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LaCombe JM, Sloan K, Thomas JR, Blackwell MP, Crawford I, Wallace JM, Roper RJ. Sex specific emergence of trisomic Dyrk1a-related skeletal phenotypes in the development of a Down syndrome mouse model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.24.595804. [PMID: 38826419 PMCID: PMC11142220 DOI: 10.1101/2024.05.24.595804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Skeletal insufficiency affects all individuals with Down syndrome (DS) or Trisomy 21 (Ts21) and may alter bone strength throughout development due to a reduced period of bone formation and early attainment of peak bone mass compared to typically developing individuals. Appendicular skeletal deficits also appear in males before females with DS. In femurs of male Ts65Dn DS model mice, cortical deficits were pronounced throughout development, but trabecular deficits and Dyrk1a overexpression were transitory until postnatal day (P) 30 when there were persistent trabecular and cortical deficits and Dyrk1a was trending overexpression. Correction of DS-related skeletal deficits by a purported DYRK1A inhibitor or through genetic means beginning at P21 was not effective at P30, but germline normalization of Dyrk1a improved male bone structure by P36. Trabecular and cortical deficits in female Ts65Dn mice were evident at P30 but subsided by P36, typifying periodic developmental skeletal normalizations that progressed to more prominent bone deficiencies. Sex-dependent differences in skeletal deficits with a delayed impact of trisomic Dyrk1a are important to find temporally specific treatment periods for bone and other phenotypes associated with Ts21.
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Affiliation(s)
- Jonathan M. LaCombe
- Department of Biology, Indiana University-Indianapolis, IN, USA
- Labcorp Early Development Laboratories, Inc., Greenfield, IN, USA
| | - Kourtney Sloan
- Department of Biology, Indiana University-Indianapolis, IN, USA
| | - Jared R. Thomas
- Department of Biology, Indiana University-Indianapolis, IN, USA
| | | | | | - Joseph M. Wallace
- Department of Biomedical Engineering, Purdue University, Indianapolis, IN, USA
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Molinari S, Fossati C, Nicolosi ML, Di Marco S, Faraguna MC, Limido F, Ocello L, Pellegrinelli C, Lattuada M, Gazzarri A, Lazzerotti A, Sala D, Vimercati C, Capitoli G, Daolio C, Biondi A, Balduzzi A, Cattoni A. Endocrine, auxological and metabolic profile in children and adolescents with Down syndrome: from infancy to the first steps into adult life. Front Endocrinol (Lausanne) 2024; 15:1348397. [PMID: 38654931 PMCID: PMC11036865 DOI: 10.3389/fendo.2024.1348397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Down syndrome (DS) is the most common chromosomal disorder worldwide. Along with intellectual disability, endocrine disorders represent a remarkable share of the morbidities experienced by children, adolescents and young adults with DS. Auxological parameters are plotted on syndrome-specific charts, as growth rates are reduced compared to healthy age- and gender-matched peers. Furthermore, children with DS are at increased risk for thyroid dysfunctions, diabetes mellitus, osteopenia and obesity compared to general population. Additionally, male individuals with DS often show infertility, while women tend to experience menopause at an overall younger age than healthy controls. Given the recent outstanding improvements in the care of severe DS-related comorbidities, infant mortality has dramatically decreased, with a current average life expectancy exceeding 60 years. Accordingly, the awareness of the specificities of DS in this field is pivotal to timely detect endocrine dysfunctions and to undertake a prompt dedicated treatment. Notably, best practices for the screening and monitoring of pediatric endocrine disorders in DS are still controversial. In addition, specific guidelines for the management of metabolic issues along the challenging period of transitioning from pediatric to adult health care are lacking. By performing a review of published literature, we highlighted the issues specifically involving children and adolescent with DS, aiming at providing clinicians with a detailed up-to-date overview of the endocrine, metabolic and auxological disorders in this selected population, with an additional focus on the management of patients in the critical phase of the transitioning from childhood to adult care.
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Affiliation(s)
- Silvia Molinari
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Chiara Fossati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Laura Nicolosi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Santo Di Marco
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Francesca Limido
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Laura Ocello
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Martina Lattuada
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandra Gazzarri
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Debora Sala
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Chiara Vimercati
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Capitoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cecilia Daolio
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Andrea Biondi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Adriana Balduzzi
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Lamantia J, Sloan K, Wallace JM, Roper RJ. Compromised femoral and lumbovertebral bone in the Dp(16)1Yey Down syndrome mouse model. Bone 2024; 181:117046. [PMID: 38336158 PMCID: PMC11000152 DOI: 10.1016/j.bone.2024.117046] [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] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
Down syndrome (DS), affecting ∼1 in 800 live births, is caused by the triplication of human chromosome 21 (Hsa21). Individuals with DS have skeletal features including craniofacial abnormalities and decreased bone mineral density (BMD). Lowered BMD can lead to increased fracture risk, with common fracture points at the femoral neck and lumbar spine. While the femur has been studied in DS mouse models, there is little research done on the vertebrae despite evidence that humans with DS have affected vertebrae. Additionally, it is important to establish when skeletal deficits occur to find times of potential intervention. The Dp(16)1Yey DS mouse model has all genes triplicated on mouse chromosome 16 orthologous to Hsa21 and displayed deficits in long bone, including trabecular and cortical deficits in male but not female mice, at 12 weeks. We hypothesized that the long bone and lumbovertebral microarchitecture would exhibit sexually dimorphic deficits in Dp(16)1Yey mice compared to control mice and long bone strength would be diminished in Dp(16)1Yey mice at 6 weeks. The trabecular region of the 4th lumbar (L4) vertebra and the trabecular and cortical regions of the femur were analyzed via micro-computed tomography and 3-point bending in 6-week-old male and female Dp(16)1Yey and control mice. Trabecular and cortical deficits were observed in femurs from male Dp(16)1Yey mice, and cortical deficits were seen in femurs of male and female Dp(16)1Yey mice. Male Dp(16)1Yey femurs had more deficits in bone strength at whole bone and tissue-estimate level properties, but female Dp(16)1Yey mice were also affected. Additionally, the L4 of male and female Dp(16)1Yey mice show trabecular deficits, which have not been previously reported in a DS mouse model. Our results indicate that skeletal deficits associated with DS occur early in skeletal development, are dependent on skeletal compartment and site, are sex dependent, and potential interventions should likely begin early in skeletal development of DS mouse models.
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Affiliation(s)
- Joshua Lamantia
- Department of Biology, Indiana University-Purdue University Indianapolis (IUPUI), United States of America
| | - Kourtney Sloan
- Department of Biology, Indiana University-Purdue University Indianapolis (IUPUI), United States of America
| | - Joseph M Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis (IUPUI), United States of America
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University Indianapolis (IUPUI), United States of America.
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Derry PJ, Liopo AV, Mouli K, McHugh EA, Vo ATT, McKelvey A, Suva LJ, Wu G, Gao Y, Olson KR, Tour JM, Kent TA. Oxidation of Hydrogen Sulfide to Polysulfide and Thiosulfate by a Carbon Nanozyme: Therapeutic Implications with an Emphasis on Down Syndrome. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2211241. [PMID: 37272655 PMCID: PMC10696138 DOI: 10.1002/adma.202211241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/20/2023] [Indexed: 06/06/2023]
Abstract
Hydrogen sulfide (H2 S) is a noxious, potentially poisonous, but necessary gas produced from sulfur metabolism in humans. In Down Syndrome (DS), the production of H2 S is elevated and associated with degraded mitochondrial function. Therefore, removing H2 S from the body as a stable oxide could be an approach to reducing the deleterious effects of H2 S in DS. In this report we describe the catalytic oxidation of hydrogen sulfide (H2 S) to polysulfides (HS2+n - ) and thiosulfate (S2 O3 2- ) by poly(ethylene glycol) hydrophilic carbon clusters (PEG-HCCs) and poly(ethylene glycol) oxidized activated charcoal (PEG-OACs), examples of oxidized carbon nanozymes (OCNs). We show that OCNs oxidize H2 S to polysulfides and S2 O3 2- in a dose-dependent manner. The reaction is dependent on O2 and the presence of quinone groups on the OCNs. In DS donor lymphocytes we found that OCNs increased polysulfide production, proliferation, and afforded protection against additional toxic levels of H2 S compared to untreated DS lymphocytes. Finally, in Dp16 and Ts65DN murine models of DS, we found that OCNs restored osteoclast differentiation. This new action suggests potential facile translation into the clinic for conditions involving excess H2 S exemplified by DS.
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Affiliation(s)
- Paul J Derry
- Center for Genomic and Precision Medicine, Department of Translational Medical Science, Institute of Bioscience and Technology, Texas A&M Health Science Center, 2121 W. Holcombe Boulevard, Houston, Texas, USA
- EnMed, School of Engineering Medicine, Texas A&M University, 1020 W. Holcombe Boulevard, Houston, Texas, USA
| | - Anton V Liopo
- Center for Genomic and Precision Medicine, Department of Translational Medical Science, Institute of Bioscience and Technology, Texas A&M Health Science Center, 2121 W. Holcombe Boulevard, Houston, Texas, USA
- Department of Chemistry, Rice University, Houston, 77005, Texas, USA
| | - Karthik Mouli
- Center for Genomic and Precision Medicine, Department of Translational Medical Science, Institute of Bioscience and Technology, Texas A&M Health Science Center, 2121 W. Holcombe Boulevard, Houston, Texas, USA
| | - Emily A McHugh
- Department of Chemistry, Rice University, Houston, 77005, Texas, USA
- Smalley-Curl Institute, Rice University, Houston, 77005, Texas, USA
| | - Anh T T Vo
- Center for Genomic and Precision Medicine, Department of Translational Medical Science, Institute of Bioscience and Technology, Texas A&M Health Science Center, 2121 W. Holcombe Boulevard, Houston, Texas, USA
| | - Ann McKelvey
- Center for Inflammation and Infectious Disease, Department of Translational Medical Science, Institute of Bioscience and Technology, Texas A&M Health Science Center, 2121 W. Holcombe Boulevard, Houston, 77030, Texas, USA
| | - Larry J Suva
- Department of Veterinary Physiology and Pharmacology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, 77843, Texas, USA
| | - Gang Wu
- Division of Hematology, Internal Medicine, John P. and Kathrine G. McGovern Medical School at UTHealth Houston, Houston, 77005, Texas, USA
| | - Yan Gao
- Indiana University School of Medicine-South Bend, South Bend, 46617, Indiana, USA
| | - Kenneth R Olson
- Indiana University School of Medicine-South Bend, South Bend, 46617, Indiana, USA
| | - James M Tour
- Department of Chemistry, Rice University, Houston, 77005, Texas, USA
- Smalley-Curl Institute, Rice University, Houston, 77005, Texas, USA
- Welch Institute for Advanced Materials, Rice University, Houston, 77005, Texas, USA
- The NanoCarbon Center, Rice University, Houston, 77005, Texas, USA
| | - Thomas A Kent
- Center for Genomic and Precision Medicine, Department of Translational Medical Science, Institute of Bioscience and Technology, Texas A&M Health Science Center, 2121 W. Holcombe Boulevard, Houston, Texas, USA
- Department of Chemistry, Rice University, Houston, 77005, Texas, USA
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital and Research Institute, 6560 Fannin Street, Houston, 77030, Texas, USA
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O' Malley BGJ, Duong H, Kafer G, Maugham-Macan M. The aetiology of atypical bone health in individuals with Down syndrome. Arch Osteoporos 2023; 18:140. [PMID: 37996656 DOI: 10.1007/s11657-023-01348-1] [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] [Received: 08/30/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Trisomy 21 (T21), more commonly known as Down syndrome (DS) is a genetic condition where every cell in the body has an additional copy of chromosome 21. Despite improvements in our management of DS-associated health risks, we still do not understand how T21 impacts human bone health. This is a critical area of research owing to increased life expectancy of people with DS, and the predisposition of individuals with DS to early-onset osteoporosis and osteopenia. METHODS We have conducted a scoping review using the methodological framework of Arksey and O'Malley (2005) which analysed the existing data on bone growth, development, maintenance and repair in T21 using the Medical Subject Headings (MeSH) terms: Trisomy 21, Down syndrome, Down's syndrome, bone development, bone growth, bone maintenance, fracture risk, osteoporosis, bone mineral density, bone strength, bone mineral content, bone formation, bone repair, osteoblast, osteoclast, osteocyte, osteomacs. A total of 31 papers were identified. After screening, 16 articles were included in full-text review. RESULTS There was a total of eleven in vivo animal model studies identified and included in the scoping review. Of those eleven, ten revealed a difference in bone growth and development in animal models of DS, and two found that bone maintenance and repair in animal models of DS is reduced with both studies reporting an osteoporotic bone phenotype in male and female mice. All five studies that included human participants reported impacts on bone growth and development with reduced bone growth rates and delayed bone maturation in individuals with DS. At the time of review, there were no human studies directly investigating bone maintenance and repair in individuals with DS. CONCLUSION We found documented evidence that T21 impacts bone growth and development, maintenance and repair in both animal models and human studies.
