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DeBoer EM, Wolter-Warmerdam K, Deterding RR, Marmolejo J, Blumenthal T, Espinosa JM, Hickey F, Wagner BD. Cardiopulmonary Phenotypes and Protein Signatures in Children With Down Syndrome. Clin Pediatr (Phila) 2024; 63:474-481. [PMID: 37306037 PMCID: PMC11060669 DOI: 10.1177/00099228231179453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pulmonary disease, lower respiratory tract infection, and pneumonia are the largest causes of morbidity and mortality in individuals with Down syndrome (DS), but whether pulmonary diagnoses in children with DS are common and occur independently of cardiac disease and pulmonary hypertension (PH) is unknown. Cardiopulmonary phenotypes were examined in a cohort of 1248 children with DS. Aptamer-based proteomic analysis of blood was performed in a subset (n = 120) of these children. By the age of 10 years, half of the patients in this cohort (n = 634, 50.8%) had co-occurring pulmonary diagnoses. That proteins and related pathways were distinct between children with pulmonary diagnoses and those with cardiac disease and/or PH may indicate that pulmonary diagnoses appear to occur independently of cardiac disease and PH. Heparin sulfate-glycosaminoglycandegradation, nicotinate metabolism, and elastic fiber formation were ranked highest in the group with pulmonary diagnoses.
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Affiliation(s)
- Emily M. DeBoer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Robin R. Deterding
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | - Tom Blumenthal
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joaquin M. Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO, USA
| | - Francis Hickey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Brandie D. Wagner
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Biostatistics & Informatics, University of Colorado School of Public Health, Aurora, CO, USA
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Pitchan Velammal PNK, Balasubramanian S, Ayoobkhan FS, Mohan GVK, Aggarwal P, Rabaan AA, Khan SA, Yasmin F, Koritala T, Surani SR. COVID-19 in patients with Down syndrome: A systematic review. Immun Inflamm Dis 2024; 12:e1219. [PMID: 38501534 PMCID: PMC10949394 DOI: 10.1002/iid3.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/24/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Down syndrome (DS) is associated with multiple comorbid conditions and chronic immune dysfunction. Persons with DS who contract COVID-19 are at high risk for complications and have a poor prognosis. We aimed to study the clinical symptoms, laboratory and biochemical profiles, radiologic findings, treatment, and outcomes of patients with DS and COVID-19. METHOD We systematically searched PubMed, MEDLINE, Web of Science, Scopus, and the Cochrane Library using the keywords COVID-19 or coronavirus or SARS-CoV-2 and DS or trisomy 21. Seventeen articles were identified: eight case reports and nine case series published from December 2019 through March 2022, with a total of 55 cases. RESULTS Patients averaged 24.8 years (26 days to 60 years); 29 of the patients were male. The most common symptoms were fever, dyspnea, and cough. Gastrointestinal and upper respiratory tract symptoms were commonly reported for pediatric patients. The most common comorbidities present in patients with DS were obesity (49.0%), hypothyroidism (21.6%) and obstructive sleep apnea (15.6%). The patients were hospitalized for a mean of 14.8 days. When the patients were compared with the general COVID-19 population, the mean number of hospitalized days was higher. Most patients had leukopenia, lymphopenia, and elevated inflammatory markers (d-dimer and C-reactive protein). Bilateral infiltrations and bilateral ground-glass opacifications were frequently seen in chest radiographs and chest computed tomographic imaging. Most of the patients were treated with methylprednisolone, macrolides, and hydroxychloroquine. Of the 55 patients, 22 died. The mean age of the patients who died was 42.8 years. Mortality rate was higher in individuals with DS over 40 years of age. CONCLUSION More studies are needed to better understand COVID-19 infections among persons with DS. In addition, the study was limited by a lack of statistical analyses and a specific comparison group.
