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Huggard D, Doherty DG, Molloy EJ. Immune Dysregulation in Children With Down Syndrome. Front Pediatr 2020; 8:73. [PMID: 32175298 PMCID: PMC7056667 DOI: 10.3389/fped.2020.00073] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
Down syndrome (DS) is the most common genetic syndrome associated with immune defects. The extent of immune dysregulation in DS is substantial, spanning the innate and adaptive systems and including anomalies in: T and B cells, monocytes, neutrophil chemotaxis, circulating cytokines, and suboptimal antibody responses which all contribute to an increased risk of infections, poorer clinical outcomes and chronic inflammation in this vulnerable cohort. Other aspects of innate immunity may also be abnormal and contribute to the increased morbidity and warrant further interrogation such as: gamma delta T cell function, the inflammasome, Toll-like receptors and their pathways. Pharmacotherapies such as pavilizumab, pneumococcal and influenza immunizations, as well as potential immunoprophylactic agents such as pidotimod, azithromycin and Broncho-Vaxom may help alleviate the infectious consequences. Children with DS need to be managed with a heightened sense of awareness and urgency in the setting of sepsis and signs of chronic inflammation need regular screening and appropriate follow up.
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Affiliation(s)
- Dean Huggard
- Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Children's Hospital Ireland at Crumlin and Tallaght, Dublin, Ireland.,National Children's Research Centre Dublin, Dublin, Ireland
| | - Derek G Doherty
- Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Children's Hospital Ireland at Crumlin and Tallaght, Dublin, Ireland.,National Children's Research Centre Dublin, Dublin, Ireland.,Coombe Women and Infants University Hospital, Dublin, Ireland
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Huggard D, McGrane F, Lagan N, Roche E, Balfe J, Leahy TR, Franklin O, Moreno A, Melo AM, Doherty DG, Molloy EJ. Altered endotoxin responsiveness in healthy children with Down syndrome. BMC Immunol 2018; 19:31. [PMID: 30390640 PMCID: PMC6215672 DOI: 10.1186/s12865-018-0270-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Down syndrome (DS) is the most common syndromic immunodeficiency with an increased risk of infection, mortality from sepsis, and autoinflammation. Innate immune function is altered in DS and therefore we examined responses in CD11b and Toll like receptor 4 (TLR-4), which are important immune cell surface markers upregulated in response to Lipopolysaccharide (LPS) endotoxin, and the immunomodulator melatonin. Neutrophil and monocyte responses to LPS and melatonin in children with Down syndrome (DS) who were clinically stable were compared to age-matched controls. Whole blood was incubated with LPS and melatonin and the relative expression of CD11b and TLR-4 evaluated by flow cytometry. RESULTS Children with DS had an increased response to LPS in neutrophils and intermediate monocytes, while also having elevated TLR-4 expression on non-classical monocytes compared to controls at baseline. Melatonin reduced CD11b expression on neutrophils, total monocytes, both classical and intermediate sub-types, in children with DS and controls. CONCLUSION Melatonin could represent a useful clinical adjunct in the treatment of sepsis as an immunomodulator. Children with DS had increased LPS responses which may contribute to the more adverse outcomes seen in sepsis.
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Affiliation(s)
- Dean Huggard
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland. .,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland. .,Paediatrics, Tallaght Hospital, Dublin, Ireland. .,National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland. .,Department of Paediatrics, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, 24, Ireland.