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Affiliation(s)
- Bridgette G J O' Malley
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Brisbane, QLD, Australia
| | - Huong Duong
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Brisbane, QLD, Australia
| | - Georgia Kafer
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Brisbane, QLD, Australia
| | - Michelle Maugham-Macan
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Brisbane, QLD, Australia.
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Alfhmi S, Sejeeni N, Alharbi K, Alharbi R, Malayoo B. Atlantoaxial Subluxation in a 10-Year-Old Girl With Down Syndrome: A Case Report. Cureus 2023; 15:e43955. [PMID: 37746433 PMCID: PMC10514675 DOI: 10.7759/cureus.43955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Down syndrome is the most common inherited chromosomal disorder caused by trisomy 21. Atlantoaxial instability (AAI) is more common in children with Down syndrome, resulting from ligament laxity and odontoid dysplasia. We report the case of a 10-year-old girl with Down syndrome submental. She came to the ER with a history of abnormal gait for one week and was admitted with a case of ataxia for investigations. Moreover, we discovered that she had atlantoaxial subluxation, which was treated surgically.
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Affiliation(s)
- Sumaiah Alfhmi
- Pediatric Medicine, Maternity and Children Hospital, Makkah, SAU
| | - Nevein Sejeeni
- Pediatric Medicine, Maternity and Children Hospital, Makkah, SAU
| | | | - Rahaf Alharbi
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Baraah Malayoo
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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7
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Fedrigo A, Skare TL, Levandoski GR, Chrisostomo KR, de Oliveira NP, Nisihara R. Bone mineral density in adults with Down syndrome: a cross-sectional study in a Brazilian sample. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023. [PMID: 37066674 DOI: 10.1111/jir.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/07/2023] [Accepted: 03/25/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND We aim to investigate the relationship between bone mass in a sample of Brazilian individuals with DS and handgrip strength, body mass index (BMI) and physical exercise. METHODS Dual-energy X-ray emission densitometry analysis of bone mass in 26 individuals with DS (8 men and 18 women with a mean age of 30.7 ± 10.3 years) was conducted. Additionally, weight and height were measured to determine BMI, palmar grip strength was measured using a Jammar dynamometer®, and physical activity was classified using the International Physical Activity Questionnaire (IPAQ). RESULTS In this sample, 2/15 (13.3%) individuals with age between 18 to 29 years had low BMD in the spine; 2/8 (25%) of those with age between 30 and 39 years also had low BMD in the spine and 2/3 (66.6%) with age ≥40 had low BMD in the femur. There were significant correlations between palmar grip strength and Z femoral neck score in women (P = 0.02) and between BMI and Z femoral neck score in men (P = 0.04). All other correlations lacked statistical significance (P > 0.05). CONCLUSIONS Brazilian patients with DS showed a high prevalence of low bone mass. Traditional factors such as muscle strength, BMI and physical activity appear to have little effect on bone mineral density in this population.
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Affiliation(s)
- A Fedrigo
- Internal Medicine Post Graduate, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - T L Skare
- Department of Medicine, Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil
| | - G R Levandoski
- Department of Medicine, Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil
| | - K R Chrisostomo
- Internal Medicine Post Graduate, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - N P de Oliveira
- Internal Medicine Post Graduate, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
| | - R Nisihara
- Internal Medicine Post Graduate, Clinical Hospital, Federal University of Paraná, Curitiba, Brazil
- Department of Medicine, Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil
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Aboud MA, Arya VK, Dutta V, Ducas R, Al-Moustadi W, Niyogi SG. Anesthetic Considerations for Adult Patients With Both Down Syndrome and Congenital Heart Disease Undergoing Noncardiac Surgery: A Review Article. J Cardiothorac Vasc Anesth 2023; 37:613-626. [PMID: 36610856 DOI: 10.1053/j.jvca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/27/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
The population of adult patients with both Down syndrome and congenital heart disease is increasing due to better medical and surgical care. This cohort presents with multiple unique comorbidities, secondary to both progressions of health conditions associated with the aging of patients with Down syndrome, as well as due to pathophysiologic effects of uncorrected, corrected, or palliated congenital heart disease. These patients need frequent medical care and interventions requiring multiple anesthetics. This review focuses on the various factors relevant to the perioperative medical care of adult patients with both Down syndrome and congenital heart disease, founded on existing literature. Various anesthetic considerations for the different patterns of noncardiac and cardiac comorbidities are reviewed, and a systematic approach for the perioperative anesthetic management of these patients is presented.
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Affiliation(s)
| | - Virendra K Arya
- Department of Anesthesiology, Perioperative and Pain Medicine, Section of Cardiac Anesthesia, Max Rady College of Medicine, University of Manitoba, Saint Boniface Hospital, Winnipeg, Canada.
| | - Vikas Dutta
- Department of Anesthesiology, Perioperative and Pain Medicine, Section of Cardiac Anesthesia, Max Rady College of Medicine, University of Manitoba, Saint Boniface Hospital, Winnipeg, Canada
| | - Robin Ducas
- Department of Medicine, Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Cardiac Sciences Program, Saint Boniface Hospital, Winnipeg, Canada
| | - Waiel Al-Moustadi
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Saint Boniface Hospital, Winnipeg, Canada
| | - Subhrashis Guha Niyogi
- Paediatric Cardiac Anaesthesia, Department of Anaesthesia and Intensive Care, Advanced cardiac Centre, PGIMER, Chandigarh, India
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9
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Sloan K, Thomas J, Blackwell M, Voisard D, Lana-Elola E, Watson-Scales S, Roper DL, Wallace JM, Fisher EMC, Tybulewicz VLJ, Roper RJ. Genetic dissection of triplicated chromosome 21 orthologs yields varying skeletal traits in Down syndrome model mice. Dis Model Mech 2023; 16:dmm049927. [PMID: 36939025 PMCID: PMC10163323 DOI: 10.1242/dmm.049927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/02/2023] [Indexed: 03/21/2023] Open
Abstract
Down syndrome (DS) phenotypes result from triplicated genes, but the effects of three copy genes are not well known. A mouse mapping panel genetically dissecting human chromosome 21 (Hsa21) syntenic regions was used to investigate the contributions and interactions of triplicated Hsa21 orthologous genes on mouse chromosome 16 (Mmu16) on skeletal phenotypes. Skeletal structure and mechanical properties were assessed in femurs of male and female Dp9Tyb, Dp2Tyb, Dp3Tyb, Dp4Tyb, Dp5Tyb, Dp6Tyb, Ts1Rhr and Dp1Tyb;Dyrk1a+/+/- mice. Dp1Tyb mice, with the entire Hsa21 homologous region of Mmu16 triplicated, display bone deficits similar to those of humans with DS and served as a baseline for other strains in the panel. Bone phenotypes varied based on triplicated gene content, sex and bone compartment. Three copies of Dyrk1a played a sex-specific, essential role in trabecular deficits and may interact with other genes to influence cortical deficits related to DS. Triplicated genes in Dp9Tyb and Dp2Tyb mice improved some skeletal parameters. As triplicated genes can both improve and worsen bone deficits, it is important to understand the interaction between and molecular mechanisms of skeletal alterations affected by these genes.
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Affiliation(s)
- Kourtney Sloan
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Jared Thomas
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Matthew Blackwell
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Deanna Voisard
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | | | | | | | - Joseph M. Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | | | | | - Randall J. Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
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10
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Levin J, Hasan A, Alejandre IA, Lorenzi I, Mall V, Rohrer TR. Diseases affecting middle-aged and elderly individuals with trisomy 21. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2023. [DOI: 10.3238/arztebl.m2022.03711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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11
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Sherman KM, Williams DK, Welsh CA, Cooper AM, Falck A, Huggins S, Bokhari RS, Gaddy D, McKelvey KD, Dawson LA, Suva LJ. Low bone mass and impaired fracture healing in mouse models of Trisomy21 (Down syndrome). Bone 2022; 162:116471. [PMID: 35716916 PMCID: PMC9356441 DOI: 10.1016/j.bone.2022.116471] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
Individuals with Down syndrome (DS), the result of trisomy of human chromosome Hsa21 (Ts21), present with an array of skeletal abnormalities typified by altered craniofacial features, short stature and low bone mineral density (BMD). While bone deficits progress with age in both sexes, low bone mass is more pronounced in DS men than women and osteopenia appears earlier. In the current study, the reproductive hormone status (FSH, LH, testosterone) of 17 DS patients (males, ages range 19-52 years) was measured. Although testosterone was consistently low, the hypothalamic-pituitary-gonadal axis was intact with corresponding rises in FSH and LH. To provide further insight into the heterogeneity of the bone mass in DS, the skeletal phenotypes of three of the most used murine DS models, Ts65Dn (Ts65), TC1, and Dp16(Yey1) (Dp16) were characterized and contrasted. Evaluation of the bone phenotype of both male and female 3-month-old Dp16 mice demonstrated sexual dimorphism, with low bone mass apparent in males, as it is in Ts65, but not in female Dp16. In contrast, male TC1 mice had no apparent bone phenotype. To determine whether low bone mass in DS impacted fracture healing, fractures of the middle phalanx (P2) digits were generated in both male and female Dp16 mice at 15 weeks of age, an age where the sexually dimorphic low BMD persisted. Fracture healing was assessed via in vivo microCT over (13 weeks) 93 days post fracture (DPF). At 93 DPF, 0 % of DS male (n = 12) or female (n = 8) fractures healed, compared to 50 % of the male (n = 28) or female (n = 8) WT littermate fractures. MicroCT revealed periosteal unbridged mineralized callus formation across the fracture gap in Dp16 mice, which was confirmed by subsequent histology. These studies provide the first direct evidence of significantly impaired fracture healing in the setting of DS.