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Affiliation(s)
| | | | | | - Gautham V. K. Mohan
- Department of MedicineTirunelveli Medical College and HospitalTirunelveliIndia
| | - Pearl Aggarwal
- Department of MedicineSt Vincent Charity Medical CenterClevelandOhioUSA
| | - Ali A. Rabaan
- Department of MedicineJohns Hopkins Aramco HealthcareDhahranSaudi Arabia
- Department of MedicineAlfaisal UniversityRiyadhSaudi Arabia
- Department of MedicineThe University of HaripurHaripurPakistan
| | - Syed A. Khan
- Critical Care MedicineMayo Clinic Health SystemMankatoMinnesotaUSA
| | - Farah Yasmin
- Department of MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Thoyaja Koritala
- Critical Care MedicineMayo Clinic Health SystemMankatoMinnesotaUSA
| | - Salim R. Surani
- Department of Medicine & PharmacologyTexas A&M UniversityCollege StationTexasUSA
- Department of Medicine & PharmacologyResearch Collaborator, Mayo ClinicRochesterMinnesotaUSA
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da Silva MVG, Pereira LRG, de Avó LRDS, Germano CMR, Melo DG. Enhancing understanding of SARS-CoV-2 infection among individuals with Down syndrome: An integrative review. SAO PAULO MED J 2023; 142:e2023015. [PMID: 37610949 PMCID: PMC10445757 DOI: 10.1590/1516-3180.2023.0015.r1.230523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/14/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Down syndrome (DS) is a non-rare genetic condition that affects approximately 1 in every 800 live births worldwide. Further, it is associated with comorbidities, anatomical alterations of the respiratory tract, and immunological dysfunctions that make individuals more susceptible to respiratory infections. OBJECTIVE To systematize the current scientific knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among individuals with DS. DESIGN AND SETTING This integrative review was conducted at the Universidade Federal de São Carlos, São Paulo, Brazil. METHODS This review was conducted in the following databases: the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), PubMed, and Web of Science, using MeSH descriptors. The search included English or Portuguese studies published between January 1, 2020, and October 14, 2022. RESULTS A total of 55 articles from 24 countries were selected, comprising 21 case-control or cohort studies, 23 case reports or series, and 11 narrative reviews or opinion studies. The articles were grouped into five categories: previous comorbidities, coronavirus disease 2019 (COVID-19) clinical features and evolution, cytokine storm and interleukins, living in institutions as a risk factor, and behavioral actions as a protective factor against SARS-CoV-2 infection. CONCLUSION Individuals with DS are more susceptible to COVID-19 infection due to variables such as previous comorbidities, immunological factors, and their habitable environments. These aspects confer a higher risk of infection and an unfavorable clinical course. The precise pathways involved in the pathophysiology of COVID-19 in individuals with DS are not clear, thus requiring further studies. SYSTEMATIC REVIEW REGISTRATION The Open Science Framework registered the research protocol (https://osf.io/jyb97/).
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Affiliation(s)
- Maria Vitoria Gomes da Silva
- Medical Undergraduate Student, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | | | - Lucimar Retto da Silva de Avó
- MD, PhD. Associate Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Carla Maria Ramos Germano
- MD, PhD. Associate Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Débora Gusmão Melo
- MD, PhD. Full Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
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4
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Niemann A, Boudriot A, Brett B, Fritzsch C, Götz D, Haase R, Höhne S, Jorch G, Köhn A, Lux A, Zenker M, Rissmann A. Impact of the COVID-19 Pandemic Regulations on the Health Status and Medical Care of Children with Trisomy 21. KLINISCHE PADIATRIE 2023; 235:31-37. [PMID: 36108644 DOI: 10.1055/a-1757-9948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND While children are considered at low risk for COVID-19, little is known about the impact of SARS-CoV-2 on paediatric risk patients like children with Trisomy 21 (T21). As these children often need regular therapy and various medical appointments, this study aimed to investigate the possible impact of the COVID-19 pandemic on children with T21. PATIENTS AND METHODS Parents of children with T21 in the age of 0-12 years in Saxony-Anhalt were interviewed via phone in June 2021 regarding the health status and medical care of their children during the past 15 months of pandemic. RESULTS 37 children with mean age of 6.1 years (min 0; max 12) were included in the study. The majority did not have any additional congenital anomalies. Surveyed parents hardly reported adverse changes of health status during the pandemic, but rather improvements, such as decreased number of respiratory infections and more time spend with their children. Outpatient appointments and therapy were cancelled or postponed at the onset of the pandemic, but parents reported low impact on their child's health and development. The main concern seemed to be lack of childcare during school and day-care closures and uncertainty concerning possible health impacts of an infection on their children. CONCLUSION There was low impact of the COVID-19 pandemic on health and medical care of children with T21 in our study population. Further research is needed to help weigh the child's individual risk of infection against the need for medical treatment and therapy when dealing with paediatric risk patients.
