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Foxworthy B, Dai C, Davis EC, Xavier AC, Brackett J, Dickens D, Kahn A, Martinez I, Sharma A, Schwalm C, Foley J, Wilkes J, Bhatia S, Levine JM, Johnston EE, Wolfson JA. COVID-19 infection in children, adolescents, and young adults with Down syndrome and hematologic malignancies. Pediatr Blood Cancer 2024; 71:e31082. [PMID: 38804869 DOI: 10.1002/pbc.31082] [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: 02/08/2024] [Revised: 04/15/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Children, adolescents, and young adults (CAYAs) with Down syndrome (DS) and hematologic malignancies are particularly vulnerable to infections and related complications. There are limited data regarding COVID-19 infections in this group. We aimed to understand the clinical course of COVID-19 in this population. METHODS This observational study leverages the de-identified clinical and sociodemographic data captured by the Pediatric Oncology COVID-19 Case Report Registry (POCC) regarding CAYAs with cancer and COVID-19. We evaluated CAYAs (≤21 years at COVID-19 infection) with hematologic malignancies and COVID-19 reported from April 1, 2020 to May 2, 2023, comparing those with and without DS. Using multivariable logistic regression, we examined rates of hospitalization, intensive care unit (ICU) admission, respiratory support, and changes in cancer-directed therapy. RESULTS Among 1408 CAYAs with hematologic malignancies, 55 had DS (CAYA-DS). CAYA-DS had higher rates of hospitalization, ICU admission, and respiratory support (p < .001) than CAYAs without DS. Similarly, multivariable analyses found higher odds of hospitalization (odds ratio [OR] = 2.8, 95% confidence interval [CI]: 1.5-5.1), ICU admission (OR = 4.2, 95% CI: 1.9-9.1), and need for respiratory support (OR = 4.2, 95% CI: 2.0-8.8) among CAYA-DS. Modifications to cancer-directed therapy were more common among CAYA-DS when related to neutropenia (p = .001), but not when unrelated to neutropenia (p = .88); CAYA-DS did not have higher odds of changes to cancer-directed therapy (OR = 1.20, 95% CI: 0.7-2.1). CONCLUSIONS We identify CAYA-DS with hematologic malignancies as a vulnerable subpopulation at greater risk for severe COVID-19 infection. This can inform conversations with patients and families regarding therapeutic and preventive measures, as well as the risks and benefits of modifying chemotherapy in the setting of COVID-19.
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Affiliation(s)
- Blake Foxworthy
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chen Dai
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Ana C Xavier
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - David Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Alissa Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Bronson Methodist Hospital, Kalamazoo, Michigan, USA
| | - Jessica Foley
- Pediatric Hematology-Oncology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Jennifer Wilkes
- Department of Pediatrics, Division of Cancer and Blood Disorders, University of Washington, Seattle, Washington, USA
| | - Smita Bhatia
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer M Levine
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Emily E Johnston
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie A Wolfson
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kozlov G, Franceschi C, Vedunova M. Intricacies of aging and Down syndrome. Neurosci Biobehav Rev 2024; 164:105794. [PMID: 38971514 DOI: 10.1016/j.neubiorev.2024.105794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
Down syndrome is the most frequently occurring genetic condition, with a substantial escalation in risk associated with advanced maternal age. The syndrome is characterized by a diverse range of phenotypes, affecting to some extent all levels of organization, and its progeroid nature - early manifestation of aspects of the senile phenotype. Despite extensive investigations, many aspects and mechanisms of the disease remain unexplored. The current review aims to provide an overview of the main causes and manifestations of Down syndrome, while also examining the phenomenon of accelerated aging and exploring potential therapeutic strategies.
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Affiliation(s)
- G Kozlov
- Institute of Biology and Biomedicine, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Gagarin ave., 23, 603022, Russia
| | - C Franceschi
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Gagarin ave., 23, 603022, Russia
| | - M Vedunova
- Institute of Biology and Biomedicine, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Gagarin ave., 23, 603022, Russia; Prokhorov General Physics Institute of the Russian Academy of Sciences, 38 Vavilov str., 119991 Moscow, Russia.
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Becker JE, Shebl FM, Losina E, Wilson A, Levison JH, Donelan K, Fung V, Trieu H, Panella C, Qian Y, Kazemian P, Bird B, Skotko BG, Bartels S, Freedberg KA. Using simulation modeling to inform intervention and implementation selection in a rapid stakeholder-engaged hybrid effectiveness-implementation randomized trial. Implement Sci Commun 2024; 5:70. [PMID: 38915130 PMCID: PMC11194878 DOI: 10.1186/s43058-024-00593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/03/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Implementation research generally assumes established evidence-based practices and prior piloting of implementation strategies, which may not be feasible during a public health emergency. We describe the use of a simulation model of the effectiveness of COVID-19 mitigation strategies to inform a stakeholder-engaged process of rapidly designing a tailored intervention and implementation strategy for individuals with serious mental illness (SMI) and intellectual/developmental disabilities (ID/DD) in group homes in a hybrid effectiveness-implementation randomized trial. METHODS We used a validated dynamic microsimulation model of COVID-19 transmission and disease in late 2020/early 2021 to determine the most effective strategies to mitigate infections among Massachusetts group home staff and residents. Model inputs were informed by data from stakeholders, public records, and published literature. We assessed different prevention strategies, iterated over time with input from multidisciplinary stakeholders and pandemic evolution, including varying symptom screening, testing frequency, isolation, contact-time, use of personal protective equipment, and vaccination. Model outcomes included new infections in group home residents, new infections in group home staff, and resident hospital days. Sensitivity analyses were performed to account for parameter uncertainty. Results of the simulations informed a stakeholder-engaged process to select components of a tailored best practice intervention and implementation strategy. RESULTS The largest projected decrease in infections was with initial vaccination, with minimal benefit for additional routine testing. The initial level of actual vaccination in the group homes was estimated to reduce resident infections by 72.4% and staff infections by 55.9% over the 90-day time horizon. Increasing resident and staff vaccination uptake to a target goal of 90% further decreased resident infections by 45.2% and staff infections by 51.3%. Subsequent simulated removal of masking led to a 6.5% increase in infections among residents and 3.2% among staff. The simulation model results were presented to multidisciplinary stakeholders and policymakers to inform the "Tailored Best Practice" package for the hybrid effectiveness-implementation trial. CONCLUSIONS Vaccination and decreasing vaccine hesitancy among staff were predicted to have the greatest impact in mitigating COVID-19 risk in vulnerable populations of group home residents and staff. Simulation modeling was effective in rapidly informing the selection of the prevention and implementation strategy in a hybrid effectiveness-implementation trial. Future implementation may benefit from this approach when rapid deployment is necessary in the absence of data on tailored interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT04726371.
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Affiliation(s)
- Jessica E Becker
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, NYU Langone Health, One Park Avenue, Seventh Floor, New York, NY, 10016, USA.
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elena Losina
- Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Anna Wilson
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Julie H Levison
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Vicki Fung
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Hao Trieu
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Panella
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Yiqi Qian
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Pooyan Kazemian
- Department of Operations, Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA
| | - Bruce Bird
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Brian G Skotko
- Harvard Medical School, Boston, MA, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen Bartels
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Shaker MR, Slonchak A, Al-Mhanawi B, Morrison SD, Sng JDJ, Cooper-White J, Khromykh AA, Wolvetang EJ. Choroid plexus defects in Down syndrome brain organoids enhance neurotropism of SARS-CoV-2. SCIENCE ADVANCES 2024; 10:eadj4735. [PMID: 38838150 DOI: 10.1126/sciadv.adj4735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
Why individuals with Down syndrome (DS) are more susceptible to SARS-CoV-2-induced neuropathology remains elusive. Choroid plexus (ChP) plays critical roles in barrier function and immune response modulation and expresses the ACE2 receptor and the chromosome 21-encoded TMPRSS2 protease, suggesting its substantial role in establishing SARS-CoV-2 infection in the brain. To explore this, we established brain organoids from DS and isogenic euploid iPSC that consist of a core of functional cortical neurons surrounded by a functional ChP-like epithelium (ChPCOs). DS-ChPCOs recapitulated abnormal DS cortical development and revealed defects in ciliogenesis and epithelial cell polarity in ChP-like epithelium. We then demonstrated that the ChP-like epithelium facilitates infection and replication of SARS-CoV-2 in cortical neurons and that this is increased in DS. Inhibiting TMPRSS2 and furin activity reduced viral replication in DS-ChPCOs to euploid levels. This model enables dissection of the role of ChP in neurotropic virus infection and euploid forebrain development and permits screening of therapeutics for SARS-CoV-2-induced neuropathogenesis.
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Affiliation(s)
- Mohammed R Shaker
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
- UQ Centre in Stem Cell Engineering and Regenerative Engineering (UQ StemCARE), The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Andrii Slonchak
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Bahaa Al-Mhanawi
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Sean D Morrison
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Julian D J Sng
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Justin Cooper-White
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
- UQ Centre in Stem Cell Engineering and Regenerative Engineering (UQ StemCARE), The University of Queensland, Brisbane, Queensland 4072, Australia
- School of Chemical Engineering, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Alexander A Khromykh
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Queensland 4072, Australia
- GVN Centre of Excellence, Australian Infectious Diseases Research Centre, Brisbane, Queensland, Australia
| | - Ernst J Wolvetang
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
- UQ Centre in Stem Cell Engineering and Regenerative Engineering (UQ StemCARE), The University of Queensland, Brisbane, Queensland 4072, Australia
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Ramacieri G, Locatelli C, Semprini M, Pelleri MC, Caracausi M, Piovesan A, Cicilloni M, Vigna M, Vitale L, Sperti G, Corvaglia LT, Pirazzoli GL, Strippoli P, Catapano F, Vione B, Antonaros F. Zinc metabolism and its role in immunity status in subjects with trisomy 21: chromosomal dosage effect. Front Immunol 2024; 15:1362501. [PMID: 38694501 PMCID: PMC11061464 DOI: 10.3389/fimmu.2024.1362501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Trisomy 21 (T21), which causes Down syndrome (DS), is the most common chromosomal aneuploidy in humankind and includes different clinical comorbidities, among which the alteration of the immune system has a heavy impact on patient's lives. A molecule with an important role in immune response is zinc and it is known that its concentration is significantly lower in children with T21. Different hypotheses were made about this metabolic alteration and one of the reasons might be the overexpression of superoxide dismutase 1 (SOD1) gene, as zinc is part of the SOD1 active enzymatic center. Methods The aim of our work is to explore if there is a linear correlation between zinc level and immune cell levels measured in a total of 217 blood samples from subjects with T21. Furthermore, transcriptome map analyses were performed using Transcriptome Mapper (TRAM) software to investigate whether a difference in gene expression is detectable between subjects with T21 and euploid control group in tissues and cells involved in the immune response such as lymphoblastoid cells, thymus and white blood cells. Results Our results have confirmed the literature data stating that the blood zinc level in subjects with T21 is lower compared to the general population; in addition, we report that the T21/control zinc concentration ratio is 2:3, consistent with a chromosomal dosage effect due to the presence of three copies of chromosome 21. The transcriptome map analyses showed an alteration of some gene's expression which might explain low levels of zinc in the blood. Discussion Our data suggest that zinc level is not associated with the levels of immunity cells or proteins analyzed themselves and rather the main role of this ion might be played in altering immune cell function.