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Affiliation(s)
- Kirby M Sherman
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Diarra K Williams
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Casey A Welsh
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Alexis M Cooper
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Alyssa Falck
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Shannon Huggins
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Rihana S Bokhari
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Dana Gaddy
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Kent D McKelvey
- Department of Family Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Department of Medical Genetics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Lindsay A Dawson
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America
| | - Larry J Suva
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, United States of America.
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12
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Metwalley KA, Farghaly HS. Endocrinal dysfunction in children with Down syndrome. Ann Pediatr Endocrinol Metab 2022; 27:15-21. [PMID: 35368192 PMCID: PMC8984752 DOI: 10.6065/apem.2142236.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/10/2022] [Indexed: 12/16/2022] Open
Abstract
Down syndrome (DS) is the most common genetic disorder in live-born infants. Children with DS are at increased risk of numerous endocrinal comorbidities. The information contained in this article will provide pediatricians with a narrative overview of different presentations, diagnoses, and management recommendations of various endocrinal disorders in children with DS. We systematically searched PubMed, Embase, Google Scholar, MEDLINE, EBSCO, and Science Direct, and potentially relevant articles were identified and retrieved from electronic and print journals.
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Affiliation(s)
- Kotb Abbass Metwalley
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt,Address for correspondence: Kotb Abbass Metwalley Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, 71111 Assiut, Egypt ,
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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13
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Abstract
The epidemiology of male hypogonadism has been understudied. Of the known causes of endogenous androgen deficiency, only Klinefelter syndrome is common with a likely population prevalence of greater than 5:10,000 men (possibly as high as 10-25:10,000). Mild traumatic injury might also be a common cause of androgen deficiency (prevalence 5-10:10,000 men), but large, long-term studies must be completed to confirm this prevalence estimation that might be too high. The classic causes of male androgen deficiency-hyperprolactinemia, pituitary macroadenoma, endogenous Cushing syndrome, and iron overload syndrome-are rare (prevalence < 10,000 men).
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Affiliation(s)
- Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Box 356420, 1959 Northeast Pacific Avenue, Seattle, WA 98195, USA
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Box 356420, 1959 Northeast Pacific Avenue, Seattle, WA 98195, USA.
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14
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Zhang Y, Tian Z, Ye S, Mu Q, Wang X, Ren S, Hou X, Yu W, Guo J. Changes in bone mineral density in Down syndrome individuals: a systematic review and meta-analysis. Osteoporos Int 2022; 33:27-37. [PMID: 34383099 DOI: 10.1007/s00198-021-06070-7] [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] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Data evaluating changes in bone mineral density (BMD) in Down syndrome (DS) individuals remains controversial. Therefore, we conducted a systematic review and meta-analysis to better understand associations between BMD and DS. A systematic literature search of PubMed, EMBASE, Web of Science, and the Cochrane Library up until 1st January 2021 was conducted. We used the keywords "bone mineral density" and "Down Syndrome." Fifteen studies were included. Overall, our results showed a significant decrease in BMD of total body (TB BMD) [MD = - 0.18; 95% CI (- 0.23 and - 0.12), P < 0.00001, I2 = 89%], total hip (TH BMD) [MD = - 0.12; 95% CI (- 0.15 and - 0.10), P < 0.00001, I2 = 0%], lumbar spine (LS BMD) [MD = - 0.12; 95% CI (- 0.14 and - 0.09), P < 0.00001, I2 = 18%], and femoral neck (FN BMD) [MD = - 0.08; 95% CI (- 0.10 and - 0.06), P < 0.00001, I2 = 0%] in DS individuals when compared with controls. Moreover, the volumetric BMD of lumbar spine (LS vBMD) [MD = - 0.01; 95% CI (- 0.02 and - 0.01), P = 0.0004, I2 = 19%] also showed a decreasing tendency while the volumetric BMD of the femoral neck (FN vBMD) [MD = 0.01; 95% CI (0.00 and 0.02), P = 0.02, I2 = 0%] was elevated in DS individuals versus controls. These findings demonstrated that individuals with DS had a decreased total and regional (TH, LS, and FN) BMD when compared with the general population. Additionally, when BMD was adjusted for skeletal volume, LS vBMD was also lower, while FN vBMD was elevated in DS individuals versus controls.
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Affiliation(s)
- Y Zhang
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - Z Tian
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China
| | - S Ye
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - Q Mu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China
| | - X Wang
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China
| | - S Ren
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - X Hou
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - W Yu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China.
| | - J Guo
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China.
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15
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Thomas JR, Sloan K, Cave K, Wallace JM, Roper RJ. Skeletal Deficits in Male and Female down Syndrome Model Mice Arise Independent of Normalized Dyrk1a Expression in Osteoblasts. Genes (Basel) 2021; 12:1729. [PMID: 34828335 PMCID: PMC8624983 DOI: 10.3390/genes12111729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 01/11/2023] Open
Abstract
Trisomy 21 (Ts21) causes alterations in skeletal development resulting in decreased bone mass, shortened stature and weaker bones in individuals with Down syndrome (DS). There is a sexual dimorphism in bone mineral density (BMD) deficits associated with DS with males displaying earlier deficits than females. The relationships between causative trisomic genes, cellular mechanisms, and influence of sex in DS skeletal abnormalities remain unknown. One hypothesis is that the low bone turnover phenotype observed in DS results from attenuated osteoblast function, contributing to impaired trabecular architecture, altered cortical geometry, and decreased mineralization. DYRK1A, found in three copies in humans with DS, Ts65Dn, and Dp1Tyb DS model mice, has been implicated in the development of postnatal skeletal phenotypes associated with DS. Reduced copy number of Dyrk1a to euploid levels from conception in an otherwise trisomic Ts65Dn mice resulted in a rescue of appendicular bone deficits, suggesting DYRK1A contributes to skeletal development and homeostasis. We hypothesized that reduction of Dyrk1a copy number in trisomic osteoblasts would improve cellular function and resultant skeletal structural anomalies in trisomic mice. Female mice with a floxed Dyrk1a gene (Ts65Dn,Dyrk1afl/wt) were mated with male Osx-Cre+ (expressed in osteoblasts beginning around E13.5) mice, resulting in reduced Dyrk1a copy number in mature osteoblasts in Ts65Dn,Dyrk1a+/+/Osx-Cre P42 male and female trisomic and euploid mice, compared with littermate controls. Male and female Ts65Dn,Dyrk1a+/+/+ (3 copies of DYRK1A in osteoblasts) and Ts65Dn,Dyrk1a+/+/Osx-Cre (2 copies of Dyrk1a in osteoblasts) displayed similar defects in both trabecular architecture and cortical geometry, with no improvements with reduced Dyrk1a in osteoblasts. This suggests that trisomic DYRK1A does not affect osteoblast function in a cell-autonomous manner at or before P42. Although male Dp1Tyb and Ts65Dn mice exhibit similar skeletal deficits at P42 in both trabecular and cortical bone compartments between euploid and trisomic mice, female Ts65Dn mice exhibit significant cortical and trabecular deficits at P42, in contrast to an absence of genotype effect in female Dp1Tyb mice in trabecular bone. Taken together, these data suggest skeletal deficits in DS mouse models and are sex and age dependent, and influenced by strain effects, but are not solely caused by the overexpression of Dyrk1a in osteoblasts. Identifying molecular and cellular mechanisms, disrupted by gene dosage imbalance, that are involved in the development of skeletal phenotypes associated with DS could help to design therapies to rescue skeletal deficiencies seen in DS.
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Affiliation(s)
- Jared R. Thomas
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
| | - Kourtney Sloan
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
| | - Kelsey Cave
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
| | - Joseph M. Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Randall J. Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
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16
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Costa R, de Asúa DR, Gullón A, De Miguel R, Bautista A, García C, Roy E, García-Vadillo JA, Suárez C, Moldenhauer F, Castañeda S. Volumetric BMD by 3D-DXA and Trabecular Bone Score in Adults With Down Syndrome. J Clin Densitom 2021; 24:630-637. [PMID: 33618949 DOI: 10.1016/j.jocd.2021.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 01/24/2023]
Abstract
Adults with Down syndrome (DS) have lower bone mineral density (BMD) than the general population. The objective of our study was to describe bone mineral status in DS population through volumetric BMD (vBMD) and trabecular bone score (TBS). Retrospective study of 297 subjects recruited from the Adult DS Outpatient Clinic of a tertiary care hospital in Spain, who underwent a bone densitometry for clinical purposes between January 2010 and June 2015. vBMD determination and TBS analysis on conventional DXA (Hologic QDR 4500) densitometer were performed in this cohort. The mean (±SD) age of our population was 34.3 (±10.9) years; 51% were women. Trabecular vBMD at total hip and femoral neck was lower in males than in females (191.7 ± 48.4 mg/cm3 vs 206.9 ± 46.7 mg/cm3, p = 0.007, and 250.5 ± 70.1 mg/cm3 vs 275.7 ± 66.2 mg/cm3, p = 0.002, respectively). Trabecular and cortical vBMD decreased with age, but age decline in trabecular vBMD was more pronounced in males. Likewise, lumbar TBS declined with age being normal in 63%, low in 29% and very low in 8% of subjects with DS, without differences between sexes. TBS showed a positive correlation (r = 0.37; p < 0.001, Kappa index= 0.275) with conventional DXA lumbar Z-score. vBMD at the hip showed lower values in DS subjects than in the general population, especially in males. Moreover, TBS was also lower at lumbar spine. Therefore, both assessments could be used as complementary tools to areal BMD (Z-score) to assess bone status in DS subjects.
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Affiliation(s)
- Ramón Costa
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
| | - Diego Real de Asúa
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Alejandra Gullón
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Rosa De Miguel
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Azucena Bautista
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Clara García
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Emilia Roy
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Jesús A García-Vadillo
- Department of Rheumatology, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Suárez
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Santos Castañeda
- Department of Rheumatology, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma de Madrid (UAM), Spain
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17
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Abstract
PURPOSE Down syndrome (DS) is caused by trisomy 21 (Ts21) and results in skeletal deficits including shortened stature, low bone mineral density, and a predisposition to early onset osteoporosis. Ts21 causes significant alterations in skeletal development, morphology of the appendicular skeleton, bone homeostasis, age-related bone loss, and bone strength. However, the genetic or cellular origins of DS skeletal phenotypes remain unclear. RECENT FINDINGS New studies reveal a sexual dimorphism in characteristics and onset of skeletal deficits that differ between DS and typically developing individuals. Age-related bone loss occurs earlier in the DS as compared to general population. Perturbations of DS skeletal quality arise from alterations in cellular and molecular pathways affected by the overexpression of trisomic genes. Sex-specific alterations occur in critical developmental pathways that disrupt bone accrual, remodeling, and homeostasis and are compounded by aging, resulting in increased risks for osteopenia, osteoporosis, and fracture in individuals with DS.
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Affiliation(s)
- Jared R Thomas
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 West Michigan Street, SL 306, Indianapolis, IN, 46202-3275, USA
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 West Michigan Street, SL 306, Indianapolis, IN, 46202-3275, USA.