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Affiliation(s)
- Annika Niemann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anett Boudriot
- Social Paediatric Centre, Children's Centre Magdeburg gGmbH, Magdeburg, Germany
| | - Birgit Brett
- Social Paediatric Centre, Children's Centre Magdeburg gGmbH, Magdeburg, Germany
| | - Christiane Fritzsch
- Social Paediatric Centre, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Dorit Götz
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Roland Haase
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany.,Department of Neonatology and Paediatric Intensive Care, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Sibylle Höhne
- Social Paediatric Centre, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Gerhard Jorch
- Universitätsklinikum Magdeburg, Universitätskinderklinik, Magdeburg, Germany
| | - Andrea Köhn
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Martin Zenker
- Institut für Humangenetik, Otto von Guericke Universitat Magdeburg, Magdeburg, Germany.,Department of Paediatrics, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
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Boschiero MN, Lutti Filho JR, Ortega MM, Marson FAL. High case fatality rate in individuals with Down syndrome and COVID-19 in Brazil: a two-year report. J Clin Pathol 2022; 75:717-720. [PMID: 35764375 DOI: 10.1136/jcp-2021-207802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 06/10/2022] [Indexed: 11/04/2022]
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Boschiero MN, Palamim CVC, Ortega MM, Marson FAL. Clinical characteristics and comorbidities of COVID-19 in unvaccinated patients with Down syndrome: first year report in Brazil. Hum Genet 2022; 141:1887-1904. [PMID: 35763088 PMCID: PMC9244024 DOI: 10.1007/s00439-022-02468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023]
Abstract
Patients with Down syndrome (DS) are more affected by the Coronavirus Disease (COVID)-19 pandemic when compared with other populations. Therefore, the primary aim of our study was to report the death (case fatality rate) from SARS-CoV-2 infection in Brazilian hospitalized patients with DS from 03 January 2020 to 04 April 2021. The secondary objectives were (i) to compare the features of patients with DS and positive for COVID-19 (G1) to those with DS and with a severe acute respiratory infection (SARI) from other etiological factors (G2) to tease apart the unique influence of COVID-19, and (ii) to compare the features of patients with DS and positive for COVID-19 to those without DS, but positive for COVID-19 (G3) to tease apart the unique influence of DS. We obtained the markers for demographic profile, clinical symptoms, comorbidities, and the clinical features for SARI evolution during hospitalization in the first year of the COVID-19 pandemic in Brazil from a Brazilian open-access database. The data were compared between (i) G1 [1619 (0.4%) patients] and G2 [1431 (0.4%) patients]; and between (ii) G1 and G3 [222,181 (64.8%) patients]. The case fatality rate was higher in patients with DS and COVID-19 (G1: 39.2%), followed by individuals from G2 (18.1%) and G3 (14.0%). Patients from G1, when compared to G2, were older (≥ 25 years of age), presented more clinical symptoms related to severe illness and comorbidities, needed intensive care unit (ICU) treatment and non-invasive mechanical ventilation (MV) more frequently, and presented a nearly two fold-increased chance of death (OR = 2.92 [95% CI 2.44–3.50]). Patients from G1, when compared to G3, were younger (< 24 years of age), more prone to nosocomial infection, presented an increased chance for clinical symptoms related to a more severe illness; frequently needed ICU treatment, and invasive and non-invasive MV, and raised almost a three fold-increased chance of death (OR = 3.96 [95% CI 3.60–4.41]). The high case fatality rate in G1 was associated with older age (≥ 25 years of age), presence of clinical symptoms, and comorbidities, such as obesity, related to a more severe clinical condition. Unvaccinated patients with DS affected by COVID-19 had a high case fatality rate, and these patients had a different profile for comorbidities, clinical symptoms, and treatment (such as the need for ICU and MV) when compared with other study populations.