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Affiliation(s)
- Giuseppe Ramacieri
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Specialist School of Child Neuropsychiatry - University of Bologna, Bologna, Italy
| | - Chiara Locatelli
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Michela Semprini
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Maria Chiara Pelleri
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Maria Caracausi
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Allison Piovesan
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Michela Cicilloni
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Marco Vigna
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lorenza Vitale
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giacomo Sperti
- Speciality School of Paediatrics - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luigi Tommaso Corvaglia
- Neonatology Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | | | - Pierluigi Strippoli
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesca Catapano
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Beatrice Vione
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesca Antonaros
- Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Colvin KL, Wolter-Warmerdam K, Hickey F, Yeager ME. Altered peripheral blood leukocyte subpopulations, function, and gene expression in children with Down syndrome: implications for respiratory tract infection. Eur J Med Genet 2024; 68:104922. [PMID: 38325643 DOI: 10.1016/j.ejmg.2024.104922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/12/2023] [Accepted: 02/04/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES We tested the hypothesis that aberrant expression of Hsa21-encoded interferon genes in peripheral blood immune cells would correlate to immune cell dysfunction in children with Down syndrome (DS). STUDY DESIGN We performed flow cytometry to quantify peripheral blood leukocyte subtypes and measured their ability to migrate and phagocytose. In matched samples, we measured gene expression levels for constituents of interferon signaling pathways. We screened 49 children, of which 29 were individuals with DS. RESULTS We show that the percentages of two peripheral blood myeloid cell subtypes (alternatively-activated macrophages and low-density granulocytes) in children with DS differed significantly from typical children, children with DS circulate a very different pattern of cytokines vs. typical individuals, and higher expression levels of type III interferon receptor Interleukin-10Rb in individuals with DS correlated with reduced migratory and phagocytic capacity of macrophages. CONCLUSIONS Increased susceptibility to severe and chronic infection in children with DS may result from inappropriate numbers and subtypes of immune cells that are phenotypically and functionally altered due to trisomy 21 associated interferonopathy.
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Affiliation(s)
- Kelley L Colvin
- Department of Bioengineering, University of Colorado Denver, Aurora, USA; Linda Crnic Institute for Down Syndrome, University of Colorado Denver, Aurora, USA
| | | | - Francis Hickey
- Anna and John J. Sie Center for Down Syndrome, Children's Hospital Colorado, Aurora, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA
| | - Michael E Yeager
- Department of Bioengineering, University of Colorado Denver, Aurora, USA; Linda Crnic Institute for Down Syndrome, University of Colorado Denver, Aurora, USA.
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7
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Halder P, Pal U, Ganguly A, Ghosh P, Malakar MG, Guha N, Gami C, Ghosh S. Impact of COVID-19 Pandemic on Psychosocial Attributes of Indian Families Bearing Child With Down Syndrome: A Survey by Trisomy 21 Research Society (T21RS), Indian Chapter. Asia Pac J Public Health 2024:10105395241240954. [PMID: 38519483 DOI: 10.1177/10105395241240954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Affiliation(s)
- Pinku Halder
- Cytogenetics and Genomics and Down Syndrome Research Unit, Department of Zoology, University of Calcutta, Kolkata, India
- ICM Institute for Brain and Spinal Cord, Hôpital Pitié, Paris, France
| | - Upamanyu Pal
- Cytogenetics and Genomics and Down Syndrome Research Unit, Department of Zoology, University of Calcutta, Kolkata, India
| | - Agnish Ganguly
- Cytogenetics and Genomics and Down Syndrome Research Unit, Department of Zoology, University of Calcutta, Kolkata, India
| | - Papiya Ghosh
- Department of Zoology, Bijoykrishna Girls' College, Howrah, India
| | | | - Nitasha Guha
- Central Kolkata Welfare Association for Persons with Down Syndrome, Kolkata, India
| | - Chaitali Gami
- Central Kolkata Welfare Association for Persons with Down Syndrome, Kolkata, India
| | - Sujay Ghosh
- Cytogenetics and Genomics and Down Syndrome Research Unit, Department of Zoology, University of Calcutta, Kolkata, India
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Jett J, Fossi A, Blonsky H, Ross W, Townsend S, Stephens MM, Chicoine B, Santoro SL. Retrospective review of the code status of individuals with Down syndrome during the COVID-19 era. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32080. [PMID: 38087874 DOI: 10.1002/ajmg.c.32080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 03/13/2024]
Abstract
Code status is a label in the medical record indicating a patient's wishes for end-of-life (EOL) care in the event of a cardiopulmonary arrest. People with intellectual disabilities had a higher risk of both diagnosis and mortality from coronavirus infections (COVID-19) than the general population. Clinicians and disability advocates raised concerns that bias, diagnostic overshadowing, and ableism could impact the allocation of code status and treatment options, for patients with intellectual disabilities, including Down syndrome (DS). To study this, retrospective claims data from the Vizient® Clinical Data Base (used with permission of Vizient, all rights reserved.) of inpatient encounters with pneumonia (PNA) and/or COVID-19 at 825 hospitals from January 2019 to June 2022 were included. Claims data was analyzed for risk of mortality and risk of "Do Not Resuscitate" (DNR) status upon admission, considering patient age, admission source, Elixhauser comorbidities (excluding behavioral health), and DS. Logistic regression models with backward selection were created. In total, 1,739,549 inpatient encounters with diagnoses of COVID-19, PNA, or both were included. After controlling for other risk factors, a person with a diagnosis of DS and a diagnosis of COVID-19 PNA had 6.321 odds ratio of having a DNR status ordered at admission to the hospital compared with those with COVID-19 PNA without DS. The diagnosis of DS had the strongest association with DNR status after controlling for other risk factors. Open and honest discussions among healthcare professionals to foster equitable approaches to EOL care and code status are needed.
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Affiliation(s)
- Jennifer Jett
- Department of Palliative Care, Intermountain Health, Salt Lake City, Utah, USA
| | - Alexander Fossi
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Wendy Ross
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sabra Townsend
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary M Stephens
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Center for Special Healthcare Needs, Christiana Care, Christiana, Delaware, USA
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Department of Family Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Stephanie L Santoro
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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De La Garza E, Scott A, Hillerstrom H, Hendrix J, Rubenstein E. Caregivers' concerns and supports needed to care for adults with Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32041. [PMID: 37072379 PMCID: PMC10583264 DOI: 10.1002/ajmg.c.32041] [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: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
Research regarding caregivers for individuals with Down syndrome mainly focuses on outcomes for the pediatric population and not on the experience of caregivers themselves. Our objective was to understand caregiver-reported experiences and concerns for themselves and the individual they care for through a survey of caregivers of adults with Down syndrome. We conducted a survey of N = 438 caregivers of adults with Down syndrome and asked about the perspectives of the respondents surrounding caregiving and demographics. The most common concerns among caregivers were planning for future needs (72.1%) and what happens when they (the caregiver) are gone (68.3%). Concerns they had for the individual they cared for were employment (63.2%) and friendships/relationships (63.2%). We found no significant difference in responses based on caregiver education level. Our survey identified six themes for the feedback about what clinical and research professionals should know to better serve individuals with Down syndrome, their families, and those who support them. Many caregivers discussed topics including healthcare, coordination, competence, and ability. More efforts for research into the caregiver experience for adults with Down syndrome are needed.
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Affiliation(s)
- Erica De La Garza
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ashley Scott
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - James Hendrix
- LuMind IDSC, Eli Lily, Burlington, Massachusetts, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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10
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Escudero SC, Sepúlveda EM. Pragmatic competence in people with dual diagnosis: down syndrome and autism spectrum disorder. BMC Psychol 2024; 12:74. [PMID: 38360760 PMCID: PMC10870447 DOI: 10.1186/s40359-023-01508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/23/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Pragmatics is an area that can be affected in a wide variety of disorders. In this sense, Syndromic Autism is defined as a disorder in which a causal link is established between an associated syndrome and Autism Spectrum Disorder (ASD). Likewise, Down Syndrome (DS) is one of the main genetically based syndromes in which ASD is described as one of its possible manifestations. In this direction, people with DS are described as social beings whereas in ASD there seems to be a specific alteration of this domain. METHODS In this study, pragmatic performance was analysed in a sample of 72 participants, where comparisons were made between the scores obtained by children with ASD (n = 24), with DS (n = 24) and with DS + ASD (n = 24). RESULTS The Social Communication Questionnaire (SCQ), the Block Objective and Criterial Language Battery (BLOC-SR) and the Neuropsychology subtest (NEPSY-II) aimed at Theory of Mind (ToM) identified significant differences between the groups. However, two-to-two comparisons reported no significant differences between DS and DS + ASD. CONCLUSIONS Although several studies report differences between the three proposed groups, our data seem to suggest that ASD symptomatology in DS is associated with Intellectual Developmental Disorder (IDD). However, the lack of solid scientific evidence regarding comorbid diagnosis makes further research along these lines indispensable. TRIAL REGISTRATION This study was approved by the Ethics Committee for Social Research at UCLM with reference CEIS-704,511-L8M4.
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Affiliation(s)
- Sara Cortés Escudero
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Esther Moraleda Sepúlveda
- Department of Psychology, Faculty of Pychology, University Complutense. Campus de Somosaguas, 28223, Pozuelo de Alarcón. Madrid, Spain.
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11
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Sánchez Moreno B, Adán-Lirola L, Rubio-Serrano J, Real de Asúa D. Causes of mortality among adults with Down syndrome before and after the COVID-19 pandemic in Spain. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:128-139. [PMID: 37779228 DOI: 10.1111/jir.13096] [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: 05/18/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The life expectancy of people with Down syndrome (DS) is limited by Alzheimer's disease (AD)-related deaths, mainly due to respiratory infections. The emergence of the COVID-19 pandemic could have changed known, past trends in mortality in this population. We analysed the differences in causes of mortality between individuals with DS deceased before and after the onset of the pandemic. METHOD This is a cross-sectional study of adults with DS recruited at a tertiary, university outpatient clinic in Madrid, Spain. Demographic and clinical data were retrospectively collected from their medical records, including information on their deaths, if any. RESULTS Five hundred seventy-two adults were included in the study, and 67 (11.7%) died. The main cause of death was respiratory infections, which occurred in 36 participants [9 (45.0%) before, and 27 (58.7%) after the appearance of COVID-19]. No significant differences were found in the determinants of pre-pandemic and post-pandemic death after adjusting for age and AD, except for an association between the use of psychotropic medication and death in the post-pandemic period (odds ratio: 2.24; 95% confidence interval: 1.04-4.82). Vaccination against COVID-19 showed a marked protective effect against mortality (odds ratio: 0.0002; 95% confidence interval: 6.7e10-6 to 0.004). CONCLUSIONS The appearance of COVID-19 has not impacted the overall trend of increase in mean age of death of adults with DS in our milieu, probably thanks to the very important protective effect of vaccination, which supports prioritising people with DS in future immunisation campaigns. The association between psychotropic medication use and mortality requires further exploration.
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Affiliation(s)
- Beatriz Sánchez Moreno
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Adán-Lirola
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Javier Rubio-Serrano
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Diego Real de Asúa
- Department of Internal Medicine, Adult Down Syndrome Unit, Hospital Universitario de La Princesa, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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12
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Zhang X, Chen S, Ma H, Sun T, Cui X, Huo P, Man B, Yang C. Asymmetric Schottky Barrier-Generated MoS 2/WTe 2 FET Biosensor Based on a Rectified Signal. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:226. [PMID: 38276744 PMCID: PMC10820193 DOI: 10.3390/nano14020226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
Field-effect transistor (FET) biosensors can be used to measure the charge information carried by biomolecules. However, insurmountable hysteresis in the long-term and large-range transfer characteristic curve exists and affects the measurements. Noise signal, caused by the interference coefficient of external factors, may destroy the quantitative analysis of trace targets in complex biological systems. In this report, a "rectified signal" in the output characteristic curve, instead of the "absolute value signal" in the transfer characteristic curve, is obtained and analyzed to solve these problems. The proposed asymmetric Schottky barrier-generated MoS2/WTe2 FET biosensor achieved a 105 rectified signal, sufficient reliability and stability (maintained for 60 days), ultra-sensitive detection (10 aM) of the Down syndrome-related DYRK1A gene, and excellent specificity in base recognition. This biosensor with a response range of 10 aM-100 pM has significant application potential in the screening and rapid diagnosis of Down syndrome.