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18
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Jensen KM, Campagna EJ, Juarez-Colunga E, Prochazka AV, Runyan DK. Low Rates of Preventive Healthcare Service Utilization Among Adolescents and Adults With Down Syndrome. Am J Prev Med 2021; 60:1-12. [PMID: 33191063 PMCID: PMC7750281 DOI: 10.1016/j.amepre.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION People with Down syndrome have health risks that require specific lifelong preventive health care. With increasing life expectancy, people with Down syndrome also face health conditions typical of their unaffected peers and thus need coordinated health care. The purpose of this study is to describe rates of age/sex- and Down syndrome-specific preventive healthcare activities among adolescents and adults with Down syndrome. METHODS Using Medicaid claims (2006-2010) in California, Colorado, Michigan, and Pennsylvania, the cohort was defined as people with Down syndrome aged ≥12 years seen by primary care providers and enrolled in Medicaid for ≥45 of 60 months without dual Medicare enrollment (n=3,501). Age focus-consistent primary care providers were defined as having a focus concordant with a patient's age: 12-17 years, child or mixed-focus; ≥26 years, adult or mixed-focus; 18-25 years, any focus. Differences in healthcare activities were evaluated using Pearson's chi-square, Fisher's exact, and Kruskal-Wallis tests. Analyses were performed in 2015-2017. RESULTS Of the cohort, 79% had an age focus-consistent primary care provider. However, 40% of adults aged ≥26 years received care from a child-focused primary care provider. Only 43% with an age focus-consistent provider had ≥1 well examination (age focus-inconsistent primary care provider: 35%, p<0.001). Most preventive activities had poor rates (<50%) regardless of age focus consistency between provider and patient age or whether they were age/sex- or Down syndrome-specific (well examinations; vaccinations; sleep apnea; hearing; and breast, cervical, and colon cancer screenings). Lipids, vision, and thyroid screenings reached moderate levels (50% to <80%). CONCLUSIONS Rates of age/sex- and Down syndrome-specific preventive recommendations were low among adolescents and adults with Down syndrome, regardless of the age focus consistency of their primary care provider. This represents a significant opportunity to improve primary care in this vulnerable population.
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Affiliation(s)
- Kristin M Jensen
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
| | - Elizabeth J Campagna
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth Juarez-Colunga
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; University of Colorado School of Public Health, Aurora, Colorado
| | - Allan V Prochazka
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Desmond K Runyan
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Kempe Center for the Prevention of Child Abuse and Maltreatment, University of Colorado School of Medicine, Aurora, Colorado
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19
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Gusso S, Vesey RM, Derraik JGB, Munns CF, Colle P, Biggs JB, Hofman PL. The Effects of 20 Weeks of Side-Alternating Vibration Therapy on Physical Function, Bone and Muscle Health in Adolescents with Down Syndrome. Phys Occup Ther Pediatr 2021; 41:44-55. [PMID: 32345083 DOI: 10.1080/01942638.2020.1758983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the effects of side-alternating vibration therapy on physical function and body composition in adolescents with Down syndrome. METHODS Fourteen adolescents (8 males) with Down syndrome (mean ± SD age: 15.5 ± 2.3 years) performed vibration treatment nine minutes daily, four times per week, for 20 weeks on a Galileo vibration platform. Data were collected at baseline and after 20 weeks of intervention. Assessments included six-minute walk test, muscle function (force plate), whole-body dual-energy X-ray absorptiometry and peripheral quantitative computed tomography of the non-dominant tibia. RESULTS After 20 weeks, participants increased their distance walked in the six-minute walk test (p = 0.009), 2-leg single jump efficiency (p = 0.024) and jump velocity (p = 0.046). Participants also increased their power (p = 0.034) and reduced the time taken during the chair rise test (p < 0.001). At the total body level, increases were seen in bone mineral density (p = 0.004), bone mineral content (p = 0.043), fat free mass (p = 0.013) and lean mass (p = 0.021). CONCLUSION Side-alternating vibration therapy was associated with increases in physical function and muscle mass with no effects on bone health in adolescents with Down syndrome. CLINICAL TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12615000092594) - registered on 4th February 2015.
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Affiliation(s)
- Silmara Gusso
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Exercise Sciences Department, University of Auckland, Auckland, New Zealand
| | - Renuka M Vesey
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Craig F Munns
- Endocrinology Department, The Children's Hospital at Westmead, Sydney, Australia
| | - Patricia Colle
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Janene B Biggs
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
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20
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Tsou AY, Bulova P, Capone G, Chicoine B, Gelaro B, Harville TO, Martin BA, McGuire DE, McKelvey KD, Peterson M, Tyler C, Wells M, Whitten MS. Medical Care of Adults With Down Syndrome: A Clinical Guideline. JAMA 2020; 324:1543-1556. [PMID: 33079159 DOI: 10.1001/jama.2020.17024] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. OBJECTIVE To develop an evidence-based clinical practice guideline for adults with Down syndrome. EVIDENCE REVIEW The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence. FINDINGS From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome. CONCLUSIONS AND RELEVANCE These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.
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Affiliation(s)
- Amy Y Tsou
- Evidence-Based Practice Center, ECRI Center for Clinical Excellence and Guidelines, Plymouth Meeting, Pennsylvania
- Division of Neurology, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Peter Bulova
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George Capone
- Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, Illinois
| | - Bryn Gelaro
- Global Down Syndrome Foundation, Denver, Colorado
| | - Terry Odell Harville
- Division of Hematology, Department of Pathology and Laboratory Services, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Barry A Martin
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Center, Aurora
| | | | | | - Moya Peterson
- University of Kansas Medical Center Schools of Nursing and Medicine, Kansas City
| | - Carl Tyler
- Developmental Disabilities-Practice-Based Research Network, Cleveland, Ohio
- Family Medicine and Community Health, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael Wells
- Developmental Disabilities-Practice-Based Research Network, Cleveland, Ohio
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21
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Thomas JR, LaCombe J, Long R, Lana-Elola E, Watson-Scales S, Wallace JM, Fisher EMC, Tybulewicz VLJ, Roper RJ. Interaction of sexual dimorphism and gene dosage imbalance in skeletal deficits associated with Down syndrome. Bone 2020; 136:115367. [PMID: 32305495 PMCID: PMC7262595 DOI: 10.1016/j.bone.2020.115367] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/01/2020] [Accepted: 04/14/2020] [Indexed: 12/17/2022]
Abstract
All individuals with Down syndrome (DS), which results from trisomy of human chromosome 21 (Ts21), present with skeletal abnormalities typified by craniofacial features, short stature and low bone mineral density (BMD). Differences in skeletal deficits between males and females with DS suggest a sexual dimorphism in how trisomy affects bone. Dp1Tyb mice contain three copies of all of the genes on mouse chromosome 16 that are homologous to human chromosome 21, males and females are fertile, and therefore are an excellent model to test the hypothesis that gene dosage influences the sexual dimorphism of bone abnormalities in DS. Dp1Tyb as compared to control littermate mice at time points associated with bone accrual (6 weeks) and skeletal maturity (16 weeks) showed deficits in BMD and trabecular architecture that occur largely through interactions between sex and genotype and resulted in lower percent bone volume in all female and Dp1Tyb male mice. Cortical bone in Dp1Tyb as compared to control mice exhibited different changes over time influenced by sex × genotype interactions including reduced cortical area in both male and female Dp1Tyb mice. Mechanical testing analyses suggested deficits in whole bone properties such as bone mass and geometry, but improved material properties in female and Dp1Tyb mice. Sexual dimorphisms and the influence of trisomic gene dosage differentially altered cellular properties of male and female Dp1Tyb bone. These data establish sex, gene dosage, skeletal site and age as important factors in skeletal development of DS model mice, paving the way for identification of the causal dosage-sensitive genes. Skeletal differences in developing male and female Dp1Tyb DS model mice replicated differences in less-studied adolescents with DS and established a foundation to understand the etiology of trisomic bone deficits.
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Affiliation(s)
- Jared R Thomas
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Jonathan LaCombe
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Rachel Long
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA
| | | | | | - Joseph M Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, IN, USA
| | | | - Victor L J Tybulewicz
- The Francis Crick Institute, London, UK; Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA.
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Carfì A, Romano A, Zaccaria G, Villani ER, Manes Gravina E, Vetrano DL, Bernabei R, Onder G. The burden of chronic disease, multimorbidity, and polypharmacy in adults with Down syndrome. Am J Med Genet A 2020; 182:1735-1743. [PMID: 32449279 DOI: 10.1002/ajmg.a.61636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/02/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Abstract
Data on clinical characteristics of adults with Down syndrome (DS) are limited and the clinical phenotype of these persons is poorly described. This study aimed to describe the occurrence of chronic diseases and pattern of medication use in a population of adults with DS. Participants were 421 community dwelling adults with DS, aged 18 years or older. Individuals were assessed through a standardized clinical protocol. Multimorbidity was defined as the occurrence of two or more chronic conditions and polypharmacy as the concomitant use of five or more medications. The mean age of study participants was 38.3 ± 12.8 years and 214 (51%) were women. Three hundred and seventy-four participants (88.8%) presented with multimorbidity. The most prevalent condition was visual impairment (72.9%), followed by thyroid disease (50.1%) and hearing impairment (26.8%). Chronic diseases were more prevalent among participants aged >40 years. The mean number of medications used was 2.09 and polypharmacy was observed in 10.5% of the study sample. Psychotropic medications were used by a mean of 0.7 individuals of the total sample. The high prevalence of multimorbidity and the common use of multiple medications contributes to a high level of clinical complexity, which appears to be similar to the degree of complexity of the older non-trisomic population. A comprehensive and holistic approach, commonly adopted in geriatric medicine, may provide the most appropriate care to persons with DS as they grow into adulthood.
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Affiliation(s)
- Angelo Carfì
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Allegra Romano
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Zaccaria
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Rocco Villani
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ester Manes Gravina
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Liborio Vetrano
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Roberto Bernabei
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
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LaCombe JM, Roper RJ. Skeletal dynamics of Down syndrome: A developing perspective. Bone 2020; 133:115215. [PMID: 31887437 PMCID: PMC7044033 DOI: 10.1016/j.bone.2019.115215] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 01/14/2023]
Abstract
Individuals with Down syndrome (DS) display distinctive skeletal morphology compared to the general population, but disparate descriptions, methodologies, analyses, and populations sampled have led to diverging conclusions about this unique skeletal phenotype. As individuals with DS are living longer, they may be at a higher risk of aging disorders such as osteoporosis and increased fracture risk. Sexual dimorphism has been suggested between males and females with DS in which males, not females, experience an earlier decline in bone mineral density (BMD). Unfortunately, studies focusing on skeletal health related to Trisomy 21 (Ts21) are few in number and often too underpowered to answer questions about skeletal development, resultant osteoporosis, and sexual dimorphism, especially in stages of bone accrual. Further confounding the field are the varied methods of bone imaging, analysis, and data interpretation. This review takes a critical look at the current knowledge of DS skeletal phenotypes, both from human and mouse studies, and presents knowledge gaps that need to be addressed, differences in research methodologies and analyses that affect the interpretation of results, and proposes guidelines for overcoming obstacles to understand skeletal traits associated with DS. By examining our current knowledge of bone in individuals with Ts21, a trajectory for future studies may be established to provide meaningful solutions for understanding the development of and improving skeletal structures in individuals with and without DS.
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Affiliation(s)
- Jonathan M LaCombe
- Department of Biology, Indiana University-Purdue University Indianapolis, United States of America
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, United States of America.