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Affiliation(s)
- Matheus Negri Boschiero
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil
| | - Camila Vantini Capasso Palamim
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Manoela Marques Ortega
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Fernando Augusto Lima Marson
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil. .,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil.
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7
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Dai P, Yang Y, Zhao G, Gu Z, Ren H, Hu S, Liu N, Jiao W, Li J, Kong X. A dPCR-NIPT assay for detections of trisomies 21, 18 and 13 in a single-tube reaction-could it replace serum biochemical tests as a primary maternal plasma screening tool? J Transl Med 2022; 20:269. [PMID: 35706031 PMCID: PMC9198625 DOI: 10.1186/s12967-022-03455-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background The next generation sequencing (NGS) based non-invasive prenatal test (NIPT) has outplayed the traditional serum biochemical tests (SBT) in screen of fetal aneuploidies with a high sensitivity and specificity. However, it has not been widely used as a primary screen tool due to its high cost and the cheaper SBT is still the choice for primary screen even with well-known shortages in sensitivity and specificity. Here, we report a multiplex droplet digital PCR NIPT (dPCR-NIPT) assay that can detect trisomies 21, 18 and 13 (T21, T18 and T13) in a single tube reaction with a better sensitivity and specificity than the SBT and a much cheaper price than the NGS-NIPT. Methods In this study, the dPCR-NIPT assay’s non-clinical characteristics were evaluated to verify the cell free fetal DNA (cffDNA) fraction enrichment efficiencies, the target cell free DNA (cfDNA) concentration enrichment, the analytical sensitivity, and the sample quality control on the minimum concentration of cfDNA required for the assay. We validated the clinical performance for this assay by blindly testing 283 clinical maternal plasma samples, including 36 trisomic positive samples, from high risk pregnancies to access its sensitivity and specificity. The cost effectiveness of using the dPCR-NIPT assay as the primary screen tool was also analyzed and compared to that of the existing contingent strategy (CS) using the SBT as the primary screen tool and the strategy of NGS-NIPT as the first-tier screen tool in a simulating situation. Results For the non-clinical characteristics, the sample processing reagents could enrich the cffDNA fraction by around 2 folds, and the analytical sensitivity showed that the assay was able to detect trisomies at a cffDNA fraction as low as 5% and the extracted cfDNA concentration as low as 0.2 ng/μL. By testing the 283 clinical samples, the dPCR-NIPT assay demonstrated a detection sensitivity of 100% and a specificity of 95.12%. Compared to the existing CS and the NGS-NIPT as the first-tier screen strategy, dPCR-NIPT assay used as a primary screen tool followed by the NGS-NIPT rescreen is the most economical approach to screen pregnant women for fetal aneuploidies without sacrificing the positive detection rate. Conclusion This is the first report on a dPCR-NIPT assay, consisting of all the necessary reagents from sample processing to multiplex dPCR amplification, can detect T21, T18 and T13 in a single tube reaction. The study results reveal that this assay has a sensitivity and specificity superior to the SBT and a cost much lower than the NGS-NIPT. Thus, from both the test performance and the economic benefit points of views, using the dPCR-NIPT assay to replace the SBT as a primary screen tool followed by the NGS-NIPT rescreen would be a better approach than the existing CS for detection of fetal aneuploidies in maternal plasma. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03455-y.