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Affiliation(s)
- Xinhao Zhang
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
| | - Shuo Chen
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
| | - Heqi Ma
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
| | - Tianyu Sun
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
| | - Xiangyong Cui
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
| | - Panpan Huo
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
| | - Baoyuan Man
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
| | - Cheng Yang
- School of Physics and Electronics, Shandong Normal University, Jinan 250014, China; (X.Z.); (S.C.); (H.M.); (T.S.); (X.C.); (P.H.)
- Shandong Provincial Engineering and Technical Center of Light Manipulations, Shandong Normal University, Jinan 250014, China
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Colvin KL, Nguyen K, Boncella KL, Goodman DM, Elliott RJ, Harral JW, Bilodeaux J, Smith BJ, Yeager ME. Lung and Heart Biology of the Dp16 Mouse Model of down Syndrome: Implications for Studying Cardiopulmonary Disease. Genes (Basel) 2023; 14:1819. [PMID: 37761959 PMCID: PMC10530394 DOI: 10.3390/genes14091819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: We sought to investigate the baseline lung and heart biology of the Dp16 mouse model of Down syndrome (DS) as a prelude to the investigation of recurrent respiratory tract infection. (2) Methods: In controls vs. Dp16 mice, we compared peripheral blood cell and plasma analytes. We examined baseline gene expression in lungs and hearts for key parameters related to susceptibility of lung infection. We investigated lung and heart protein expression and performed lung morphometry. Finally, and for the first time each in a model of DS, we performed pulmonary function testing and a hemodynamic assessment of cardiac function. (3) Results: Dp16 mice circulate unique blood plasma cytokines and chemokines. Dp16 mouse lungs over-express the mRNA of triplicated genes, but not necessarily corresponding proteins. We found a sex-specific decrease in the protein expression of interferon α receptors, yet an increased signal transducer and activator of transcription (STAT)-3 and phospho-STAT3. Platelet-activating factor receptor protein was not elevated in Dp16 mice. The lungs of Dp16 mice showed increased stiffness and mean linear intercept and contained bronchus-associated lymphoid tissue. The heart ventricles of Dp16 mice displayed hypotonicity. Finally, Dp16 mice required more ketamine to achieve an anesthetized state. (4) Conclusions: The Dp16 mouse model of DS displays key aspects of lung heart biology akin to people with DS. As such, it has the potential to be an extremely valuable model of recurrent severe respiratory tract infection in DS.
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Affiliation(s)
- Kelley L. Colvin
- Linda Crnic Institute for Down Syndrome, University of Colorado, Aurora, CO 80045, USA (D.M.G.)
| | - Kathleen Nguyen
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA; (K.N.); (K.L.B.); (R.J.E.); (J.B.); (B.J.S.)
| | - Katie L. Boncella
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA; (K.N.); (K.L.B.); (R.J.E.); (J.B.); (B.J.S.)
| | - Desiree M. Goodman
- Linda Crnic Institute for Down Syndrome, University of Colorado, Aurora, CO 80045, USA (D.M.G.)
| | - Robert J. Elliott
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA; (K.N.); (K.L.B.); (R.J.E.); (J.B.); (B.J.S.)
| | - Julie W. Harral
- Department of Medicine, University of Colorado, Aurora, CO 80045, USA;
| | - Jill Bilodeaux
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA; (K.N.); (K.L.B.); (R.J.E.); (J.B.); (B.J.S.)
| | - Bradford J. Smith
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA; (K.N.); (K.L.B.); (R.J.E.); (J.B.); (B.J.S.)
- Section of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Michael E. Yeager
- Linda Crnic Institute for Down Syndrome, University of Colorado, Aurora, CO 80045, USA (D.M.G.)
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA; (K.N.); (K.L.B.); (R.J.E.); (J.B.); (B.J.S.)
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Kuper H, Smythe T. Are people with disabilities at higher risk of COVID-19-related mortality?: a systematic review and meta-analysis. Public Health 2023; 222:115-124. [PMID: 37541064 PMCID: PMC10308224 DOI: 10.1016/j.puhe.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Accepted: 06/23/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES To undertake a systematic review and meta-analysis to estimate the relative risk of COVID-19-related mortality among people with disabilities compared to people without disabilities. STUDY DESIGN Systematic review and meta-analysis. METHODS We systematically searched four databases from March 1, 2020, to August 15, 2022. We included prospective studies with a baseline assessment of disability and a longitudinal assessment of the COVID-19-related mortality. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We undertook random-effects meta-analyses to calculate pooled adjusted hazard ratios for COVID-19-related mortality for people with disabilities, also disaggregated by disability type and study setting. RESULTS We identified 2596 articles throughout the electronic data search, and 56 studies were included in the review. Most (73%) had a moderate risk of bias. The pooled adjusted effect estimate for COVID-19-related mortality in people with disabilities compared to those without was 2.7 (95% confidence interval [CI]: 2.4-3.2). Heterogeneity between the studies was high (τ2 = 0.28, I2 = 97%). Effect estimates were highest for population-based samples (3.3, 95% CI: 2.7-3.9), compared to hospital settings (2.1, 95% CI: 1.7-2.7). Risk was not elevated among people with disabilities in care home settings (1.6, 95% CI: 0.7-3.5). Disaggregation by disability type showed that people with intellectual disabilities were at the highest relative risk of COVID-19 mortality. DISCUSSION Risk of COVID-19 mortality is elevated among people with disabilities, especially people with intellectual disabilities. Efforts are needed to collect better routine data on disability and to include people with disabilities in the pandemic response for COVID-19.
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Affiliation(s)
- H Kuper
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - T Smythe
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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15
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da Silva MVG, Pereira LRG, de Avó LRDS, Germano CMR, Melo DG. Enhancing understanding of SARS-CoV-2 infection among individuals with Down syndrome: An integrative review. SAO PAULO MED J 2023; 142:e2023015. [PMID: 37610949 PMCID: PMC10445757 DOI: 10.1590/1516-3180.2023.0015.r1.230523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/14/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Down syndrome (DS) is a non-rare genetic condition that affects approximately 1 in every 800 live births worldwide. Further, it is associated with comorbidities, anatomical alterations of the respiratory tract, and immunological dysfunctions that make individuals more susceptible to respiratory infections. OBJECTIVE To systematize the current scientific knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among individuals with DS. DESIGN AND SETTING This integrative review was conducted at the Universidade Federal de São Carlos, São Paulo, Brazil. METHODS This review was conducted in the following databases: the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), PubMed, and Web of Science, using MeSH descriptors. The search included English or Portuguese studies published between January 1, 2020, and October 14, 2022. RESULTS A total of 55 articles from 24 countries were selected, comprising 21 case-control or cohort studies, 23 case reports or series, and 11 narrative reviews or opinion studies. The articles were grouped into five categories: previous comorbidities, coronavirus disease 2019 (COVID-19) clinical features and evolution, cytokine storm and interleukins, living in institutions as a risk factor, and behavioral actions as a protective factor against SARS-CoV-2 infection. CONCLUSION Individuals with DS are more susceptible to COVID-19 infection due to variables such as previous comorbidities, immunological factors, and their habitable environments. These aspects confer a higher risk of infection and an unfavorable clinical course. The precise pathways involved in the pathophysiology of COVID-19 in individuals with DS are not clear, thus requiring further studies. SYSTEMATIC REVIEW REGISTRATION The Open Science Framework registered the research protocol (https://osf.io/jyb97/).
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Affiliation(s)
- Maria Vitoria Gomes da Silva
- Medical Undergraduate Student, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | | | - Lucimar Retto da Silva de Avó
- MD, PhD. Associate Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Carla Maria Ramos Germano
- MD, PhD. Associate Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
| | - Débora Gusmão Melo
- MD, PhD. Full Professor, Department of Medicine, Universidade
Federal de São Carlos (UFSCar), São Carlos (SP), Brazil
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Huang YN, Huang JY, Wang CH, Su PH. Long-Term Non-Congenital Cardiac and Renal Complications in Down Syndrome: A Study of 32,936 Patients. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1351. [PMID: 37628350 PMCID: PMC10453106 DOI: 10.3390/children10081351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Individuals with Down syndrome are at a higher risk of cardiac, renal, and other health issues due to a complex disease physiology. However, few data exist on long-term disease risks to guide prevention and care. We aimed to determine the 10-year incidence of cardiac, renal, and urinary tract complications in Down syndrome versus matched controls. METHODS This retrospective cohort study utilized a large collaborative database. We identified 32,444 patients with Down syndrome and matched controls, excluding those with pre-follow-up target events. Covariates included demographics, lifestyle factors, and comorbidities. Outcomes were ischemic heart disease, hypertension, hypothyroidism, epilepsy, urinary tract infections and chronic kidney disease. We calculated unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox regression and plotted Kaplan-Meier survival curves. FINDINGS Over 10 years, Down syndrome patients showed a 3.7-fold higher ischemic heart disease risk (95% CI: 3.0-4.6) and a 1.6-fold higher hypertension risk (95% CI: 1.4-1.8) versus controls. Hypothyroidism (HR = 2.0; 95% CI: 1.7-2.4), epilepsy (HR = 4.5; 95% CI: 3.5-5.8), and urinary tract infection (HR = 3.9; 95% CI: 3.4-4.6) risks were also higher. Chronic kidney disease risk was 2.7-fold greater (95% CI: 2.1-3.5). Survival analysis confirmed a significantly higher incidence of all outcomes in Down syndrome (p < 0.0001). INTERPRETATION This large study found major health challenges in Down syndrome, with risks 3- to 5-fold higher for chronic conditions versus matched controls over 10 years. Though survival remains high with proper care, focusing resources on the prevention and management of complications in this high-risk group can optimize well-being across the lifespan. Future research accounting for limitations here would provide definitive estimates of disease risk in Down syndrome to guide targeted health strategies.
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Affiliation(s)
- Yu-Nan Huang
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402306, Taiwan (C.-H.W.)
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Jing-Yang Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Chung-Hsing Wang
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402306, Taiwan (C.-H.W.)
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
- Division of Genetics and Metabolism, Children’s Hospital of China Medical University, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404327, Taiwan
| | - Pen-Hua Su
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402306, Taiwan (C.-H.W.)
- School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan
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Santoro SL, Baker S, Blake JM, Cabrera MJ, Caughman K, Chung J, Cullen S, Gallagher M, Haugen K, Hoke-Chandler R, Krell K, Maina J, McLuckie D, Merker VL, Michael C, O’Neill K, Peña A, Pless A, Royal D, Slape M, Spinazzi NA, Torres A, Torres CG, Skotko BG. Views on the impact of the COVID-19 pandemic on health in people with Down syndrome from diverse backgrounds. Am J Med Genet A 2023; 191:2045-2056. [PMID: 37264986 PMCID: PMC10524618 DOI: 10.1002/ajmg.a.63233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
Down syndrome (DS) has a unique medical and psychological profile. To date, few studies have asked individuals with DS about their views of health, and fewer have explored the impact of COVID-19 on the health of individuals with DS and their families. We used a mixed methods approach including two studies on the health of individuals with DS and their parents conducted during the COVID-19 pandemic: (1) eight virtual focus groups, comprised of 20 parents and 8 individuals with DS to obtain participants' views of health, and (2) a 20-item questionnaire on health care experience of patients with DS who are African American or come from primarily Spanish-speaking homes. Focus group transcripts were coded using a hybrid inductive/deductive framework and thematically analyzed using the Framework Method. This questionnaire included questions regarding the impact of COVID-19 on caregivers and their loved ones with DS; responses to these questions were summarized using descriptive statistics. Individuals with DS discussed the impact of the COVID-19 pandemic on their physical and social health including masking, online learning, and online communication with friends and family. Parents of individuals with DS discussed how the COVID-19 pandemic negatively impacted their child's physical, social, and mental health, as a result of virtual schooling and decreased socialization. There were unexpected positives of the pandemic such as improved hygiene and eased scheduling with telehealth visits. Caregivers noted COVID-19 impacted their own anxiety, employment, and other domains that have potential ripple effects on the health of their children. The COVID-19 pandemic had a pervasive impact on the mental health and wellness of caregivers as well as the physical, social, and mental health of individuals with DS.