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24
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Atlantoaxial dislocation due to os odontoideum in patients with Down's syndrome: literature review and case reports. Childs Nerv Syst 2020; 36:19-26. [PMID: 31680204 DOI: 10.1007/s00381-019-04401-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/27/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To clarify etiology, clinical features, and diagnostic and treatment options of atlantoaxial dislocation (AAD) due to os odontoideum (OsO) in patients with Down's syndrome (DS). METHODS We described and analyzed three clinical cases of AAD due to OsO in DS patients and reviewed descriptions of similar cases in the scientific sources. RESULTS According to literature review, more than 80% of DS patients with odontoid ossicles had atlantoaxial instability (AAI). AAI in DS patients with OsO is more often manifested in childhood and adolescence, rarely in adults when ligament relaxation is reduced. Some patients had acute clinical manifestation after a minor trauma without any precursors; in some of the cases, neurological deterioration increased during several years. We found that the earlier surgical treatment of AAD due to OsO in DS patients carries the higher recovery potential. CONCLUSIONS Most patients with DS and OsO had AAI. The method of appropriate treatment in such cases is a posterior screw fixation. Preoperative halo traction and posterior fusion have proved to be a very useful tool in the treatment of AAD due to OsO in DS patients. Even if irreducibility of the AAD established preoperatively, it should not be an absolute indication for anterior decompression. In such cases, an attempt to reduce the AAD should be made under general anesthesia during posterior fixation.
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25
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Qin F, Tang H, Zhang Y, Zhang Z, Huang P, Zhu J. Bone marrow-derived mesenchymal stem cell-derived exosomal microRNA-208a promotes osteosarcoma cell proliferation, migration, and invasion. J Cell Physiol 2019; 235:4734-4745. [PMID: 31637737 DOI: 10.1002/jcp.29351] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022]
Abstract
A recent study has discovered that mesenchymal stem cells (MSCs) are recruited into tumors and MSC-derived exosomes in a novel mechanism of cell-to-cell communication in human cancers. Here, in this study, we explore the impact of the microRNA-208a (miR-208a)-enriched exosomes derived from bone marrow-derived mesenchymal stem cells (BMSCs) on osteosarcoma cells. Human osteosarcoma cells MG-63 and Saos-2 were exposed to BMSCs-derived exosomes treated with either miR-208a mimic or inhibitor. The MTT assay, transwell migration assay, and soft agar colony formation assay were used to evaluate the viability, migration, and clonogenicity of osteosarcoma cells. Bioinformatics analysis and dual-luciferase reporter gene assays validated the targeted relationship between miR-208a and PDCD4. Western blot assay was used to detect the expression of PDCD4 and related proteins in the ERK1/2 pathway in osteosarcoma cells. BMSCs communicated with osteosarcoma cells via exosomes. Ectopic expression of miR-208a was shown to increase the viability, migration, and clonogenicity of osteosarcoma cells. Analysis of the exosomal content identified miR-208a as a mediator of the exosomal effects on osteosarcoma cells in part via downregulation of PDCD4 and activating the ERK1/2 pathway. In summary, our study illuminates that BMSC-derived exosomal miR-208a enhances the progression of osteosarcoma.
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Affiliation(s)
- Fa Qin
- Minimally Invasive Department of Orthopaedics, The Fourth Affiliated Hospital of Jishou University, Huaihua, Hunan, China.,Minimally Invasive Department of Orthopedics, The First People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Haoyu Tang
- Minimally Invasive Department of Orthopaedics, The Fourth Affiliated Hospital of Jishou University, Huaihua, Hunan, China.,Minimally Invasive Department of Orthopedics, The First People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Yong Zhang
- Minimally Invasive Department of Orthopaedics, The Fourth Affiliated Hospital of Jishou University, Huaihua, Hunan, China.,Minimally Invasive Department of Orthopedics, The First People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Zhenhua Zhang
- Minimally Invasive Department of Orthopaedics, The Fourth Affiliated Hospital of Jishou University, Huaihua, Hunan, China.,Minimally Invasive Department of Orthopedics, The First People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Pinge Huang
- Minimally Invasive Department of Orthopaedics, The Fourth Affiliated Hospital of Jishou University, Huaihua, Hunan, China.,Minimally Invasive Department of Orthopedics, The First People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Jun Zhu
- Minimally Invasive Department of Orthopaedics, The Fourth Affiliated Hospital of Jishou University, Huaihua, Hunan, China.,Minimally Invasive Department of Orthopedics, The First People's Hospital of Huaihua, Huaihua, Hunan, China
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26
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Tang JYM, Luo H, Wong GHY, Lau MMY, Joe GM, Tse MA, Ip P, Wong ICK, Lum TYS. Bone mineral density from early to middle adulthood in persons with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:936-946. [PMID: 30775821 DOI: 10.1111/jir.12608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND While accelerated ageing is recognised among individuals with Down syndrome (DS), the trajectory of their bone health across adulthood remains poorly understood. METHODS This study aimed to determine the age-related loss of bone mineral density (BMD) of the lumbar spine in 128 adults with DS aged 18 to 54 years compared with 723 counterparts without DS. RESULTS Men and women with DS had lower level of BMD than counterparts without DS across age groups. Magnitude of decrement in BMD as reflected in the z-scores was similar between younger and older men with DS. Older women with DS, on the contrary, showed greater decrement in older ages especially in their fourth decade of life. Osteopenia and osteoporosis as defined using age-specific and gender-specific T-scores affected greater number of men with DS (38% and 25%) than women (17% and 17%) aged 40-49 years. CONCLUSIONS Findings supported adults with DS, especially men, to have early bone mineral testing.
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Affiliation(s)
- J Y M Tang
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - H Luo
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - G H Y Wong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - M M Y Lau
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - G M Joe
- Institute of Human Performance, The University of Hong Kong, Hong Kong
| | - M A Tse
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Institute of Human Performance, The University of Hong Kong, Hong Kong
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - I C K Wong
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
- School of Pharmacy, University College London, London, UK
| | - T Y S Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Abstract
During the past decades, life expectancy of subjects with Down syndrome (DS) has greatly improved, but age-specific mortality rates are still important and DS subjects are characterized by an acceleration of the ageing process, which affects particularly the immune and central nervous systems. In this chapter, we will first review the characteristics of the ageing phenomenon in brain and in immune system in DS and we will then discuss the biological hallmarks of ageing in this specific population. Finally, we will also consider in detail the knowledge on epigenetics in DS, particularly DNA methylation.
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28
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Grabeklis AR, Skalny AV, Skalnaya AA, Zhegalova IV, Notova SV, Mazaletskaya AL, Skalnaya MG, Tinkov AA. Hair Mineral and Trace Element Content in Children with Down's Syndrome. Biol Trace Elem Res 2019; 188:230-238. [PMID: 30209729 DOI: 10.1007/s12011-018-1506-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
Abstract
The objective of the present study was to assess the level of minerals and trace elements in 40 children with Down's syndrome and 40 controls aged 1-2 years old. Hair mineral and trace element analysis was performed using inductively coupled plasma mass spectrometry. The obtained data demonstrate that hair levels of Mg, P, I, Cr, Si, Zn, and Pb in Down's syndrome patients exceeded the respective control values by 36, 36, 93, 57, 45, 28, and 54%, whereas hair mercury was more than twofold lower in children with Down's syndrome. The observed difference in the levels of trace elements was age-dependent. In particular, in 1-year-olds, major differences were observed for essential elements (Cr, Si, Zn), whereas in 2-year-olds-for toxic elements (Hg, Pb). At the same time, hair P levels in Down's syndrome patients were 14 and 35% higher at the age of 1 and 2 years in comparison to the respective controls. Multiple regression analysis demonstrated that a model incorporating all elements, being characterized by a significant group difference, accounted for 42.5% of status variability. At the same time, only hair phosphorus was significantly interrelated with Down's syndrome status (β = 0.478; p < 0.001). Principal component analysis (PCA) used As, Ca, Cr, Fe, Hg, I, Mg, P, Pb, Se, Si, Sn, and Zn as predictors, with the resulting R2 = 0.559. The OPLS-DA models also separated between Down's and health control groups. Therefore, 1-2-year-old patients with Down's syndrome are characterized by significant alterations of mineral and trace element status.
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Affiliation(s)
- Andrey R Grabeklis
- Yaroslavl State University, Yaroslavl, Russia
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Anatoly V Skalny
- Yaroslavl State University, Yaroslavl, Russia.
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
- All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR), Moscow, Russia.
| | | | - Irina V Zhegalova
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Svetlana V Notova
- Orenburg State University, Orenburg, Russia
- Federal Research Centre of Biological Systems and Agro-technologies of the Russian Academy of Sciences, Orenburg, Russia
| | | | - Margarita G Skalnaya
- Yaroslavl State University, Yaroslavl, Russia
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Alexey A Tinkov
- Yaroslavl State University, Yaroslavl, Russia
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
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29
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Lizondo V, Caplliure-Llopis J, Escrivá D, De La Rubia JE, Barrios C. Bone quality in young adults with intellectual disability involved in adapted competitive football. Eur J Sport Sci 2019; 19:850-859. [PMID: 30624162 DOI: 10.1080/17461391.2018.1563633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to analyse bone quality parameters of football players with intellectual disability (ID) participating in adapted competitive football. Sixty-seven male football players with ID were studied: 22 with Down syndrome (DS) and 45 without DS. The average age was 26 years (range: 16 ̶ 50 years). A group of 25 age-matched sedentary individuals with ID (11 DS and 14 non-DS) and another group of 20 healthy participants of the same age group not involved in competitive football were comparatively analysed. There were no differences in the bone quality parameters when the healthy sedentary individuals were compared with both the sedentary and the football players with ID. However, the speed of sound (SOS), T-score, and estimated bone mineral density (BMD) were of higher values in the football players with ID than in the sedentary ID group (p < 0.05). On comparing the football players with non-DS ID with the sedentary non-DS individuals, significant differences were noted in SOS (p < 0.01), T-scores (p < 0.01), and estimated BMD (p < 0.01). Four of the 45 non-DS (8.9%) and none of the football players with DS had T-scores less than -1.5. Two of the 14 sedentary non-DS participants (14.3%) had T-scores indicating osteoporosis. In summary, the ID population actively involved in football showed higher values of bone mass parameters than their sedentary ID and healthy peers. The participants with non-DS ID showed a higher prevalence of osteoporosis than the football players with DS. Participation in sports seems to prevent bone loss in individuals with ID.