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Affiliation(s)
- Peng Dai
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yanfeng Yang
- Shanghai Tage Biotechnology Co., Ltd, Shanghai, 201201, China
| | - Ganye Zhao
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Zhiqiang Gu
- Shanghai Tage Biotechnology Co., Ltd, Shanghai, 201201, China
| | - Huanan Ren
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shuang Hu
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ning Liu
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Weimeng Jiao
- Shanghai Tage Biotechnology Co., Ltd, Shanghai, 201201, China
| | - Jinfang Li
- Henan Newbern Medical Technology Co. Ltd, Zhengzhou, 450053, Henan, China
| | - Xiangdong Kong
- The Genetics and Prenatal Diagnosis Center, The Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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8
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Chung H, Green PHR, Wang TC, Kong XF. Interferon-Driven Immune Dysregulation in Down Syndrome: A Review of the Evidence. J Inflamm Res 2021; 14:5187-5200. [PMID: 34675597 PMCID: PMC8504936 DOI: 10.2147/jir.s280953] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023] Open
Abstract
Down syndrome (DS) is a unique genetic disease caused by the presence of an extra copy of chromosome 21, which carries four of the six interferon receptor (IFN-R) genes on its long arm. Recent studies reporting higher levels of interferon-stimulated gene (ISG) expression in primary immune cells studied ex vivo have suggested that the additional copies of the IFN-R genes in DS result in mild interferonopathy. In this review, we analyze the potential clinical and immunological impacts of this interferonopathy in DS. We performed a literature review to explore the epidemiology and risks of celiac disease, type 1 diabetes, thyroid dysfunction, mucocutaneous manifestations, infectious diseases (including COVID-19), and Alzheimer’s disease in individuals with DS relative to the general population with or without iatrogenic exposure to interferons. We analyzed immunophenotyping data and the current experimental evidence concerning IFN-R expression, constitutive JAK-STAT activation, and ISG overexpression in DS. Despite the lack of direct evidence that implicating this mild interferonopathy directly in illnesses in individuals with DS, we highlight the challenges ahead and directions that could be taken to determine more clearly the biological impact of interferonopathy on various immune-related conditions in DS.
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Affiliation(s)
- Howard Chung
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens (Queens Hospital Center), Jamaica, NY, 11432, USA
| | - Peter H R Green
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - Timothy C Wang
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Xiao-Fei Kong
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
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9
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Real de Asua D, Mayer MA, Ortega MDC, Borrel JM, Bermejo TDJ, González-Lamuño D, Manso C, Moldenhauer F, Carmona-Iragui M, Hüls A, Sherman SL, Strydom A, de la Torre R, Dierssen M. Comparison of COVID-19 and Non-COVID-19 Pneumonia in Down Syndrome. J Clin Med 2021; 10:3748. [PMID: 34442043 PMCID: PMC8397064 DOI: 10.3390/jcm10163748] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/02/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022] Open
Abstract
Whether the increased risk for coronavirus disease 2019 (COVID-19) hospitalization and death observed in Down syndrome (DS) are disease specific or also occur in individuals with DS and non-COVID-19 pneumonias is unknown. This retrospective cohort study compared COVID-19 cases in persons with DS hospitalized in Spain reported to the Trisomy 21 Research Society COVID-19 survey (n = 86) with admissions for non-COVID-19 pneumonias from a retrospective clinical database of the Spanish Ministry of Health (n = 2832 patients). In-hospital mortality rates were significantly higher for COVID-19 patients (26.7% vs. 9.4%), especially among individuals over 40 and patients with obesity, dementia, and/or epilepsy. The mean length of stay of deceased patients with COVID-19 was significantly shorter than in those with non-COVID-19 pneumonias. The rate of admission to an ICU in patients with DS and COVID-19 (4.3%) was significantly lower than that reported for the general population with COVID-19. Our findings confirm that acute SARS-CoV-2 infection leads to higher mortality than non-COVID-19 pneumonias in individuals with DS, especially among adults over 40 and those with specific comorbidities. However, differences in access to respiratory support might also account for some of the heightened mortality of individuals with DS with COVID-19.
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Affiliation(s)
- Diego Real de Asua
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (D.R.d.A.); (F.M.)
- Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Miguel A. Mayer
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - María del Carmen Ortega
- Department of Psychiatry, Research Institute i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | | | | | - Domingo González-Lamuño
- Department of Pediatrics, University Hospital Marqués de Valdecilla-Universidad de Cantabria, 39008 Santander, Spain;
| | | | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (D.R.d.A.); (F.M.)
- Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - María Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain;
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, 08029 Barcelona, Spain
| | - Anke Hüls
- Department of Epidemiology and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK;
- The London Down Syndrome (LonDownS) Consortium, London, United Kingdom and South London and the Maudsley NHS Foundation Trust, London SE5 8AF, UK
| | - Rafael de la Torre
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Neurosciences Research Programme, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), 08003 Barcelona, Spain
| | - Mara Dierssen
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, 08003 Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), 08003 Barcelona, Spain
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Santoro SL, Campbell A, Balasubramanian A, Haugen K, Schafer K, Mobley W. Specialty clinics for adults with Down syndrome: A clinic survey. Am J Med Genet A 2021; 185:1767-1775. [PMID: 33729670 DOI: 10.1002/ajmg.a.62169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 01/17/2023]
Abstract
Specialty centers improve care for patients with Down syndrome. The cohort of adults with Down syndrome is increasing, but the capacity for specialty centers to meet their medical care needs is unknown. Electronic survey of staff of specialty clinics for adults with Down syndrome was conducted. Review of online clinic listings, and calculation of the number of adults with Down syndrome were performed. Analysis identified the percent of adults with Down syndrome who could have their medical care needs met in a current specialty clinic. Fourteen specialty clinics report providing care for 4038 adults with Down syndrome. Respondents reported gaps in care including: limitations of existing clinics, need for additional clinics, and knowledgeable health professionals in Down syndrome. Survey-respondent clinic capacity would meet needs of 3% of adults with Down syndrome. Twenty-five clinics for adults with Down syndrome were listed online with capacity to care for 6517 adults with Down syndrome meeting the needs of 5% of the population. Additional clinic capacity is needed to meet the needs of adults with Down syndrome. Survey of existing clinics provides guidance to create additional clinics, including: must-have team members, current sources of clinic financial support, and gaps in current clinical care.
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Affiliation(s)
- Stephanie L Santoro
- Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashlee Campbell
- Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kelsey Haugen
- Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly Schafer
- Department of Neurosciences, University of California, San Diego, California, USA
| | - William Mobley
- Department of Neurosciences, University of California, San Diego, California, USA
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11
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Majnemer A, McGrath PJ, Baumbusch J, Camden C, Fallon B, Lunsky Y, Miller SP, Sansone G, Stainton T, Sumarah J, Thomson D, Zwicker J. Time to be counted: COVID-19 and intellectual and developmental disabilities—an RSC Policy Briefing. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has impacted the lives and well-being of all people globally, with consequences being observed across all domains from physical and mental health, to education and employment outcomes, to access to community supports and services. However, the disproportionate impact of the COVID-19 pandemic and its associated public health restrictions on individuals with intellectual and developmental disabilities (IDD) has largely been overlooked. Not only do people with IDD have a greater risk of severe complications and death from the virus as shown in large-scale studies, but they also face significant short- and long-term consequences of COVID-related public health measures on their mental health and well-being. At a time when this vulnerable population is already feeling undervalued, ignored, and forgotten, it is imperative that the risks facing adults and children with IDD—as well as their families and caregivers—are recognized, valued, and addressed through a disability-inclusive approach to Canada’s pandemic policy response planning. This requires both a mainstreaming of disability inclusion into all COVID-19 response and recovery policies as well as disability-specific policies to address the unique barriers and challenges encountered by people with IDD during the pandemic. The recommendations in this policy briefing aim to achieve a more inclusive, accessible, and sustainable Canada for people with IDD both during and after the pandemic—an approach that will result in benefits for all of society.