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Affiliation(s)
- Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Jasmine M. Blake
- Departments of Internal Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria J. Cabrera
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Jeanhee Chung
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA
| | - Sarah Cullen
- Massachusetts Down Syndrome Congress, Burlington, MA
| | | | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Vanessa L. Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Carie Michael
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Kate O’Neill
- LuMind IDSC Down Syndrome Foundation, Burlington, MA
| | - Angeles Peña
- Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert Pless
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | | | - Noemi Alice Spinazzi
- Division of Primary Care, Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | | | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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Rubenstein E, Kyprianou N, Kumar PS, Kriova AM, Sokoloff A, Hillerstrom H, Hendrix J. Healthcare and Behavior Changes for Adults With Down Syndrome 1-Year Into COVID-19. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:273-281. [PMID: 37470258 PMCID: PMC10512186 DOI: 10.1352/1944-7558-128.4.273] [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: 02/08/2022] [Accepted: 08/02/2022] [Indexed: 07/21/2023]
Abstract
Individuals with Down syndrome (DS) have been disproportionately harmed by the COVID-19 pandemic and may have been more likely to have sacrificed opportunity and activity to avoid potential exposures. Our objective was to describe the experience one to one and half years into the COVID-19 pandemic for adults with DS, as reported by their caregivers in an online survey conducted between April 2021 and September of 2021. In our sample of 438 adults with DS, caregivers reported that adults with DS lost activities, struggled with employment, had negative behavioral changes, lost skills, and developed more mental health conditions. For adults with DS, one in five caregivers reported less healthcare usage, one in four reported delayed routine care, and 86.5% reported lost activities. As the pandemic continues, targeted support for adults with DS is needed to prevent further skill loss and mental health conditions.
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Affiliation(s)
- Eric Rubenstein
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Nichole Kyprianou
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Prisha Sujin Kumar
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Anna-Mariya Kriova
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | | | - Hampus Hillerstrom
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
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Galbraith MD, Rachubinski AL, Smith KP, Araya P, Waugh KA, Enriquez-Estrada B, Worek K, Granrath RE, Kinning KT, Paul Eduthan N, Ludwig MP, Hsieh EW, Sullivan KD, Espinosa JM. Multidimensional definition of the interferonopathy of Down syndrome and its response to JAK inhibition. SCIENCE ADVANCES 2023; 9:eadg6218. [PMID: 37379383 PMCID: PMC10306300 DOI: 10.1126/sciadv.adg6218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023]
Abstract
Individuals with Down syndrome (DS) display chronic hyperactivation of interferon signaling. However, the clinical impacts of interferon hyperactivity in DS are ill-defined. Here, we describe a multiomics investigation of interferon signaling in hundreds of individuals with DS. Using interferon scores derived from the whole blood transcriptome, we defined the proteomic, immune, metabolic, and clinical features associated with interferon hyperactivity in DS. Interferon hyperactivity associates with a distinct proinflammatory phenotype and dysregulation of major growth signaling and morphogenic pathways. Individuals with the highest interferon activity display the strongest remodeling of the peripheral immune system, including increased cytotoxic T cells, B cell depletion, and monocyte activation. Interferon hyperactivity accompanies key metabolic changes, most prominently dysregulated tryptophan catabolism. High interferon signaling stratifies a subpopulation with elevated rates of congenital heart disease and autoimmunity. Last, a longitudinal case study demonstrated that JAK inhibition normalizes interferon signatures with therapeutic benefit in DS. Together, these results justify the testing of immune-modulatory therapies in DS.
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Affiliation(s)
- Matthew D. Galbraith
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela L. Rachubinski
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Keith P. Smith
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Paula Araya
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine A. Waugh
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Belinda Enriquez-Estrada
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kayleigh Worek
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ross E. Granrath
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kohl T. Kinning
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Neetha Paul Eduthan
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael P. Ludwig
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elena W. Y. Hsieh
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, Division of Allergy/Immunology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly D. Sullivan
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, Section of Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joaquin M. Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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20
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Waugh KA, Minter R, Baxter J, Chi C, Galbraith MD, Tuttle KD, Eduthan NP, Kinning KT, Andrysik Z, Araya P, Dougherty H, Dunn LN, Ludwig M, Schade KA, Tracy D, Smith KP, Granrath RE, Busquet N, Khanal S, Anderson RD, Cox LL, Estrada BE, Rachubinski AL, Lyford HR, Britton EC, Fantauzzo KA, Orlicky DJ, Matsuda JL, Song K, Cox TC, Sullivan KD, Espinosa JM. Triplication of the interferon receptor locus contributes to hallmarks of Down syndrome in a mouse model. Nat Genet 2023; 55:1034-1047. [PMID: 37277650 PMCID: PMC10260402 DOI: 10.1038/s41588-023-01399-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/14/2023] [Indexed: 06/07/2023]
Abstract
Down syndrome (DS), the genetic condition caused by trisomy 21, is characterized by variable cognitive impairment, immune dysregulation, dysmorphogenesis and increased prevalence of diverse co-occurring conditions. The mechanisms by which trisomy 21 causes these effects remain largely unknown. We demonstrate that triplication of the interferon receptor (IFNR) gene cluster on chromosome 21 is necessary for multiple phenotypes in a mouse model of DS. Whole-blood transcriptome analysis demonstrated that IFNR overexpression associates with chronic interferon hyperactivity and inflammation in people with DS. To define the contribution of this locus to DS phenotypes, we used genome editing to correct its copy number in a mouse model of DS, which normalized antiviral responses, prevented heart malformations, ameliorated developmental delays, improved cognition and attenuated craniofacial anomalies. Triplication of the Ifnr locus modulates hallmarks of DS in mice, suggesting that trisomy 21 elicits an interferonopathy potentially amenable to therapeutic intervention.
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Affiliation(s)
- Katherine A Waugh
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ross Minter
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica Baxter
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Congwu Chi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Gates Center for Regenerative Medicine and Stem Cell Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- The Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew D Galbraith
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn D Tuttle
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Neetha P Eduthan
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kohl T Kinning
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Zdenek Andrysik
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Paula Araya
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hannah Dougherty
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren N Dunn
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, Section of Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Ludwig
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kyndal A Schade
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dayna Tracy
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Keith P Smith
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ross E Granrath
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicolas Busquet
- Animal Behavior Core, NeuroTechnology Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Santosh Khanal
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ryan D Anderson
- Department of Oral and Craniofacial Sciences, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Liza L Cox
- Department of Oral and Craniofacial Sciences, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Belinda Enriquez Estrada
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela L Rachubinski
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hannah R Lyford
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Eleanor C Britton
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine A Fantauzzo
- Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David J Orlicky
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer L Matsuda
- Department of Immunology and Genomic Medicine, National Jewish Health, Denver, CO, USA
| | - Kunhua Song
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Gates Center for Regenerative Medicine and Stem Cell Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- The Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Timothy C Cox
- Department of Oral and Craniofacial Sciences, University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kelly D Sullivan
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Pediatrics, Section of Developmental Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Joaquin M Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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21
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Strine MS, Cai WL, Wei J, Alfajaro MM, Filler RB, Biering SB, Sarnik S, Chow RD, Patil A, Cervantes KS, Collings CK, DeWeirdt PC, Hanna RE, Schofield K, Hulme C, Konermann S, Doench JG, Hsu PD, Kadoch C, Yan Q, Wilen CB. DYRK1A promotes viral entry of highly pathogenic human coronaviruses in a kinase-independent manner. PLoS Biol 2023; 21:e3002097. [PMID: 37310920 PMCID: PMC10263356 DOI: 10.1371/journal.pbio.3002097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/29/2023] [Indexed: 06/15/2023] Open
Abstract
Identifying host genes essential for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has the potential to reveal novel drug targets and further our understanding of Coronavirus Disease 2019 (COVID-19). We previously performed a genome-wide CRISPR/Cas9 screen to identify proviral host factors for highly pathogenic human coronaviruses. Few host factors were required by diverse coronaviruses across multiple cell types, but DYRK1A was one such exception. Although its role in coronavirus infection was previously undescribed, DYRK1A encodes Dual Specificity Tyrosine Phosphorylation Regulated Kinase 1A and is known to regulate cell proliferation and neuronal development. Here, we demonstrate that DYRK1A regulates ACE2 and DPP4 transcription independent of its catalytic kinase function to support SARS-CoV, SARS-CoV-2, and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) entry. We show that DYRK1A promotes DNA accessibility at the ACE2 promoter and a putative distal enhancer, facilitating transcription and gene expression. Finally, we validate that the proviral activity of DYRK1A is conserved across species using cells of nonhuman primate and human origin. In summary, we report that DYRK1A is a novel regulator of ACE2 and DPP4 expression that may dictate susceptibility to multiple highly pathogenic human coronaviruses.
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Affiliation(s)
- Madison S. Strine
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Wesley L. Cai
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Jin Wei
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei Province, China
| | - Mia Madel Alfajaro
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Renata B. Filler
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Scott B. Biering
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Sylvia Sarnik
- University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Ryan D. Chow
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Ajinkya Patil
- Department of Pediatric Oncology, Dana–Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Program in Virology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kasey S. Cervantes
- Department of Pediatric Oncology, Dana–Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Clayton K. Collings
- Department of Pediatric Oncology, Dana–Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Peter C. DeWeirdt
- Genetic Perturbation Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Ruth E. Hanna
- Genetic Perturbation Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Kevin Schofield
- Department of Chemistry and Biochemistry, College of Science, The University of Arizona, Tucson, Arizona, United States of America
| | - Christopher Hulme
- Department of Chemistry and Biochemistry, College of Science, The University of Arizona, Tucson, Arizona, United States of America
- Division of Drug Discovery and Development, Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson, Arizona, United States of America
| | - Silvana Konermann
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California, United States of America
- Arc Institute, Palo Alto, California, United States of America
| | - John G. Doench
- Genetic Perturbation Platform, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Patrick D. Hsu
- Arc Institute, Palo Alto, California, United States of America
- Department of Bioengineering, University of California, Berkeley, Berkeley, California, United States of America
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, California, United States of America
- Center for Computational Biology, University of California, Berkeley, California, United States of America
| | - Cigall Kadoch
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Pediatric Oncology, Dana–Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, United States of America
- Howard Hughes Medical Institute, Chevy Chase, Maryland, United States of America
| | - Qin Yan
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Craig B. Wilen
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, United States of America
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22
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Hamlett ED, Flores-Aguilar L, Handen B, Potier MC, Granholm AC, Sherman S, Puig V, Santoro JD, Carmona-Iragui M, Rebillat AS, Head E, Strydom A, Busciglio J. Innovating Therapies for Down Syndrome: An International Virtual Conference of the T21 Research Society. Mol Syndromol 2023; 14:89-100. [PMID: 37064334 PMCID: PMC10090974 DOI: 10.1159/000526021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Research focused on Down syndrome continued to gain momentum in the last several years and is advancing our understanding of how trisomy 21 (T21) modifies molecular and cellular processes. The Trisomy 21 Research Society (T21RS) is the premier scientific organization for researchers and clinicians studying Down syndrome. During the COVID pandemic, T21RS held its first virtual conference program, sponsored by the University of California at Irvine, on June 8-10, 2021 and brought together 342 scientists, families, and industry representatives from over 25 countries to share the latest discoveries on underlying cellular and molecular mechanisms of T21, cognitive and behavioral changes, and comorbidities associated with Down syndrome, including Alzheimer's disease and Regression Disorder. Presentations of 91 cutting-edge abstracts reflecting neuroscience, neurology, model systems, psychology, biomarkers, and molecular and pharmacological therapeutic approaches demonstrate the compelling interest and continuing advancement toward innovating biomarkers and therapies aimed at ameliorating health conditions associated with T21.
