic acid and 5-oxo-eicosatetraenoic acid, and
certain leukotrienes like leukotriene B4 (LTB4) and MCP1/4. Interleukin-13, another TH2
cytokine, primes eosinophilic exit from the bone marrow by lining vessel walls with adhesion
molecules such as VCAM-1 and ICAM-1.[6] When eosinophils are activated, they undergo
cytolysis, where the breaking of the cell releases eosinophilic granules found in extracellular DNA
traps.[6] High concentrations of these DNA traps are known to cause cellular damage, as the
granules they contain are responsible for the ligand-induced secretion of eosinophilic toxins
which cause structural damage.[6] There is evidence to suggest that eosinophil granule protein
expression is regulated by the non-coding RNA EGOT.[13]

Function[edit]

Histology of an eosinophil within epithelium, characterized by its

bilobed nucleus despite scant visible eosinophilic cytoplasm.
Following activation, eosinophils effector functions include production of the following:

 Cationic granule proteins and their release by degranulation[14][15][16]

 Reactive oxygen species such as hypobromite, superoxide,
and peroxide (hypobromous acid, which is preferentially produced by eosinophil
peroxidase)[17]
 Lipid mediators like the eicosanoids from the leukotriene (e.g., LTC4, LTD4, LTE4)
and prostaglandin (e.g., PGE2) families[18]
 Enzymes, such as elastase
 Growth factors such as TGF beta, VEGF, and PDGF[19][20]
 Cytokines such as IL-1, IL-2, IL-4, IL-5, IL-6, IL-8, IL-9, IL-13, and TNF alpha[15][21]
There are also eosinophils that play a role in fighting viral infections, which is evident from the
abundance of RNases they contain within their granules, and in fibrin removal
during inflammation. Eosinophils, along with basophils and mast cells, are important mediators
of allergic responses and asthma pathogenesis and are associated with disease severity. They
also fight helminth (worm) colonization and may be slightly elevated in the presence of certain
parasites. Eosinophils are also involved in many other biological processes, including
postpubertal mammary gland development, oestrus cycling, allograft rejection and neoplasia.
[21]
They have also been implicated in antigen presentation to T cells.[22]

Eosinophils are responsible for tissue damage and inflammation in many diseases, including
asthma.[6][7] High levels of interleukin-5 has been observed to up regulate the expression of
adhesion molecules, which then facilitate the adhesion of eosinophils to endothelial cells, thereby
causing inflammation and tissue damage.[7]

An accumulation of eosinophils in the nasal mucosa is considered a major diagnostic criterion

for allergic rhinitis (nasal allergies).

Granule proteins[edit]
Following activation by an immune stimulus, eosinophils degranulate to release an array of
cytotoxic granule cationic proteins that are capable of inducing tissue damage and dysfunction.
[23]
These include:

 major basic protein (MBP)

 eosinophil cationic protein (ECP)
 eosinophil peroxidase (EPX)
 eosinophil-derived neurotoxin (EDN)
Major basic protein, eosinophil peroxidase, and eosinophil cationic protein are toxic to many
tissues.[21] Eosinophil cationic protein and eosinophil-
derived neurotoxin are ribonucleases with antiviral activity.[24] Major basic protein induces mast
cell and basophil degranulation, and is implicated in peripheral nerve remodelling.[25][26] Eosinophil
cationic protein creates toxic pores in the membranes of target cells, allowing potential entry of
other cytotoxic molecules to the cell,[27] can inhibit proliferation of T cells,
suppress antibody production by B cells, induce degranulation by mast cells, and stimulate
fibroblast cells to secrete mucus and glycosaminoglycan.[28] Eosinophil peroxidase forms reactive
oxygen species and reactive nitrogen intermediates that promote oxidative stress in the target,
causing cell death by apoptosis and necrosis.[21]

Clinical significance[edit]
Eosinophilia[edit]
Main article: Eosinophilia
An increase in eosinophils, i.e., the presence of more than 500 eosinophils/microlitre of blood is
called an eosinophilia, and is typically seen in people with a parasitic infestation of
the intestines; autoimmune and collagen vascular disease (such as rheumatoid arthritis)
and Systemic lupus erythematosus; malignant diseases such as eosinophilic leukemia, clonal
hypereosinophilia, and Hodgkin lymphoma; lymphocyte-variant hypereosinophilia;
extensive skin diseases (such as exfoliative dermatitis); Addison's disease and other causes of
low corticosteroid production (corticosteroids suppress blood eosinophil levels); reflux
esophagitis (in which eosinophils will be found in the squamous epithelium of the esophagus)
and eosinophilic esophagitis; and with the use of certain drugs such as penicillin. But, perhaps
the most common cause for eosinophilia is an allergic condition such as asthma. In 1989,
contaminated L-tryptophan supplements caused a deadly form of eosinophilia known
as eosinophilia-myalgia syndrome, which was reminiscent of the toxic oil syndrome in Spain in
1981.

Reference
ranges for blood tests of white blood cells, comparing eosinophil granulocyte amount (shown
in light red) with other cells
Eosinophils play an important role in asthma as the number of accumulated eosinophils
corresponds to the severity of asthmatic reaction.[7] Eosinophilia in mice models are shown to be
associated with high interleukin-5 levels.[7] Furthermore, mucosal bronchial biopsies conducted on
patients with diseases such as asthma have been found to have higher levels of interleukin-5
leading to higher levels of eosinophils.[7] The infiltration of eosinophils at these high concentrations
causes an inflammatory reaction.[7] This ultimately leads to airway remodelling and difficulty of
breathing.[7]

Eosinophils can also cause tissue damage in the lungs of asthmatic patients. [7] High
concentrations of eosinophil major basic protein and eosinophil-derived neurotoxin that approach
cytotoxic levels are observed at degranulation sites in the lungs as well as in the asthmatic
sputum.[7]

Treatment[edit]
Treatments used to combat autoimmune diseases and conditions caused by eosinophils include:
  corticosteroids – promote apoptosis. Numbers of eosinophils in blood are rapidly
reduced
 monoclonal antibody therapy – e.g., mepolizumab or reslizumab against IL-5,
prevents eosinophilopoiesis, or benralizumab against IL-5 receptor, which eliminates
eosinophils through ADCC
 antagonists of leukotriene synthesis or receptors
 imatinib (STI571) – inhibits PDGF-BB in hypereosinophilic leukemia
Monoclonal antibodies such as dupilumab and lebrikizumab target IL-13 and its receptor, which
reduces eosinophilic inflammation in patients with asthma due to lowering the number of
adhesion molecules present for eosinophils to bind to, thereby decreasing inflammation. [29]
[30]
Mepolizumab and benralizumab are other treatment options that target the alpha subunit of
the IL-5 receptor, thereby inhibiting its function and reducing the number of developing
eosinophils as well as the number of eosinophils leading to inflammation through antibody-
dependent cell-mediated cytotoxicity and eosinophilic apoptosis.[31][32]

Animal studies[edit]
Within the fat (adipose) tissue of CCR2 deficient mice, there is an increased number of
eosinophils, greater alternative macrophage activation, and a propensity towards type
2 cytokine expression. Furthermore, this effect was exaggerated when the mice
became obese from a high fat diet.[33] Mouse models of eosinophilia from mice infected with T.
canis showed an increase in IL-5 mRNA in mice spleen.[7] Mouse models of asthma from OVA
show a higher TH2 response.[6] When mice are administered IL-12 to induce the TH1 response,
the TH2 response becomes suppressed, showing that mice without TH2 cytokines are
significantly less likely to express asthma symptoms.[6]