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Affiliation(s)
- Vicente Lizondo
- a School of Doctorate , Valencia Catholic University , Valencia , Spain
| | | | - Dolores Escrivá
- b Nursing School , Valencia Catholic University , Valencia , Spain
| | | | - Carlos Barrios
- c Institute for Research on Musculoskeletal Disorders , Valencia Catholic University , Valencia , Spain
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30
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A case report of atlanto-axial instability in a Down Syndrome patient. Spinal Cord Ser Cases 2018; 4:106. [DOI: 10.1038/s41394-018-0139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 11/08/2022] Open
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Costa R, Gullón A, De Miguel R, de Asúa DR, Bautista A, García C, Suarez C, Castañeda S, Moldenhauer F. Bone Mineral Density Distribution Curves in Spanish Adults With Down Syndrome. J Clin Densitom 2018; 21:493-500. [PMID: 29681439 DOI: 10.1016/j.jocd.2018.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
According to reports from small-sized case series, adults with Down syndrome (DS) appear to have lower bone mineral density (BMD) than the general population. The objective of our study was to further characterize the bone mass acquisition curve in an adult DS population. This is a retrospective study of 297 adults with DS from the Adult Down Syndrome Outpatient Clinic of a tertiary care hospital in Madrid, Spain, who underwent a bone densitometry (Hologic QDR-4500W), for clinical purposes between January 2010 and June 2015. The mean age of our sample population was 34 yr (±10.9); 51% were women. Bone mass peak was reached earlier and was lower than the general population (around 20-25 yr), with almost parallel curves. The mean BMD was 0.715 ± 0.12 g/cm2 in femoral neck (FN) and 0.872 ± 0.11 g/cm2 in lumbar spine (LS). According to FN scores, 52% of the subjects were classified as osteopenic and 18% as osteoporotic. According to LS scores, frequencies were 54% and 25%, respectively. BMD was considered inadequate for the age (Z-score < -2 standard deviation) in 18% of the subjects at FN and 40% at LS. BMD at LS was significantly lower in males than in females (52% vs 38%, p < 0.001). Male DS subjects had a 2.58-fold (95% confidence interval: 1.57-4.25) higher risk of developing reduced BMD at LS than females. Persons with DS reach the bone mass peak earlier and this bone mass is lower than the general population. Among subjects with DS, male gender is a risk factor for developing low BMD, especially at LS.
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Affiliation(s)
- Ramón Costa
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
| | - Alejandra Gullón
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Rosa De Miguel
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Real de Asúa
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Azucena Bautista
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Clara García
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Suarez
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Santos Castañeda
- Department of Rheumatology, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Instituto de Investigación Sanitaria-Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
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32
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Tamplen M, Fowler T, Markey J, Knott PD, Suva LJ, Alliston T. Treatment with anti-Sclerostin antibody to stimulate mandibular bone formation. Head Neck 2018; 40:1453-1460. [PMID: 29522281 PMCID: PMC6037571 DOI: 10.1002/hed.25128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 11/19/2017] [Accepted: 01/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anti-Sclerostin antibody (Scl-Ab) is a promising new bone anabolic therapy. Although anti-Scl-Ab stimulates bone formation and repair in the appendicular and axial skeleton, its efficacy in the craniofacial skeleton is still poorly understood. METHODS Using an established model of Down syndrome-dependent bone deficiency, 10 Ts65Dn mice and 10 wild-type mice were treated weekly via i.v. tail vein injection with vehicle or anti-Sclerostin for 3 weeks and euthanized 1 week after. RESULTS Wild-type mice treated with the anti-Scl-Ab had increased mandibular bone, trabecular thickness, and alveolar height compared with controls. Anti-Scl-Ab increased Ts65Dn mandibular bone parameters such that they were statistically indistinguishable from those in vehicle-treated wild-type mandibles. CONCLUSION Treatment with anti-Scl-Ab significantly increased mandibular bone mass and alveolar height in wild type mice and normalized mandibular bone mass and alveolar height in Ts65Dn mice. The anti-Scl-Ab therapy represents a novel method for increasing mandibular bone formation.
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Affiliation(s)
- Matthew Tamplen
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California
| | - Tristan Fowler
- Department of Orthopedic Surgery, University of California, San Francisco, California
| | - Jeffery Markey
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California
| | - P Daniel Knott
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California
| | - Larry J Suva
- Department of Veterinary Physiology, Texas A&M University, College Station, Texas
| | - Tamara Alliston
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California.,Department of Orthopedic Surgery, University of California, San Francisco, California
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33
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Saquetto MB, Pereira FF, Queiroz RS, da Silva CM, Conceição CS, Gomes Neto M. Effects of whole-body vibration on muscle strength, bone mineral content and density, and balance and body composition of children and adolescents with Down syndrome: a systematic review. Osteoporos Int 2018; 29:527-533. [PMID: 29330572 DOI: 10.1007/s00198-017-4360-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/18/2017] [Indexed: 01/23/2023]
Abstract
The aim of this study is to verify the effects of whole-body vibration (WBV) training on the muscle strength of children and adolescents with Down syndrome. We searched MEDLINE, Cochrane, SciELO, Lilacs and PUBMED databases and included manual searches to identify randomised controlled trials to investigate the effects of WBV on the structure and body function of children and adolescents with Down syndrome. Two reviewers independently selected the studies and performed statistical analysis. In total, five studies with 171 patients that compared WBV with exercise and/or control were included. Two studies demonstrated a significant difference between the muscle strength of children and adolescents with Down syndrome who received WBV training and that of those who did not receive the intervention. The studies included in this systematic review showed that WBV training has positive effects on bone mineral density (BMD), body composition and balance. Results of this study showed that WBV training improves muscle strength, BMD, body composition and balance of children and adolescents with Down syndrome, and a more in-depth analysis of its effects on other variables in this population is required, as well as of parameters to be used.
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Affiliation(s)
- M B Saquetto
- Departamento de Fisioterapia, Instituto de Ciências da Saúde, Curso de Fisioterapia da Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela, Salvador, BA, 40110-100, Brazil.
- Grupo de Pesquisa em Fisioterapia - UFBA, Salvador, BA, Brazil.
| | - F F Pereira
- Grupo de Pesquisa em Fisioterapia - UFBA, Salvador, BA, Brazil
| | - R S Queiroz
- Grupo de Pesquisa em Fisioterapia - UFBA, Salvador, BA, Brazil
- Departamento de Saúde I, Curso de Fisioterapia da Universidade Estadual do Sudoeste da Bahia - UESB, Jequié, BA, Brazil
| | - C M da Silva
- Departamento de Fisioterapia, Instituto de Ciências da Saúde, Curso de Fisioterapia da Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela, Salvador, BA, 40110-100, Brazil
- Grupo de Pesquisa em Fisioterapia - UFBA, Salvador, BA, Brazil
| | - C S Conceição
- Departamento de Fisioterapia, Instituto de Ciências da Saúde, Curso de Fisioterapia da Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela, Salvador, BA, 40110-100, Brazil
- Grupo de Pesquisa em Fisioterapia - UFBA, Salvador, BA, Brazil
| | - M Gomes Neto
- Departamento de Fisioterapia, Instituto de Ciências da Saúde, Curso de Fisioterapia da Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela, Salvador, BA, 40110-100, Brazil
- Grupo de Pesquisa em Fisioterapia - UFBA, Salvador, BA, Brazil
- Programa de Pós Graduação em Medicina e Saúde - UFBA, Salvador, BA, Brazil
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Abstract
PURPOSE OF REVIEW To summarize the recent developments in endocrine disorders associated with Down syndrome. RECENT FINDINGS Current research regarding bone health and Down syndrome continues to show an increased prevalence of low bone mass and highlights the importance of considering short stature when interpreting dual energy x-ray absorptiometry. The underlying cause of low bone density is an area of active research and will shape treatment and preventive measures. Risk of thyroid disease is present throughout the life course in individuals with Down syndrome. New approaches and understanding of the pathophysiology and management of subclinical hypothyroidism continue to be explored. Individuals with Down syndrome are also at risk for other autoimmune conditions, with recent research revealing the role of the increased expression of the Autoimmune Regulatory gene on 21st chromosome. Lastly, Down-syndrome-specific growth charts were recently published and provide a better assessment of growth. SUMMARY Recent research confirms and expands on the previously known endocrinopathies in Down syndrome and provides more insight into potential underlying mechanisms.
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Affiliation(s)
- Rachel Whooten
- Department of Pediatrics, Division of Pediatric Endocrinology, Massachusetts General Hospital for Children
- Department of Pediatrics, Division of General Academic Pediatrics, Massachusetts General Hospital for Children
- Corresponding author: ; Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA, 02114
| | - Jessica Schmitt
- Department of Pediatrics, Division of Pediatric Endocrinology, Massachusetts General Hospital for Children
| | - Alison Schwartz
- Department of Pediatrics, Down Syndrome Clinic, Massachusetts General Hospital for Children
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Ito K, Imagama S, Ando K, Kobayashi K, Tsushima M, Matsumoto A, Morozumi M, Tanaka S, Machino M, Nishida Y, Ishiguro N. Posterior fusion of the occipital axis in children with upper cervical disorder using both C2 pedicle and laminar screws (C2 hybrid screws). Spine Surg Relat Res 2018; 2:82-85. [PMID: 31440652 PMCID: PMC6698545 DOI: 10.22603/ssrr.2017-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/07/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction An occipital-cervical surgery for children is challenging for surgeons because of the immature bone quality, extensive anatomical variability, and small osseous structures. Furthermore, occipital-C2 fusion in children results in great stress on the C2 screws. We report a technique that uses both C2 pedicle and bilateral lateral mass screws (C2 hybrid screws) in children with an upper cervical disorder to preserve motion segment and secure strength in those who require occipital-cervical fusion. Case Report Case 1 was that of a 5-year-old girl with Down syndrome who had atlantoaxial dislocation and os odontoideum. Owing to the C1 hypoplasia, the posterior arch was fractured by the C1 lateral mass screw. Therefore, O-C2 fusion was performed. C2 bilateral lamina screws were added along with the C2 bilateral pedicle screws for reinforcement. Case 2 was that of an 8-year-old boy who presented with torticollis and neck pain. The patient was diagnosed as having atlantoaxial rotatory fixation. The right vertebral artery was obstructed, and the left vertebral artery was dominant. The C1 posterior arch was bifid and assimilated with the occipital bone. C2 bilateral lamina screws were added with the right C2 pedicle screw for reinforcement. Both cases attained bone union after O-C2 fusion surgery using hybrid screws. Conclusions The use of C2 hybrid screws with both C2 pedicle and bilateral lateral mass screws can preserve mobile segments in the fusion area in young children who require occipital-cervical fixation.