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Affiliation(s)
- Eric D. Hamlett
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisi Flores-Aguilar
- Department of Anatomy and Cell Biology, McGill University, Montreal, Québec, Canada
- Department of Pathology and Laboratory Medicine, University of California, Irvine, California, USA
| | - Benjamin Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Ann-Charlotte Granholm
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Stephanie Sherman
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Victoria Puig
- Catalan Institute of Nanoscience and Nanotechnology, Barcelona, Spain
| | - Jonathan D. Santoro
- Neurological Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - María Carmona-Iragui
- Hospital de la Santa Crue I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, California, USA
| | - André Strydom
- Institute of Psychiatry, King's College London, London, UK
| | - Jorge Busciglio
- Neurobiology and Behavior School of Biological Sciences, University of California, Irvine, California, USA
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23
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Ren J, Jin H, Zhu Y. The Role of Placental Non-Coding RNAs in Adverse Pregnancy Outcomes. Int J Mol Sci 2023; 24:ijms24055030. [PMID: 36902459 PMCID: PMC10003511 DOI: 10.3390/ijms24055030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Non-coding RNAs (ncRNAs) are transcribed from the genome and do not encode proteins. In recent years, ncRNAs have attracted increasing attention as critical participants in gene regulation and disease pathogenesis. Different categories of ncRNAs, which mainly include microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), are involved in the progression of pregnancy, while abnormal expression of placental ncRNAs impacts the onset and development of adverse pregnancy outcomes (APOs). Therefore, we reviewed the current status of research on placental ncRNAs and APOs to further understand the regulatory mechanisms of placental ncRNAs, which provides a new perspective for treating and preventing related diseases.
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Affiliation(s)
- Jiawen Ren
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
| | - Heyue Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
| | - Yumin Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
- Correspondence:
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24
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Cappell MS, Tobi M, Friedel DM. The Impact of COVID-19 Infection on Miscellaneous Inflammatory Disorders of the Gastrointestinal Tract. Gastroenterol Clin North Am 2023; 52:115-138. [PMID: 36813420 PMCID: PMC9537253 DOI: 10.1016/j.gtc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The novel coronavirus pandemic of COVID-19 has emerged as a highly significant recent threat to global health with about 600,000,000 known infections and more than 6,450,000 deaths worldwide since its emergence in late 2019. COVID-19 symptoms are predominantly respiratory, with mortality largely related to pulmonary manifestations, but the virus also potentially infects all parts of the gastrointestinal tract with related symptoms and manifestations that affect patient treatment and outcome. COVID-19 can directly infect the gastrointestinal tract because of the presence of widespread angiotensin-converting enzyme 2 receptors in the stomach and small intestine that can cause local COVID-19 infection and associated inflammation. This work reviews the pathopysiology, clinical manifestations, workup, and treatment of miscellaneous inflammatory disorders of the gastrointestinal tract other than inflammatory bowel disease.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Aleda E. Lutz Veterans Hospital, Gastroenterology Service, Main Building, Room 3212, 1500 Weiss Street, Saginaw, MI 48602, USA.
| | - Martin Tobi
- Department of Research and Development, John D. Dingell Veterans Affairs Medical Center, 4747 John R. Street, Detroit, MI 48201, USA
| | - David M Friedel
- Division of Therapeutic Endoscopy, Division of Gastroenterology, Department of Medicine, NY of New York University Langone Hospital, 259 1st Street, Mineola, NY 11501, USA
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25
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Hughes MC, Gray JA, Kim J. The Perspective of Administrators of Intellectual Disability Organizations on the COVID-19 Pandemic. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:206-220. [PMID: 35037499 PMCID: PMC9939914 DOI: 10.1177/17446295211062400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To learn about the challenges, policies, and needed resources to serve people with intellectual disability and protect staff during the COVID-19 pandemic. From the perspective of intellectual disability service providers. METHODS We conducted in-depth qualitative interviews with 16 intellectual disability organization administrators throughout Illinois, USA from November 2020 through February 2021. We coded and analyzed the data using thematic analysis. RESULTS Three major themes emerged: (1) COVID-19 caused considerable challenges to people with intellectual disability and staff and service providers, (2) intellectual disability organizations reinvented service provisions in response to COVID-19 challenges, and (3) the interrelatedness of intellectual disability organizations, public policies, and community entities became evident. CONCLUSIONS Exhibiting responsiveness to needs and developing innovative solutions were strategies championed by intellectual disability organizations during the pandemic. Fostering collaboration with community entities may assist these organizations in navigating pandemic challenges and developing resilient infrastructure for future environmental threats.
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Affiliation(s)
| | | | - Jinsook Kim
- School of Health Studies, Northern Illinois
University, DeKalb, IL, USA
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26
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O'Leary L, Maine A, Ring N, Reid J, Speirs L, Allan L, Truesdale M, Taggart L. A scoping review of the evidence for the use of screening tools in people with intellectual disabilities with dysphagia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:429-447. [PMID: 36797039 DOI: 10.1111/jar.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/11/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Dysphagia can have serious health implications including choking and respiratory infection leading to poorer quality of life. People with intellectual disabilities are at higher risk of dysphagia related health complications and early death. Robust dysphagia screening tools are vital for this population. METHOD A scoping review and appraisal of the evidence for dysphagia and feeding screening tools for use with people with intellectual disabilities was undertaken. RESULTS Seven studies (using six screening tools) met the review inclusion criteria. Mostly studies were limited by no defined dysphagia criteria, no verification of tools with a gold reference standard (e.g., videofluoroscopic examination) and lack of participant diversity (small samples, narrow age range, severity of intellectual disability or limited settings). CONCLUSIONS There is urgent need for development and rigorous appraisal of existing dysphagia screening tools to meet the needs of a wider range of people with intellectual disabilities (particularly mild-to-moderate severity) and in wider settings.
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Affiliation(s)
- Lisa O'Leary
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Andrew Maine
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nicola Ring
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - James Reid
- NHS Forth Valley, Community Hospital, Stirling, UK
| | | | - Louise Allan
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Maria Truesdale
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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27
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Friedman C. COVID-19 infection differences among people with disabilities. DIALOGUES IN HEALTH 2022; 1:100083. [PMID: 36785631 PMCID: PMC9675937 DOI: 10.1016/j.dialog.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
Purpose People with disabilities may be at higher risk for COVID-19 infection and death as a result of their impairments and/or medical conditions, and systemic inequities and disadvantages. People with disabilities are also a very heterogenous group, with many people with disabilities being multiply marginalized. The aim of this study was to examine differences in COVID-19 diagnosis and vaccination between people with and without disabilities, and to explore sociodemographic differences in COVID-19 diagnosis and vaccination among the disability community itself. Methods To do so, we analyzed secondary United States Census Bureau data from 444,422 people (52,890 adults with disabilities and 391,532 adults without disabilities) about COVID-19 diagnosis, vaccination, and sociodemographics. Frequency person-weights were applied. Results In this study, 19.3% of adults with disabilities were diagnosed with COVID-19 during the pandemic compared to 16.7% of adults without disabilities. People with disabilities were 1.20 times more likely to be diagnosed with COVID-19 than adults without disabilities. Among people with disabilities, the following groups were more likely to be diagnosed with COVID-19: people with cognitive disabilities; cisgender women; Black people; Hispanic people; people with some college or associate's degrees; people with employer and/or private insurance; and people who lived in larger households. There was not a significant difference in vaccination between people with and without disabilities; however, there were vaccination disparities among the disability community. Conclusions Many of the people with disabilities who were more likely to face health care disparities prior to the pandemic were also more likely to be diagnosed with COVID-19 during the pandemic.
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Key Words
- ADHD, Attention deficit hyperactivity disorder
- CDC, Center for Disease Control
- CI, Confidence interval
- DV, Dependent variable
- IDD, Intellectual and developmental disabilities
- IRB, Institutional Review Board
- IV, Independent variable
- LGBTQ, Lesbian, gay, bisexual, transgender, queer
- OR, Odds ratio
- SARS-CoV-2
- disabled persons
- pandemics
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Amatori S, Sisti D, Perroni F, Brandi G, Rocchi MBL, Gobbi E. Physical activity, sedentary behaviour and screen time among youths with Down syndrome during the COVID-19 pandemic. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:903-912. [PMID: 35445779 PMCID: PMC9115083 DOI: 10.1111/jir.12933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/17/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19-related restrictions hampered habitual physical activity (PA), particularly affecting the more vulnerable, such as people with Down syndrome (DS). The study aimed to investigate changes in PA, sedentary behaviour (SB) and screen time (ST) of youths with DS, before, during and after the restrictions, also in relation to parental PA levels. METHODS A cross-sectional design with a retrospective assessment of variables for the before and during restrictions periods was adopted. Parents of youths with DS completed an online questionnaire. Sociodemographic aspects, weekly PA levels and youths' daily SB and ST were investigated, referring to three time-points: before the pandemic, during the restrictions and the restrictions-easing phase. RESULTS A total of 57 parents voluntarily participated in the study, proxy-reporting on their child (male = 41, female = 16, age = 21.4 ± 7.7 years). A repeated measures multivariate analysis of variance showed negative effects of restrictions (P < 0.05) on PA levels, SB and ST, independently from sociodemographic characteristics. In the restrictions-easing phase, PA levels did not return to before the pandemic values (P < 0.05). A positive correlation between parents and their child's PA was detected before the pandemic (r = 0.38; P < 0.01), no longer reported in the restrictions-easing phase. CONCLUSIONS The findings showed the negative impact of restrictions on youths with DS lifestyle. Moreover, the importance of addressing the needs of the disabled community including the whole family is highlighted.