| | - Fiona McGrane
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland
| | - Niamh Lagan
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland
| | - Edna Roche
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland
| | - Joanne Balfe
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland
| | - Timothy Ronan Leahy
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Immunology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Orla Franklin
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Ana Moreno
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Ashanty M Melo
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Derek G Doherty
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Paediatrics, Trinity College, the University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland.,Coombe Women and Infants University Hospital, Dublin, Ireland.,Neonatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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Elsayed SM, Elsayed GM. Phenotype of apoptotic lymphocytes in children with Down syndrome. IMMUNITY & AGEING 2009; 6:2. [PMID: 19267926 PMCID: PMC2657904 DOI: 10.1186/1742-4933-6-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 03/06/2009] [Indexed: 02/05/2023]
Abstract
Background Down syndrome (DS) is the most common and best-known chromosomal disorder and is associated with several other pathologic conditions including immunodeficiency which makes a significant contribution to morbidity and mortality. Various immunological theories and observations to explain the predisposition of individuals with DS to various infections have been published, one of which is increased apoptotic cells. Aim The aim of this study was to identify the effect of apoptosis on both types of cells of specific immune response (T and B lymphocytes) in children with DS using Annexin V staining of phosphatidyserine (PS) as a specific marker of early apoptosis. Subjects and methods The study included 17 children with karyotypically ascertained DS (7 males and 10 females). Their ages ranged from 4 months to 14 years with mean age of 5.7 ± 4.35 years. Seventeen age and sex matched healthy children were included in the study as controls. Patients or controls with infections were excluded from the study. Complete blood picture, immunophenotyping, analysis of apoptosis using Annexin V was done at National cancer Institute to all children included in this study. Results Although CBC, differential count, relative and absolute number of CD3+ and CD16+ did not show significant differences between DS children and control group, the relative and the absolute size of apoptotic CD3+ T lymphocytes, and the relative size of apoptotic CD19+ B lymphocytes were significantly higher in DS children than in controls. On the other hand, no significant difference was detected as regards the absolute size of CD19+ B lymphocytes in DS children and in controls Conclusion our finding of increased early apoptotic cells (especially T cells) in DS children may emphasize the fact that the function of cells- and not their number- is main mechanism responsible for the impairment of the immune system in DS children and may further add to the known fact that cellular immunity is more severely affected than humoral immunity in these children. Further studies on apoptotic cellular phenotype in larger number of DS are needed
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Affiliation(s)
- Solaf M Elsayed
- Genetics Unit, Pediatrics Department, Ain Shams University, Cairo, Egypt.
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Zaldivar-Chiapa RM, Arce-Mendoza AY, De La Rosa-Ramírez M, Caffesse RG, Solis-Soto JM. Evaluation of Surgical and Non-Surgical Periodontal Therapies, and Immunological Status, of Young Down's Syndrome Patients. J Periodontol 2005; 76:1061-5. [PMID: 16018747 DOI: 10.1902/jop.2005.76.7.1061] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Individuals with Down's syndrome (DS) differ in their oral condition compared with the healthy population. Periodontal disease in persons with DS under the age of 30 years is very high. Immune deficiencies are also present. For dental practitioners it is difficult to decide on a particular course of treatment. In this study, patients with DS were selected in order to 1) evaluate the effectiveness of surgical and non-surgical periodontal therapies and 2) assess their immunological status. METHODS The population consisted of 14 DS patients (14 to 30 years old). Surgical and non-surgical periodontal therapies were compared in a split-mouth design. Clinical measurements of plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment levels (CAL) were taken at baseline, posttreatment, 6 months, and 1 year. Immunomodulatory activity of neutrophils was analyzed in vitro by chemotaxis (Boyden migration chamber), phagocytic activity, and production of super-oxide anion (NBT reduction) tests and compared between DS patients and healthy controls. RESULTS Both surgical and non-surgical therapies showed a significant improvement in all the clinical parameters compared to baseline. There were no differences between surgical and nonsurgical therapy in PI or GI. There was a significant PD reduction with the non-surgical therapy at 1 to 3 mm PD. However in PD >3 mm the surgical therapy, although not statistically significant, showed better results. Neutrophil chemotaxis, phagocytic activity, and production of super-oxide anion were significantly decreased in the DS patients. CONCLUSIONS After a year, both surgical and non-surgical therapies have similar periodontal clinical improvement in DS patients. There is partial impairment of immunological functions in DS individuals which does not seem to affect the clinical response to therapy.
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Affiliation(s)
- R M Zaldivar-Chiapa
- Postgraduate Periodontics, Faculty of Dentistry, Autonomous University of Nuevo Leon, Gonzalitos 235, Mitras Centro, Monterrey, Nuevo Leon, México
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