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Affiliation(s)
- Kenyu Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Mikito Tsushima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akiyuki Matsumoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
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Burke ÉA, Carroll R, O’Dwyer M, Walsh JB, McCallion P, McCarron M. Osteoporosis and People with Down Syndrome: A Preliminary Descriptive Examination of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing Wave 1 Results. Health (London) 2018. [DOI: 10.4236/health.2018.109095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Williams DK, Parham SG, Schryver E, Akel NS, Shelton RS, Webber J, Swain FL, Schmidt J, Suva LJ, Gaddy D. Sclerostin Antibody Treatment Stimulates Bone Formation to Normalize Bone Mass in Male Down Syndrome Mice. JBMR Plus 2017; 2:47-54. [PMID: 30283889 PMCID: PMC6124205 DOI: 10.1002/jbm4.10025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/05/2017] [Accepted: 11/14/2017] [Indexed: 01/28/2023] Open
Abstract
Down syndrome (DS), characterized by trisomy of human chromosome 21, is associated with a variety of endocrine disorders as well as profound skeletal abnormalities. The low bone mass phenotype in DS is defined by low bone turnover due to decreased osteoclast and osteoblast activity, decreasing the utility of antiresorptive agents in people with DS. Sclerostin antibody (SclAb) is a therapeutic candidate currently being evaluated as a bone anabolic agent. Scl, the product of the sclerostin gene (SOST), inhibits bone formation through its inhibition of Wnt signaling. SclAb increases bone mass by suppressing the action of the endogenous inhibitor of bone formation, Scl. To examine the effects of SclAb on the DS bone phenotype, 8‐week‐old male wild‐type (WT) andTs65Dn DS mice were treated with 4 weekly iv injections of 100 mg/kg SclAb. Dual‐energy X‐ray absorptiometry (DXA), microCT, and dynamic histomorphometry analyses revealed that SclAb had a significant anabolic effect on both age‐matched WT littermate controls and Ts65Dn DS mice that was osteoblast mediated, without significant changes in osteoclast parameters. SclAb treatment significantly increased both cortical and trabecular bone mass at multiple sites; SclAb treatment resulted in the normalization of Ts65Dn bone mineral density (BMD) to WT levels in the proximal tibia, distal femur, and whole body. Ex vivo bone marrow cultures demonstrated that SclAb increased the recruitment of the mesenchymal progenitors into the osteoblast lineage, as indicated by increased alkaline phosphatase–positive colonies, with no effect on osteoclast differentiation. Together, in the setting of a murine model of DS and decreased bone turnover, SclAb had a potent anabolic effect. SclAb stimulated bone formation and increased osteoblastogenesis without affecting osteoclastogenesis or bone resorption. These data suggest that SclAb is a promising new therapy to improve bone mass and reduce fracture risk in the face of the low bone mass and turnover prevalent in the DS population. © 2017 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Diarra K Williams
- Department of Veterinary Physiology and Pharmacology College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station TX USA
| | - Sean G Parham
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - Eric Schryver
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - Nisreen S Akel
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - R Shane Shelton
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - Jessica Webber
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - Francis L Swain
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - Jami Schmidt
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - Larry J Suva
- Department of Veterinary Physiology and Pharmacology College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station TX USA.,Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA
| | - Dana Gaddy
- Department of Orthopaedic Surgery Center for Orthopaedic Research University of Arkansas for Medical Sciences Little Rock AR USA.,Department of Veterinary Integrative Biosciences College of Veterinary Medicine and Biomedical Sciences Texas A&M University College Station TX USA
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Capone GT, Chicoine B, Bulova P, Stephens M, Hart S, Crissman B, Videlefsky A, Myers K, Roizen N, Esbensen A, Peterson M, Santoro S, Woodward J, Martin B, Smith D. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Am J Med Genet A 2017; 176:116-133. [PMID: 29130597 DOI: 10.1002/ajmg.a.38512] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 11/06/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. The United States Preventive Service Task Force (USPSTF) has developed criteria for prioritizing conditions of public health importance with the potential for providing screening recommendations to improve clinical care. The quality of existing evidence needed to inform clinical guidelines has not been previously reviewed. Using the National Library of Medicine (NLM) database PubMed, we first identified 18 peer reviewed articles that addressed co-occurring medical conditions in adults with DS. Those conditions discussed in over half of the articles were prioritized for further review. Second, we performed detailed literature searches on these specific conditions. To inform the search strategy and review process a series of key questions were formulated a priori. The quality of available evidence was then graded and knowledge gaps were identified. The number of participating adults and the design of clinical studies varied by condition and were often inadequate for answering all of our key questions. We provide data on thyroid disease, cervical spine disease, hearing impairment, overweight-obesity, sleep apnea, congenital heart disease, and osteopenia-osteoporosis. Minimal evidence demonstrates massive gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The development of evidence-based clinical guidance will require an expanded clinical knowledge-base in order to move forward.
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Affiliation(s)
- George T Capone
- Kennedy Krieger Institute, Down Syndrome Clinic & Research Center, Baltimore, Maryland
| | - Brian Chicoine
- Advocate Adult Down Syndrome Center, Park Ridge, Illinois
| | - Peter Bulova
- Montefiore Hospital, Adult Down Syndrome Clinic, Pittsburgh, Pennsylvania
| | - Mary Stephens
- Christiana Care Health System, Adult Down Syndrome Clinic, Wilmington, Delaware
| | - Sarah Hart
- Duke University Medical Center, Durham, North Carolina
| | | | - Andrea Videlefsky
- The Adult Disability Medical Home, Urban Family Practice, Marietta, Georgia
| | | | - Nancy Roizen
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Moya Peterson
- University of Kansas Medical Center, Adults with Down Syndrome Specialty Clinic, Kansas City, Kansas
| | | | - Jason Woodward
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Barry Martin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Smith
- Children's Hospital of Wisconsin, Down Syndrome Clinic of Wisconsin, Milwaukee, Wisconsin
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Matute-Llorente Á, González-Agüero A, Vicente-Rodríguez G, Sardinha LB, Baptista F, Casajús JA. Physical activity and bone mineral density at the femoral neck subregions in adolescents with Down syndrome. J Pediatr Endocrinol Metab 2017; 30:1075-1082. [PMID: 28902628 DOI: 10.1515/jpem-2017-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/31/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Low bone mineral density (BMD) has been frequently described in subjects with Down syndrome (DS). Reduced physical activity (PA) levels may contribute to low BMD in this population. The objective of the study was to investigate whether PA levels were related to the femoral neck bone mass distribution in a sample of 14 males and 12 females with DS aged 12-18 years. METHODS BMD was evaluated by dual energy X-ray absorptiometry (DXA) at the integral, superolateral and inferomedial femoral neck regions and PA levels were assessed by accelerometry. The BMDs between the sexes and PA groups (below and above the 50th percentile of the total PA) were compared using independent t-tests and analyses of covariance (ANCOVAs) controlling for age, height and body weight. RESULTS No differences were found between the BMDs of males and females in any femoral neck region (p>0.05). Females with higher PA levels demonstrated increased integral (0.774 g/cm2 vs. 0.678 g/cm2) and superolateral femoral neck BMDs (0.696 g/cm2 vs. 0.595 g/cm2) compared to those with lower PA levels (p<0.05). In males, no differences (p<0.05) were found in the BMDs between the PA groups. CONCLUSIONS This investigation shows that females accumulating more total PA presented increased BMDs at the integral and superolateral femoral neck regions (14.1% and 17.0%, respectively) when compared to their less active peers. These data highlight the importance of PA in females with DS to counteract their low bone mass and to improve their bone health.
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Carfì A, Liperoti R, Fusco D, Giovannini S, Brandi V, Vetrano DL, Meloni E, Mascia D, Villani ER, Manes Gravina E, Bernabei R, Onder G. Bone mineral density in adults with Down syndrome. Osteoporos Int 2017; 28:2929-2934. [PMID: 28685282 DOI: 10.1007/s00198-017-4133-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study analyzed data of bone mineral density (BMD) from a large cohort of adults with Down syndrome (DS). BMD was found to decrease with age more rapidly in these subjects than in the general population, exposing adults with DS to an increased risk of osteoporosis and bone fracture. INTRODUCTION Down syndrome (DS) in adulthood presents with a high prevalence of osteoporosis. However, in DS, bone mineral density (BMD) can be underestimated due to short stature. Furthermore, the rate of age-related decline in BMD and its association with gender in DS has been rarely evaluated or compared with the general population. The present study is aimed at assessing the variation of BMD with age and gender in a sample of adults with DS and to compare these data with those of the general population, after adjusting for anthropometric differences. METHODS Adults with DS, aged 18 or older, were assessed dual-energy-X-ray-absorptiometry (DXA) at the femoral neck and at the lumbar spine. They were compared with the general population enrolled in the National Health and Nutrition Examination Survey (NHANES) 2009-2010 dataset. Bone mineral apparent density (BMAD) was calculated for each individual. RESULTS DXA was evaluated in 234 subjects with DS (mean age 36.93 ± 11.83 years, ranging from 20 to 69 years; 50.4% females). In the lumbar spine both mean BMD (DS 0.880 ± 0.141 vs. NHANES 1.062 ± 0.167, p < 0.001) and BMAD (DS 0.138 ± 0.020 vs. NHANES 0.152 ± 0.020, p < 0.001) were significantly lower in the DS sample than in the NAHNES cohort. The same trend was observed at the femoral neck in both BMD (DS 0.658 ± 0.128 vs. NHANES 0.835 ± 0.137, p < 0.001) and BMAD (DS 0.151 ± 0.030 vs. NHANES 0.159 ± 0.028, p<0.001). Age was associated with lower femoral neck BMAD in both samples; importantly, this association was significantly stronger in the DS sample. In the lumbar spine region, no significant association between BMAD and age could be observed in both samples. CONCLUSIONS Adults with DS have lower bone mineral density compared to the general population and they experience a steeper decline with age. Early screening programs are needed in DS population.
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Affiliation(s)
- A Carfì
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - R Liperoti
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D Fusco
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - S Giovannini
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - V Brandi
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D L Vetrano
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - E Meloni
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D Mascia
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - E R Villani
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - E Manes Gravina
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - R Bernabei
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - G Onder
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Costa R, De Miguel R, García C, de Asúa DR, Castañeda S, Moldenhauer F, Suárez C. Bone Mass Assessment in a Cohort of Adults With Down Syndrome: A Cross-Sectional Study. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 55:315-324. [PMID: 28972872 DOI: 10.1352/1934-9556-55.5.315] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Differences in bone mineral density (BMD) have been observed between adults with Down syndrome (DS) and the general population. The purpose of this article is to describe the prevalence of bone mass disorders in a cohort of adults with DS and their predisposing factors. We performed a cross-sectional study of 104 consecutively recruited adults with DS from an outpatient clinic of a tertiary care hospital in Madrid, Spain. We recorded epidemiological and anthropometric data, nutritional variables, coexisting clinical conditions, and laboratory variables. BMD was measured at the lumbar spine, total hip, and femoral neck using dual-energy X-ray absorptiometry. The prevalence of osteopenia ranged from 48% to 52%, and that of osteoporosis ranged from 19% to 22% depending on the site of measurement (femoral neck or lumbar spine, respectively). Age was the greatest risk factor associated for lower BMD, with similar bone mass accrual curve but with lower peak of BMD than the general population. We conclude that low bone mass is an extremely prevalent condition in adult patients with DS.
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Affiliation(s)
- Ramón Costa
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Rosa De Miguel
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Clara García
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Diego Real de Asúa
- Ramón Costa, Rosa De Miguel, Clara García, and Diego Real de Asúa, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Santos Castañeda
- Santos Castañeda, Department of Rheumatology, Hospital Universitario de La Princesa, Madrid, Spain; and
| | - Fernando Moldenhauer
- Fernando Moldenhauer and Carmen Suárez, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Suárez
- Fernando Moldenhauer and Carmen Suárez, Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Institute for Biomedical Research, Hospital Universitario de La Princesa, Madrid, Spain
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García-Hoyos M, Riancho JA, Valero C. Bone health in Down syndrome. Med Clin (Barc) 2017; 149:78-82. [PMID: 28571965 DOI: 10.1016/j.medcli.2017.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 01/08/2023]
Abstract
Patients with Down syndrome have a number of risk factors that theoretically could predispose them to osteoporosis, such as early aging, development disorders, reduced physical activity, limited sun exposure, frequent comorbidities and use of drug therapies which could affect bone metabolism. In addition, the bone mass of these people may be affected by their anthropometric and body composition peculiarities. In general terms, studies in adults with Down syndrome reported that these people have lower areal bone mineral density (g/cm2) than the general population. However, most of them have not taken the smaller bone size of people with Down syndrome into account. In fact, when body mineral density is adjusted by bone size and we obtain volumetric body mineral density (g/cm3), the difference between both populations disappears. On the other hand, although people with Down syndrome have risk factor of hypovitaminosis D, the results of studies regarding 25(OH)D in this population are not clear. Likewise, the studies about biochemical bone markers or the prevalence of fractures are not conclusive.