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Affiliation(s)
- S. Amatori
- Department of Biomolecular SciencesUniversity of Urbino Carlo BoUrbinoItaly
| | - D. Sisti
- Department of Biomolecular SciencesUniversity of Urbino Carlo BoUrbinoItaly
| | - F. Perroni
- Department of Biomolecular SciencesUniversity of Urbino Carlo BoUrbinoItaly
| | - G. Brandi
- Department of Biomolecular SciencesUniversity of Urbino Carlo BoUrbinoItaly
| | - M. B. L. Rocchi
- Department of Biomolecular SciencesUniversity of Urbino Carlo BoUrbinoItaly
| | - E. Gobbi
- Department of Biomolecular SciencesUniversity of Urbino Carlo BoUrbinoItaly
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Yarci-Carrión A, Esparcia-Pinedo L, Mateo-Jiménez G, Alfranca A, de Asúa DR, Gutiérrez-Cobos A. Effect of a SARS-CoV-2 booster vaccine dose on the immune response of adults with Down syndrome. J Infect 2022; 86:154-225. [PMID: 36417985 PMCID: PMC9675634 DOI: 10.1016/j.jinf.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Ayla Yarci-Carrión
- Microbiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Laura Esparcia-Pinedo
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Gloria Mateo-Jiménez
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Arantzazu Alfranca
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain,Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Diego Real de Asúa
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain,Internal Medicine Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain,Corresponding author: Diego Real de Asúa, Department of Internal Medicine, Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, Spain, T: +34 915202222
| | - Ainhoa Gutiérrez-Cobos
- Microbiology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
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Farrar DS, Drouin O, Moore Hepburn C, Baerg K, Chan K, Cyr C, Donner EJ, Embree JE, Farrell C, Forgie S, Giroux R, Kang KT, King M, Laffin Thibodeau M, Orkin J, Ouldali N, Papenburg J, Pound CM, Price VE, Proulx-Gauthier JP, Purewal R, Ricci C, Sadarangani M, Salvadori MI, Thibeault R, Top KA, Viel-Thériault I, Kakkar F, Morris SK. Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 15:100337. [PMID: 35936225 PMCID: PMC9342862 DOI: 10.1016/j.lana.2022.100337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Boschiero MN, Lutti Filho JR, Ortega MM, Marson FAL. High case fatality rate in individuals with Down syndrome and COVID-19 in Brazil: a two-year report. J Clin Pathol 2022; 75:717-720. [PMID: 35764375 DOI: 10.1136/jcp-2021-207802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 06/10/2022] [Indexed: 11/04/2022]
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32
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Amin MA, Khan II, Nahin S, Bonna A, Afrin S, Hawlader MDH. COVID-19 hospitalization with later long COVID in a person with Down syndrome. Clin Case Rep 2022; 10:e6425. [PMID: 36245462 PMCID: PMC9540596 DOI: 10.1002/ccr3.6425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/27/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
Viruses that induce pulmonary difficulties and auto-inflammation are more common in people with Down syndrome. They also have a higher number of comorbidities associated with a worse prognosis than the overall population. Adult patients with acute COVID-19 are increasingly being diagnosed with Long COVID. However, patients with Down syndrome with later long COVID-19 are the first example documented in Bangladesh.
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Affiliation(s)
- Mohammad Ashraful Amin
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Public Health Professional Development Society (PPDS)DhakaBangladesh
| | | | - Sabrina Nahin
- Department of PhysiologyGreen Life Medical College HospitalDhakaBangladesh
| | - Atia Sharmin Bonna
- Public Health Professional Development Society (PPDS)DhakaBangladesh
- Public Health EpidemiologistHN & HIV Sector, Save the ChildrenDhakaBangladesh
| | - Sadia Afrin
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Public Health Professional Development Society (PPDS)DhakaBangladesh
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Pinku H, Hüls A, Feany PT, Baumer N, Dierssen M, Bargagna S, Costa ACS, Chicoine BA, Rebillat AS, Sgandurra G, Valentini D, Rohrer RT, Levin J, Lakhanpaul M, Carfì A, Sherman SL, Strydom A, Ghosh S. Differences in clinical presentation, severity, and treatment of COVID-19 among individuals with Down syndrome from India and high-income countries: Data from the Trisomy 21 Research Society survey. J Glob Health 2022; 12:05035. [PMID: 35932238 PMCID: PMC9356581 DOI: 10.7189/jogh.12.05035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background People with Down syndrome (DS) are one of the highest risk groups for mortality associated with COVID-19, but outcomes may differ across countries due to different co-morbidity profiles, exposures, and societal practices, which could have implications for disease management. This study is designed to identify differences in clinical presentation, severity, and treatment of COVID-19 between India and several high-income countries (HICs). Methods We used data from an international survey to examine the differences in disease manifestation and management for COVID-19 patients with DS from India vs HIC. De-identified survey data collected from April 2020 to August 2021 were analysed. Results COVID-19 patients with DS from India were on average nine years younger than those from HICs. Comorbidities associated with a higher risk for severe COVID-19 were more frequent among the patients from India than from HICs. Hospitalizations were more frequent among patients from India as were COVID-19-related medical complications. Treatment strategies differed between India and HICs, with more frequent use of antibiotics in India. The average severity score of 3.31 was recorded for Indian DS in contrast to 2.3 for European and 2.04 for US cases. Conclusions Presentation and outcomes of COVID-19 among individuals with DS were more severe for patients from India than for those from HIC. Global efforts should especially target vaccination campaigns and other risk-reducing interventions for individuals with DS from low-income countries.
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Affiliation(s)
- Halder Pinku
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata, West Bengal, India
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Patrick T Feany
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nicole Baumer
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mara Dierssen
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | | | - Alberto CS Costa
- Department of Psychiatry, School of Medicine, and Department of Macromolecular. Science and Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian A Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, Illinois, USA
| | | | - Giuseppina Sgandurra
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata, West Bengal, India
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Diletta Valentini
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - R Tilman Rohrer
- Division of Pediatric Endocrinology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases, site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Monica Lakhanpaul
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, UK
- Whittington NHS Trust, London, UK
- Down Syndrome Medical Interest Group, London, UK
| | - Angelo Carfì
- Geriatric Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stephanie L Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Andre Strydom
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neuro-developmental Sciences, King’s College London, London, UK
- The London Down Syndrome (LonDownS) Consortium, London, UK
| | - Sujay Ghosh
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata, West Bengal, India
| | - the Trisomy 21 Research Society COVID-19 Initiative Study Group
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata, West Bengal, India
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
- Fondazione Stella Maris IRCCS, Pisa, Italy
- Department of Psychiatry, School of Medicine, and Department of Macromolecular. Science and Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, Illinois, USA
- Institut Jérôme Lejeune, Paris, France
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Division of Pediatric Endocrinology, Saarland University Medical Center, Homburg/Saar, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases, site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, UK
- Whittington NHS Trust, London, UK
- Down Syndrome Medical Interest Group, London, UK
- Geriatric Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neuro-developmental Sciences, King’s College London, London, UK
- The London Down Syndrome (LonDownS) Consortium, London, UK
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Care of Adults With Down Syndrome: The Nurse Practitioner Perspective. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Esparcia-Pinedo L, Yarci-Carrión A, Mateo-Jiménez G, Ropero N, Gómez-Cabañas L, Lancho-Sánchez Á, Almendro-Vázquez P, Martín-Gayo E, Paz-Artal E, Sanchez-Madrid F, Moldenhauer F, Gutiérrez-Cobos A, Real de Asúa D, Alfranca A. Development of an Effective Immune Response in Adults With Down Syndrome After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination. Clin Infect Dis 2022; 76:e155-e162. [PMID: 35869848 PMCID: PMC9384526 DOI: 10.1093/cid/ciac590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Immune dysregulation in individuals with Down syndrome (DS) leads to an increased risk for hospitalization and death due to coronavirus disease 2019 (COVID-19) and may impair the generation of protective immunity after vaccine administration. METHODS The cellular and humoral responses of 55 individuals with DS who received a complete SARS-CoV-2 vaccination regime at 1 to 3 (visit [V 1]) and 6 (V2) months were characterized. RESULTS SARS-CoV-2-reactive CD4+ and CD8+ T lymphocytes with a predominant Th1 phenotype were observed at V1 and increased at V2. Likewise, an increase in SARS-CoV-2-specific circulating Tfh (cTfh) cells and CD8+ CXCR5+ PD-1hi lymphocytes was already observed at V1 after vaccine administration. Specific immunoglobulin G (IgG) antibodies against SARS-CoV-2 S protein were detected in 96% and 98% of subjects at V1 and V2, respectively, although IgG titers decreased significantly between both time points. CONCLUSIONS Our findings show that DS individuals develop an effective immune response to usual regimes of SARS-CoV-2 vaccination.
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Affiliation(s)
| | | | - Gloria Mateo-Jiménez
- Fundación de Investigación Biomédica del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Noelia Ropero
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Laura Gómez-Cabañas
- Biobanco, Fundación de Investigación del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Ángel Lancho-Sánchez
- Biobanco, Fundación de Investigación del Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - Enrique Martín-Gayo
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain,Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Estela Paz-Artal
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Francisco Sanchez-Madrid
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain,Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Moldenhauer
- Internal Medicine Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | | | - Arantzazu Alfranca
- Correspondence: A. Alfranca, Immunology Department, Hospital Universitario de La Princesa, Dieo de León 62, 28006 Madrid, Spain ()
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Martini AC, Gross TJ, Head E, Mapstone M. Beyond amyloid: Immune, cerebrovascular, and metabolic contributions to Alzheimer disease in people with Down syndrome. Neuron 2022; 110:2063-2079. [PMID: 35472307 PMCID: PMC9262826 DOI: 10.1016/j.neuron.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/31/2022] [Indexed: 12/16/2022]
Abstract
People with Down syndrome (DS) have increased risk of Alzheimer disease (AD), presumably conferred through genetic predispositions arising from trisomy 21. These predispositions necessarily include triplication of the amyloid precursor protein (APP), but also other Ch21 genes that confer risk directly or through interactions with genes on other chromosomes. We discuss evidence that multiple genes on chromosome 21 are associated with metabolic dysfunction in DS. The resulting dysregulated pathways involve the immune system, leading to chronic inflammation; the cerebrovascular system, leading to disruption of the blood brain barrier (BBB); and cellular energy metabolism, promoting increased oxidative stress. In combination, these disruptions may produce a precarious biological milieu that, in the presence of accumulating amyloid, drives the pathophysiological cascade of AD in people with DS. Critically, mechanistic drivers of this dysfunction may be targetable in future clinical trials of pharmaceutical and/or lifestyle interventions.
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Affiliation(s)
- Alessandra C Martini
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA 92697, USA
| | - Thomas J Gross
- Department of Neurology, University of California, Irvine, Irvine, CA 92697, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA 92697, USA
| | - Mark Mapstone
- Department of Neurology, University of California, Irvine, Irvine, CA 92697, USA.
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Impact of the COVID-19 pandemic on daily life, mood, and behavior of adults with Down syndrome. Disabil Health J 2022; 15:101278. [PMID: 35256308 PMCID: PMC8849846 DOI: 10.1016/j.dhjo.2022.101278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The Down syndrome population has been disproportionately affected by Coronavirus 2019 (COVID-19) in terms of experiencing severe illness and death. Societal efforts to curb the spread of COVID-19 may also have taken a heavy toll on the daily lives of individuals with Down syndrome. OBJECTIVE/HYPOTHESIS The goal of the study was to understand how the COVID-19 pandemic has altered daily life (including residence, employment, and participation in adult disability day programs) and influenced the mood and behavior of adults with Down syndrome. METHODS Between September 2020 and February 2021, caregivers of 171 adults with Down syndrome (aged 22-66 years) located across the United States and in the United Kingdom enrolled in the Alzheimer's Biomarker Research Consortium on Down Syndrome (ABC-DS) completed a survey. RESULTS The residence of 17% of individuals was altered, and 89% of those who had been employed stopped working during the pandemic. One-third (33%) of individuals were reported to be more irritable or easily angered, 52% were reported to be more anxious, and 41% were reported to be more sad/depressed/unhappy relative to prepandemic. The majority of changes in mood and behavior were of modest severity. CONCLUSIONS The COVID-19 pandemic has had widespread effects on the daily life and mood and behavior of adults with Down syndrome. In the short term, caregivers and providers should be prepared to help adults with Down syndrome with changes in daily routines, residence, employment, or adult disability day programs as society shifts away from COVID-19 safety protocols.