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Affiliation(s)
- Annette Majnemer
- School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H3G 1Y5, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
| | - Patrick J. McGrath
- Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
- IWK Health Centre, Halifax, NS B3K 6R8, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Canadian Institute of Health Research Chair in Sex & Gender Science, Ottawa, ON K1A 0W9, Canada
| | - Chantal Camden
- École de Réadaptation, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
- CRCHUS et à l’IUPLSSS, Sherbrooke, QC J1H 5N4, Canada
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Steven P. Miller
- Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Genevieve Sansone
- Fraser Mustard Policy Bench, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Tim Stainton
- School of Social Work, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
- Canadian Institute for Inclusion and Citizenship, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - John Sumarah
- Counselling Psychology, Acadia University, Wolfville, NS B4P 2R6, Canada
| | | | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB T2P 1H9, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
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12
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JAK1 Inhibition Blocks Lethal Immune Hypersensitivity in a Mouse Model of Down Syndrome. Cell Rep 2020; 33:108407. [PMID: 33207208 DOI: 10.1016/j.celrep.2020.108407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/21/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022] Open
Abstract
Individuals with Down syndrome (DS; trisomy 21) display hyperactivation of interferon (IFN) signaling and chronic inflammation, which could potentially be explained by the extra copy of four IFN receptor (IFNR) genes encoded on chromosome 21. However, the clinical effects of IFN hyperactivity in DS remain undefined. Here, we report that a commonly used mouse model of DS overexpresses IFNR genes and shows hypersensitivity to IFN ligands in diverse immune cell types. When treated repeatedly with a TLR3 agonist to induce chronic inflammation, these animals overexpress key IFN-stimulated genes, induce cytokine production, exhibit liver pathology, and undergo rapid weight loss. Importantly, the lethal immune hypersensitivity and cytokine production and the ensuing pathology are ameliorated by JAK1 inhibition. These results indicate that individuals with DS may experience harmful hyperinflammation upon IFN-inducing immune stimuli, as observed during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, pointing to JAK1 inhibition as a strategy to restore immune homeostasis in DS.
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13
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Villani ER, Vetrano DL, Damiano C, Paola AD, Ulgiati AM, Martin L, Hirdes JP, Fratiglioni L, Bernabei R, Onder G, Carfì A. Impact of COVID-19-Related Lockdown on Psychosocial, Cognitive, and Functional Well-Being in Adults With Down Syndrome. Front Psychiatry 2020; 11:578686. [PMID: 33192717 PMCID: PMC7655916 DOI: 10.3389/fpsyt.2020.578686] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022] Open
Abstract
People with Down Syndrome (DS) have a high prevalence of physical and psychiatric comorbidities and experience early-onset dementia. With the outbreak of CoVID-19 pandemic, strict social isolation measures have been necessary to prevent the spreading of the disease. Effects of this lockdown period on behavior, mood and cognition in people with DS have not been assessed so far. In the present clinical study, we investigated the impact of CoVID-19-related lockdown on psychosocial, cognitive and functional well-being in a sample population of 46 adults with DS. The interRAI Intellectual Disability standardized assessment instrument, which includes measures of social withdrawal, functional impairment, aggressive behavior and depressive symptoms, was used to perform a three time-point evaluation (two pre-lockdown and one post-lockdown) in 37 subjects of the study sample, and a two time point evaluation (one pre- and one post-lockdown) in 9 subjects. Two mixed linear regression models - one before and one after the lockdown - have been fitted for each scale in order to investigate the change in the time-dependent variation of the scores. In the pre-lockdown period, significant worsening over time (i.e., per year) was found for the Depression Rating Scale score (β = 0.55; 95% CI 0.34; 0.76). In the post-lockdown period, a significant worsening in social withdrawal (β = 3.05, 95% CI 0.39; 5.70), instrumental activities of daily living (β = 1.13, 95% CI 0.08; 2.18) and depression rating (β = 1.65, 95% CI 0.33; 2.97) scales scores was observed, as was a significant improvement in aggressive behavior (β = -1.40, 95% CI -2.69; -0.10). Despite the undoubtful importance of the lockdown in order to reduce the spreading of the CoVID-19 pandemic, the related social isolation measures suggest an exacerbation of depressive symptoms and a worsening in functional status in a sample of adults with DS. At the opposite, aggressive behavior was reduced after the lockdown period. This finding could be related to the increase of negative and depressive symptoms in the study population. Studies with longer follow-up period are needed to assess persistence of these effects.
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Affiliation(s)
- Emanuele Rocco Villani
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Liborio Vetrano
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Cecilia Damiano
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Di Paola
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Aurora Maria Ulgiati
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Laura Fratiglioni
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Roberto Bernabei
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Carfì
- Centro Medicina Dell'Invecchiamento, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
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