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Affiliation(s)
- Marta García-Hoyos
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - José Antonio Riancho
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - Carmen Valero
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España.
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García-Hoyos M, García-Unzueta MT, de Luis D, Valero C, Riancho JA. Diverging results of areal and volumetric bone mineral density in Down syndrome. Osteoporos Int 2017; 28:965-972. [PMID: 27838733 DOI: 10.1007/s00198-016-3814-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Population with Down syndrome (DS) has lower areal BMD, in association with their smaller skeletal size. However, volumetric BMD and other indices of bone microarchitecture, such as trabecular bone score (TBS) and calcaneal ultrasound (QUS), were normal. INTRODUCTION Patients with DS have a number of risk factors that could predispose them to osteoporosis. Several studies reported that people with DS also have lower areal bone mineral density, but differences in the skeletal size could bias the analysis. METHODS Seventy-five patients with DS and 76 controls without intellectual disability were recruited. Controls were matched for age and sex. Bone mineral density (BMD) was measure by Dual-energy X-ray Absorptiometry (DXA), and volumetric bone mineral density (vBMD) was calculated by published formulas. Body composition was also measured by DXA. Microarchitecture was measured by TBS and QUS. Serum 25-hidroxyvitamin D (25OHD), parathyroid hormone (PTH), aminoterminal propeptide of type collagen (P1NP), and C-terminal telopeptide of type I collagen (CTX) were also determined. Physical activity was assessed by the International Physical Activity Questionnaires (IPAQ-short form). To evaluate nutritional intake, we recorded three consecutive days of food. RESULTS DS individuals had lower height (151 ± 11 vs. 169 ± 9 cm). BMD was higher in the controls (lumbar spine (LS) 0.903 ± 0.124 g/cm2 in patients and 0.997 ± 0.115 g/cm2 in the controls; femoral neck (FN) 0.761 ± .126 g/cm2 and 0.838 ± 0.115 g/cm2, respectively). vBMD was similar in the DS group (LS 0.244 ± 0.124 g/cm3; FN 0.325 ± .0.073 g/cm3) and the controls (LS 0.255 ± 0.033 g/cm3; FN 0.309 ± 0.043 g/cm3). Microarchitecture measured by QUS was slightly better in DS, and TBS measures were similar in both groups. 25OHD, PTH, and CTX were similar in both groups. P1NP was higher in the DS group. Time spent on exercise was similar in both groups, but intensity was higher in the control group. Population with DS has correct nutrition. CONCLUSIONS Areal BMD is reduced in DS, but it seems to be related to the smaller body and skeletal size. In fact, the estimated volumetric BMD is similar in patients with DS and in control individuals. Furthermore, people with DS have normal bone microarchitecture.
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Affiliation(s)
- M García-Hoyos
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain
| | - M T García-Unzueta
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain
| | - D de Luis
- Department of Internal Medicine, University Hospital Rio Hortega, Valladolid, Spain
| | - C Valero
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain.
| | - J A Riancho
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, RETICEF, IDIVAL, Santander, Spain
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Screw fixation for atlantoaxial dislocation related to Down syndrome in children younger than 5 years. J Pediatr Orthop B 2017; 26:86-90. [PMID: 27023746 DOI: 10.1097/bpb.0000000000000299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to present cases of upper cervical fixation in Down syndrome patients younger than 5 years. In two cases, C1 lateral mass screws were installed. However, owing to the irreducible atlantoaxial dislocation, the screw backed out and fractured. Therefore, O-C2 fusion was performed. Furthermore, C2 bilateral lamina screws were added to the C2 pedicle screw for reinforcement. C1-C2 fusion is an option for Down syndrome patients younger than 5 years with atlantoaxial dislocation, when the dislocation is reducible. If the dislocation is irreducible, or the implant cannot be firmly secured, the fixation range should be expanded to O-C2 or below.
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Survival of dental implants in patients with Down syndrome: A case series. J Prosthet Dent 2016; 116:880-884. [DOI: 10.1016/j.prosdent.2016.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/21/2022]
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Special Olympics swimming: positive effects on young people with Down syndrome. SPORT SCIENCES FOR HEALTH 2016. [DOI: 10.1007/s11332-016-0293-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Matute-Llorente A, González-Agüero A, Gómez-Cabello A, Tous-Fajardo J, Vicente-Rodríguez G, Casajús JA. Effect of whole-body vibration training on bone mass in adolescents with and without Down syndrome: a randomized controlled trial. Osteoporos Int 2016. [PMID: 26202487 DOI: 10.1007/s00198-015-3232-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED Whole-body vibration training (WBV) attracts great interest as osteoporosis prevention strategy. Twenty-six adolescents with and without Down syndrome (DS) (13 DS; 12-18 years) performed 20 weeks of WBV. The results indicate that WBV seems to provoke a lesser response in adolescents with DS than in those without DS. INTRODUCTION This study aims to observe the differences between adolescents with and without DS in the effects of 20 weeks of WBV training, on bone mineral content (BMC) and density (BMD). METHODS Twenty-six adolescents (13 DS; 12-18 years) were measured with dual-energy X-ray absorptiometry before and after the intervention (3/week, 10 repetitions (30-60 s) and 1-min rest, frequency 25-30 Hz and peak-to-peak displacement of 2 mm (peak acceleration 2.5-3.6 g)). Both, an intention-to-treat (ITT) analysis designed to assess the effects on bone mass and a per-protocol analysis, designed to compare poor and high compliers, were performed. RESULTS The ITT analysis revealed significant increases in all BMC and BMD parameters (dz = 0.66 to 1.64; all p < 0.05) in the non-DS group, whilst DS group improved whole-body, subtotal (whole-body less head), upper limbs (ULIMBS), pelvis, lower limbs (LLIMBS) and spine BMC (dz = 0.75 to 1.76; all p < 0.05) and subtotal, pelvis, LLIMBS and spine BMD (dz = 0.73 to 1.28; all p < 0.05). Significantly greater increases were evident in the absolute and percent changes of the non-DS group over DS group (d = 0.88 to 3.85; all p < 0.05). ULIMBS BMD showed a tendency towards an interaction (f = 0.41 and p = 0.086) with higher increase for non-DS group. When a per-protocol analysis was considered, high-complier adolescents had 8.1 versus 5.3 % of gains in the spine BMC over poor-complier adolescents (d = 0.93; p < 0.05). CONCLUSIONS Twenty weeks of WBV training may improve BMC and BMD in clinically relevant skeletal sites in both groups. Nevertheless, this type of training seems to provoke a lesser response in adolescents with DS than in those without DS.
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Affiliation(s)
- A Matute-Llorente
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna n° 12, 50009, Zaragoza, Spain.
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Ronda Misericordia 5, 22001, Huesca, Spain.
| | - A González-Agüero
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna n° 12, 50009, Zaragoza, Spain.
- Department of Sport and Exercise Science, Aberystwyth University, Ceredigion, UK.
| | - A Gómez-Cabello
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna n° 12, 50009, Zaragoza, Spain.
- Centro Universitario de la Defensa, Zaragoza, Spain.
| | - J Tous-Fajardo
- Juventus Football Club, Turin, Italy.
- Sports Performance Lab, Sport Sciences Research Group, INEFC Av. de l'Estadi 12, 08038, Barcelona, Spain.
| | - G Vicente-Rodríguez
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna n° 12, 50009, Zaragoza, Spain.
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Ronda Misericordia 5, 22001, Huesca, Spain.
| | - J A Casajús
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna n° 12, 50009, Zaragoza, Spain.
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Ronda Misericordia 5, 22001, Huesca, Spain.
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Blazek JD, Abeysekera I, Li J, Roper RJ. Rescue of the abnormal skeletal phenotype in Ts65Dn Down syndrome mice using genetic and therapeutic modulation of trisomic Dyrk1a. Hum Mol Genet 2015; 24:5687-96. [PMID: 26206885 DOI: 10.1093/hmg/ddv284] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/13/2015] [Indexed: 01/26/2023] Open
Abstract
Trisomy 21 causes skeletal alterations in individuals with Down syndrome (DS), but the causative trisomic gene and a therapeutic approach to rescue these abnormalities are unknown. Individuals with DS display skeletal alterations including reduced bone mineral density, modified bone structure and distinctive facial features. Due to peripheral skeletal anomalies and extended longevity, individuals with DS are increasingly more susceptible to bone fractures. Understanding the genetic and developmental origin of DS skeletal abnormalities would facilitate the development of therapies to rescue these and other deficiencies associated with DS. DYRK1A is found in three copies in individuals with DS and Ts65Dn DS mice and has been hypothesized to be involved in many Trisomy 21 phenotypes including skeletal abnormalities. Return of Dyrk1a copy number to normal levels in Ts65Dn mice rescued the appendicular bone abnormalities, suggesting that appropriate levels of DYRK1A expression are critical for the development and maintenance of the DS appendicular skeleton. Therapy using the DYRK1A inhibitor epigallocatechin-3-gallate improved Ts65Dn skeletal phenotypes. These outcomes suggest that the osteopenic phenotype associated with DS may be rescued postnatally by targeting trisomic Dyrk1a.
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Affiliation(s)
- Joshua D Blazek
- Department of Biology, Indiana University-Purdue University Indianapolis and Indiana University Center for Regenerative Biology and Medicine, Indianapolis, IN 46202, USA
| | - Irushi Abeysekera
- Department of Biology, Indiana University-Purdue University Indianapolis and Indiana University Center for Regenerative Biology and Medicine, Indianapolis, IN 46202, USA
| | - Jiliang Li
- Department of Biology, Indiana University-Purdue University Indianapolis and Indiana University Center for Regenerative Biology and Medicine, Indianapolis, IN 46202, USA
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University Indianapolis and Indiana University Center for Regenerative Biology and Medicine, Indianapolis, IN 46202, USA
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Carfì A, Brandi V, Zampino G, Mari D, Onder G. Editorial: Care of adults with Down syndrome: Gaps and needs. Eur J Intern Med 2015; 26:375-6. [PMID: 25957735 DOI: 10.1016/j.ejim.2015.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Angelo Carfì
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Brandi
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Zampino
- Birth Defects Unit, Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Mari
- Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Ca' Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
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Stagi S, Iurato C, Lapi E, Cavalli L, Brandi ML, de Martino M. Bone status in genetic syndromes: a review. Hormones (Athens) 2015; 14:19-31. [PMID: 25885101 DOI: 10.1007/bf03401378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
More and more data seem to indicate the presence of an increasing number of syndromes and genetic diseases characterized by impaired bone mass and quality. Meanwhile, the improvement of etiopathogenetic knowledge and the employment of more adequate treatments have generated a significant increase in survival related to these syndromes and diseases. It is thus important to identify and treat bone impairment in these patients in order to assure a better quality of life. This review provides an updated overview of bone pathophysiology and characteristics in patients with Down, Turner, Klinefelter, Marfan, Williams, Prader-Willi, Noonan, and 22q11 deletions syndrome. In addition, some options for the treatment of the bone status impairment in these patients will be briefly discussed.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Chiara Iurato
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Elisabetta Lapi
- Genetics and Molecular Medicine Unit, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Loredana Cavalli
- Department of Internal Medicine, Endocrinology Unit, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Department of Internal Medicine, Endocrinology Unit, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
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