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Boschiero MN, Palamim CVC, Ortega MM, Marson FAL. Clinical characteristics and comorbidities of COVID-19 in unvaccinated patients with Down syndrome: first year report in Brazil. Hum Genet 2022; 141:1887-1904. [PMID: 35763088 PMCID: PMC9244024 DOI: 10.1007/s00439-022-02468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023]
Abstract
Patients with Down syndrome (DS) are more affected by the Coronavirus Disease (COVID)-19 pandemic when compared with other populations. Therefore, the primary aim of our study was to report the death (case fatality rate) from SARS-CoV-2 infection in Brazilian hospitalized patients with DS from 03 January 2020 to 04 April 2021. The secondary objectives were (i) to compare the features of patients with DS and positive for COVID-19 (G1) to those with DS and with a severe acute respiratory infection (SARI) from other etiological factors (G2) to tease apart the unique influence of COVID-19, and (ii) to compare the features of patients with DS and positive for COVID-19 to those without DS, but positive for COVID-19 (G3) to tease apart the unique influence of DS. We obtained the markers for demographic profile, clinical symptoms, comorbidities, and the clinical features for SARI evolution during hospitalization in the first year of the COVID-19 pandemic in Brazil from a Brazilian open-access database. The data were compared between (i) G1 [1619 (0.4%) patients] and G2 [1431 (0.4%) patients]; and between (ii) G1 and G3 [222,181 (64.8%) patients]. The case fatality rate was higher in patients with DS and COVID-19 (G1: 39.2%), followed by individuals from G2 (18.1%) and G3 (14.0%). Patients from G1, when compared to G2, were older (≥ 25 years of age), presented more clinical symptoms related to severe illness and comorbidities, needed intensive care unit (ICU) treatment and non-invasive mechanical ventilation (MV) more frequently, and presented a nearly two fold-increased chance of death (OR = 2.92 [95% CI 2.44–3.50]). Patients from G1, when compared to G3, were younger (< 24 years of age), more prone to nosocomial infection, presented an increased chance for clinical symptoms related to a more severe illness; frequently needed ICU treatment, and invasive and non-invasive MV, and raised almost a three fold-increased chance of death (OR = 3.96 [95% CI 3.60–4.41]). The high case fatality rate in G1 was associated with older age (≥ 25 years of age), presence of clinical symptoms, and comorbidities, such as obesity, related to a more severe clinical condition. Unvaccinated patients with DS affected by COVID-19 had a high case fatality rate, and these patients had a different profile for comorbidities, clinical symptoms, and treatment (such as the need for ICU and MV) when compared with other study populations.
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Affiliation(s)
- Matheus Negri Boschiero
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil
| | - Camila Vantini Capasso Palamim
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Manoela Marques Ortega
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Fernando Augusto Lima Marson
- Postgraduate Program in Health Science, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Avenida São Francisco de Assis, 218. Jardim São José, Bragança Paulista, SP, 12916-900, Brazil. .,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil.
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Farrell C, Mumford P, Wiseman FK. Rodent Modeling of Alzheimer's Disease in Down Syndrome: In vivo and ex vivo Approaches. Front Neurosci 2022; 16:909669. [PMID: 35747206 PMCID: PMC9209729 DOI: 10.3389/fnins.2022.909669] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/16/2022] [Indexed: 12/30/2022] Open
Abstract
There are an estimated 6 million people with Down syndrome (DS) worldwide. In developed countries, the vast majority of these individuals will develop Alzheimer's disease neuropathology characterized by the accumulation of amyloid-β (Aβ) plaques and tau neurofibrillary tangles within the brain, which leads to the early onset of dementia (AD-DS) and reduced life-expectancy. The mean age of onset of clinical dementia is ~55 years and by the age of 80, approaching 100% of individuals with DS will have a dementia diagnosis. DS is caused by trisomy of chromosome 21 (Hsa21) thus an additional copy of a gene(s) on the chromosome must cause the development of AD neuropathology and dementia. Indeed, triplication of the gene APP which encodes the amyloid precursor protein is sufficient and necessary for early onset AD (EOAD), both in people who have and do not have DS. However, triplication of other genes on Hsa21 leads to profound differences in neurodevelopment resulting in intellectual disability, elevated incidence of epilepsy and perturbations to the immune system. This different biology may impact on how AD neuropathology and dementia develops in people who have DS. Indeed, genes on Hsa21 other than APP when in three-copies can modulate AD-pathogenesis in mouse preclinical models. Understanding this biology better is critical to inform drug selection for AD prevention and therapy trials for people who have DS. Here we will review rodent preclinical models of AD-DS and how these can be used for both in vivo and ex vivo (cultured cells and organotypic slice cultures) studies to understand the mechanisms that contribute to the early development of AD in people who have DS and test the utility of treatments to prevent or delay the development of disease.
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Baksh RA, Strydom A, Pape SE, Chan LF, Gulliford MC. Susceptibility to COVID-19 Diagnosis in People with Down Syndrome Compared to the General Population: Matched-Cohort Study Using Primary Care Electronic Records in the UK. J Gen Intern Med 2022; 37:2009-2015. [PMID: 35386043 PMCID: PMC8985744 DOI: 10.1007/s11606-022-07420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, people with Down syndrome (DS) have experienced a more severe disease course and higher mortality rates than the general population. It is not yet known whether people with DS are more susceptible to being diagnosed with COVID-19. OBJECTIVE To explore whether DS is associated with increased susceptibility to COVID-19. DESIGN Matched-cohort study design using anonymised primary care electronic health records from the May 2021 release of Clinical Practice Research Datalink (CPRD) Aurum. SETTING Electronic health records from approximately 1400 general practices (GPs) in England. PARTICIPANTS 8854 people with DS and 34,724 controls matched for age, gender and GP who were registered on or after the 29th January 2020. MEASUREMENTS The primary outcome was COVID-19 diagnosis between January 2020 and May 2021. Conditional logistic regression models were fitted to estimate associations between DS and COVID-19 diagnosis, adjusting for comorbidities. RESULTS Compared to controls, people with DS were more likely to be diagnosed with COVID-19 (7.4% vs 5.6%, p ≤ 0.001, odds ratio (OR) = 1.35; 95% CI = 1.23-1.48). There was a significant interaction between people with DS and a chronic respiratory disease diagnosis excluding asthma and increased odds of a COVID-19 diagnosis (OR = 1.71; 95% CI = 1.20-2.43), whilst adjusting for a number of comorbidities. CONCLUSION Individuals with DS are at increased risk for contracting COVID-19. Those with underlying lung conditions are particularly vulnerable during viral pandemics and should be prioritised for vaccinations.
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Affiliation(s)
- R Asaad Baksh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. .,The LonDowns Consortium, London, UK.
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Sarah E Pape
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Li F Chan
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London, UK
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Fujino H, Itai M. Disinfection behavior for COVID-19 in individuals with Down syndrome and caregivers' distress in Japan: a cross-sectional retrospective study. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 35:81-96. [PMID: 35637873 PMCID: PMC9132748 DOI: 10.1007/s10882-022-09845-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 outbreak affected the daily lives of individuals with Down syndrome, who were considered to have a higher risk of severe infection. While several studies have reported mental health issues in children and/or parents in the general population, no study has focused on people with Down syndrome and their caregivers. This study investigated the disinfection behaviors of individuals with Down syndrome and their caregivers' stress. A cross-sectional retrospective survey was conducted in October 2020. Caregivers of children and adults with Down syndrome were administered questionnaires including measures for practiced disinfection behavior in children, caregiver's child-related stress, and psychological distress. About half of the respondents' children practiced hand hygiene and mask-wearing behaviors, while physical distancing was performed less frequently. Habitual practices in physical distancing are affected by intellectual function. Logistic regression showed that caregivers' stress was associated with the irritability of individuals with the disorder (adjusted odds ratio [OR] = 8.44, 95% confidence interval [CI] 1.69-42.09) and the burden of infection-prevention behaviors for people with Down syndrome (adjusted OR = 4.26, 95% CI 1.88-9.65). This study showed the characteristics of disinfection behaviors in individuals with Down syndrome and associated factors for serious caregiver stress.
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Affiliation(s)
- Haruo Fujino
- Department of Child Development, Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, 5650871 Suita, Japan
- Department of Special Needs Education, Oita University, Oita, Japan
- Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Minori Itai
- Department of Special Needs Education, Oita University, Oita, Japan
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Cahapay MB. Tailoring remote special education for children with down syndrome during COVID-19 pandemic in the Philippines. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:40-48. [PMID: 38456132 PMCID: PMC10916918 DOI: 10.1080/20473869.2022.2056404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/16/2022] [Indexed: 03/09/2024]
Abstract
Down syndrome is the most common form of intellectual disability. However, there is a paucity of educational research focused on this vulnerable segment of learners especially in the present novel situation. This paper aimed to explore how teachers tailor remote special education for children with down syndrome amid the COVID-19 pandemic in the Philippines. It draws from a phenomenological qualitative study that collected information from online interviews with nine special education teachers handling children with down syndrome. The results revealed five themes: (1) contextualize individual educational plans; (2) meet sensory and movement needs; (3) emotionally connect with children; (4) communicate often with families; and (5) collaborate with community. This study provides practical insight into the enabling practices that teachers use to design the remote special education for children with down syndrome amid the current crisis.
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Affiliation(s)
- Michael B. Cahapay
- College of Education, Mindanao State University, General Santos City, Philippines
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43
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Sali M, Carfì A, Di Paola A, Pereyra Boza M, Zampino G, Sanguinetti M, Landi F, Onder G. SARS-CoV-2 vaccine humoral response in adults with down syndrome. Clin Microbiol Infect 2022; 28:1155.e1-1155.e4. [PMID: 35461998 PMCID: PMC9022372 DOI: 10.1016/j.cmi.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/19/2022]
Abstract
Objective People with Down syndrome (DS) are particularly vulnerable to coronavirus disease 2019 (COVID-19) and show altered immune response to vaccination. We aimed to evaluate the immune response of a group of adults with DS treated with standard regimens of SARS-CoV-2 vaccine as compared with an age- and sex-matched group of persons without DS. Methods We compared antibody responses between 42 subjects with DS (41.6 ± 10.8 years, 57% male), and an age- and sex-matched comparison group of healthy health care workers (HCW) (41.4 ± 8.8 years, 54.8% male) after SARS-CoV-2 vaccination with the standard regimen of BNT162b2 mRNA COVID-19. Receptor binding domain (RBD) IgG antibodies were assessed at 4 time points (baseline, 21 days after the first dose, 21 days after the second dose, and 6 months after the first dose) with Siemens SARS-CoV-2 IgG (COV2G) antibody test. Results We observed significantly different antibody responses at all time points after vaccination (HCW vs. DS: 7.9 ± 3.9 vs. 1.4 ± 3.6 IU/mL at 21 days after first dose; 358.5 ± 3.8 vs. 38.1 ± 3.0 IU/mL at 21 days after second dose; 34.6 ± 2.4 vs. 7.9 ± 3.1 IU/mL at 6 months after vaccination) and a significantly different time course of decline in antibody titers between the two groups. Discussion Subjects with DS have a valid antibody response to SARS-CoV-2 vaccination. However, this response is lower than that of subjects in the HCW group. This finding could indicate a more rapid decline in the protective effects of the vaccination in subjects with DS and could suggest that people with DS may benefit from a booster dose of vaccine.
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Affiliation(s)
- Michela Sali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Facoltà di Medicina, Rome, Italy
| | - Angelo Carfì
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | | | | | - Giuseppe Zampino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Facoltà di Medicina, Rome, Italy
| | - Maurizio Sanguinetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Facoltà di Medicina, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Facoltà di Medicina, Rome, Italy
| | - Graziano Onder
- Università Cattolica Del Sacro Cuore, Facoltà di Medicina, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
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Hüls A, Feany PT, Zisman SI, Costa ACS, Dierssen M, Balogh R, Bargagna S, Baumer NT, Brandão AC, Carfi A, Chicoine BA, Ghosh S, Lakhanpaul M, Levin J, Lunsky Y, Manso C, Okun E, Real de Asua D, Rebillat AS, Rohrer TR, Sgandurra G, Valentini D, Sherman SL, Strydom A. COVID-19 Vaccination of Individuals with Down Syndrome-Data from the Trisomy 21 Research Society Survey on Safety, Efficacy, and Factors Associated with the Decision to Be Vaccinated. Vaccines (Basel) 2022; 10:530. [PMID: 35455279 PMCID: PMC9030605 DOI: 10.3390/vaccines10040530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
Individuals with Down syndrome (DS) are among the groups with the highest risk for severe COVID-19. Better understanding of the efficacy and risks of COVID-19 vaccines for individuals with DS may help improve uptake of vaccination. The T21RS COVID-19 Initiative launched an international survey to obtain information on safety and efficacy of COVID-19 vaccines for individuals with DS. De-identified survey data collected between March and December 2021 were analyzed. Of 2172 individuals with DS, 1973 (91%) had received at least one vaccine dose (57% BNT162b2), 107 (5%) were unvaccinated by choice, and 92 (4%) were unvaccinated for other reasons. Most participants had either no side effects (54%) or mild ones such as pain at the injection site (29%), fatigue (12%), and fever (7%). Severe side effects occurred in <0.5% of participants. About 1% of the vaccinated individuals with DS contracted COVID-19 after vaccination, and all recovered. Individuals with DS who were unvaccinated by choice were more likely to be younger, previously recovered from COVID-19, and also unvaccinated against other recommended vaccines. COVID-19 vaccines have been shown to be safe for individuals with DS and effective in terms of resulting in minimal breakthrough infections and milder disease outcomes among fully vaccinated individuals with DS.
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Affiliation(s)
- Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Patrick T. Feany
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | | | - Alberto C. S. Costa
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106, USA;
- Department of Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Mara Dierssen
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Universitat Pompeu Fabra, 08016 Barcelona, Spain;
- Universitat Pompeu Fabra (UPF), 08016 Barcelona, Spain
- Centrode Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 08016 Barcelona, Spain
| | - Robert Balogh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada;
| | - Stefania Bargagna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone, Italy; (S.B.); (G.S.)
| | - Nicole T. Baumer
- Department of Neurology, Division of Developmental Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | | | - Angelo Carfi
- Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy;
| | | | - Sujay Ghosh
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata 700073, India;
| | - Monica Lakhanpaul
- Department of Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College, London WC1N 1EH, UK;
- Community Paediatrics, Whittington Health NHS, London N19 5NF, UK
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, 80539 Munich, Germany;
- German Center for Neurodegenerative Diseases, Site Munich, 53127 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, CAMH, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | | | - Eitan Okun
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar Ilan University, Ramat Gan 5290002, Israel;
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Diego Real de Asua
- Department of Internal Medicine and Instituto de Investigación Biomédica-La Princesa, Hospital Universitario de La Princesa, 28001 Madrid, Spain;
| | | | - Tilman R. Rohrer
- Division of Pediatric Endocrinology, Department of Pediatrics and Neonatology, Saarland University Medical Center, 66424 Homburg, Germany;
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone, Italy; (S.B.); (G.S.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Diletta Valentini
- Pediatric Unit, Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Andre Strydom
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; (S.I.Z.); (A.S.)
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AB, UK
- The London Down Syndrome (LonDownS) Consortium, London SE5 8AB, UK
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Meguid NA, Nashaat NH, Abdallah HR, Hemimi M, Elnahry A, El-Hariri HM, Elsaeid A. Influence of COVID-19 pandemic lockdown on a sample of Egyptian children with Down syndrome. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022; 23:68. [PMID: 37521827 PMCID: PMC8926093 DOI: 10.1186/s43042-022-00280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Down syndrome (DS) is characterized by variable degrees of intellectual disability (ID). The coronavirus disease-2019 (COVID-19) lockdown prevented children with DS from reaching their rehabilitation facilities. This could have led to deterioration of their abilities and mental health hazards. The aim of this cohort study was to investigate frequency of COVID-19, the influence of COVID-19 pandemic on health, and some abilities of children with DS, and to explore factors that could have governed receiving home-based training during the lockdown. A survey of 150 individuals with Down syndrome was answered by their caregivers. Additionally, 135 participants were subjected to assessment of cognitive, language, and motor abilities using Portage program. They were divided into 2 groups: group I who received online therapy sessions during the lockdown and group II who did not receive sessions. Logistic regression was used to determine the factors which influenced getting home-based training. Results The percentage of COVID-19 cases was 3.3%. All evaluated abilities were reduced despite receiving online sessions particularly language performance (P < 0.001). Male gender, having severe ID and low parental education were among the factors which encouraged parents to get virtual training. Conclusion COVID-19 pandemic had a negative impact on the abilities of DS children even those who got rehabilitation sessions. Their dependence on social interaction could have limited the benefit of virtual sessions. Factors that influence a parent's decision to get home-based training should be monitored and targeted in order to overcome obstacles or concepts that may prevent families from enduring home-based intervention.
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Affiliation(s)
- Nagwa A. Meguid
- Research on Children with Special Needs Department, Medical Research Division, National Research Centre, Elbuhouth Street, Dokki 12622 Cairo, Egypt
| | - Neveen Hassan Nashaat
- Research on Children with Special Needs Department, Medical Research Division, National Research Centre, Elbuhouth Street, Dokki 12622 Cairo, Egypt
| | - Hanaa Reyad Abdallah
- Biological Anthropology Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Maha Hemimi
- Research on Children with Special Needs Department, Medical Research Division, National Research Centre, Elbuhouth Street, Dokki 12622 Cairo, Egypt
| | - Ahmed Elnahry
- Research on Children with Special Needs Department, Medical Research Division, National Research Centre, Elbuhouth Street, Dokki 12622 Cairo, Egypt
| | - Hazem Mohamed El-Hariri
- Community Medicine Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Amal Elsaeid
- Research on Children with Special Needs Department, Medical Research Division, National Research Centre, Elbuhouth Street, Dokki 12622 Cairo, Egypt
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Drug-Targeted Genomes: Mutability of Ion Channels and GPCRs. Biomedicines 2022; 10:biomedicines10030594. [PMID: 35327396 PMCID: PMC8945769 DOI: 10.3390/biomedicines10030594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023] Open
Abstract
Mutations of ion channels and G-protein-coupled receptors (GPCRs) are not uncommon and can lead to cardiovascular diseases. Given previously reported multiple factors associated with high mutation rates, we sorted the relative mutability of multiple human genes by (i) proximity to telomeres and/or (ii) high adenine and thymine (A+T) content. We extracted genomic information using the genome data viewer and examined the mutability of 118 ion channel and 143 GPCR genes based on their association with factors (i) and (ii). We then assessed these two factors with 31 genes encoding ion channels or GPCRs that are targeted by the United States Food and Drug Administration (FDA)-approved drugs. Out of the 118 ion channel genes studied, 80 met either factor (i) or (ii), resulting in a 68% match. In contrast, a 78% match was found for the 143 GPCR genes. We also found that the GPCR genes (n = 20) targeted by FDA-approved drugs have a relatively lower mutability than those genes encoding ion channels (n = 11), where targeted genes encoding GPCRs were shorter in length. The result of this study suggests that the use of matching rate analysis on factor-druggable genome is feasible to systematically compare the relative mutability of GPCRs and ion channels. The analysis on chromosomes by two factors identified a unique characteristic of GPCRs, which have a significant relationship between their nucleotide sizes and proximity to telomeres, unlike most genetic loci susceptible to human diseases.
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Bensussen A, Valcarcel A, Álvarez-Buylla ER, Díaz J. ORF8 and Health Complications of COVID-19 in Down Syndrome Patients. Front Genet 2022; 13:830426. [PMID: 35222544 PMCID: PMC8864084 DOI: 10.3389/fgene.2022.830426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio Bensussen
- Laboratorio de Dinámica de Redes Genéticas, Centro de Investigación en Dinámica Celular, Universidad Autónoma del Estado de Morelos, Cuernavaca, Mexico
| | - Antonio Valcarcel
- Laboratorio de Dinámica de Redes Genéticas, Centro de Investigación en Dinámica Celular, Universidad Autónoma del Estado de Morelos, Cuernavaca, Mexico
| | - Elena R. Álvarez-Buylla
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Laboratorio de Genética Molecular, Epigenética, Desarrollo y Evolución de Plantas, Instituto de Ecología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- *Correspondence: Elena R. Álvarez-Buylla, ; José Díaz,
| | - José Díaz
- Laboratorio de Dinámica de Redes Genéticas, Centro de Investigación en Dinámica Celular, Universidad Autónoma del Estado de Morelos, Cuernavaca, Mexico
- *Correspondence: Elena R. Álvarez-Buylla, ; José Díaz,
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Brown HK, Saha S, Chan TCY, Cheung AM, Fralick M, Ghassemi M, Herridge M, Kwan J, Rawal S, Rosella L, Tang T, Weinerman A, Lunsky Y, Razak F, Verma AA. Outcomes in patients with and without disability admitted to hospital with COVID-19: a retrospective cohort study. CMAJ 2022; 194:E112-E121. [PMID: 35101870 PMCID: PMC8900770 DOI: 10.1503/cmaj.211277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. Methods: We conducted a retrospective cohort study that included adults with COVID-19 who were admitted to hospital and discharged between Jan. 1, 2020, and Nov. 30, 2020, at 7 hospitals in Ontario, Canada. We compared in-hospital death, admission to the intensive care unit (ICU), hospital length of stay and unplanned 30-day readmission among patients with and without a physical disability, hearing or vision impairment, traumatic brain injury, or intellectual or developmental disability, overall and stratified by age (≤ 64 and ≥ 65 yr) using multivariable regression, controlling for sex, residence in a long-term care facility and comorbidity. Results: Among 1279 admissions to hospital for COVID-19, 22.3% had a disability. We found that patients with a disability were more likely to die than those without a disability (28.1% v. 17.6%), had longer hospital stays (median 13.9 v. 7.8 d) and more readmissions (17.6% v. 7.9%), but had lower ICU admission rates (22.5% v. 28.3%). After adjustment, there were no statistically significant differences between those with and without disabilities for in-hospital death or admission to ICU. After adjustment, patients with a disability had longer hospital stays (rate ratio 1.36, 95% confidence interval [CI] 1.19–1.56) and greater risk of readmission (relative risk 1.77, 95% CI 1.14–2.75). In age-stratified analyses, we observed longer hospital stays among patients with a disability than in those without, in both younger and older subgroups; readmission risk was driven by younger patients with a disability. Interpretation: Patients with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. Disability-related needs should be addressed to support these patients in hospital and after discharge.
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Affiliation(s)
- Hilary K Brown
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Sudipta Saha
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Timothy C Y Chan
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Angela M Cheung
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Michael Fralick
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Marzyeh Ghassemi
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Margaret Herridge
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Janice Kwan
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Shail Rawal
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Laura Rosella
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Terence Tang
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Adina Weinerman
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Yona Lunsky
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Fahad Razak
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Amol A Verma
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont.
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Safety and Long-Term Immunogenicity of BNT162b2 Vaccine in Individuals with Down Syndrome. J Clin Med 2022; 11:jcm11030694. [PMID: 35160144 PMCID: PMC8836979 DOI: 10.3390/jcm11030694] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
We aimed to evaluate the safety and immunogenicity of the BNT162b2 vaccine in young people with Down syndrome (DS), and to compare their humoral immune response with those of the healthy controls (HC). Individuals with DS and HC received the BNT162b2 vaccine. Longitudinal blood samples were collected on the day of vaccination, twenty-one days after the first dose, seven days after the second dose, and six months after the first dose. Both the local and systemic adverse events reported by participants were mild. Pain at the injection site was the most reported local adverse event, while fever was the systemic adverse event. Humoral responses showed a significant increase of anti-S and anti-S trimeric antibody (Ab) levels after both doses of vaccine in both groups. In comparison with HC, Ab levels in individuals with DS were similar at T21, but significantly lower, both in terms anti-S and anti-S trimeric, at T28 (respectively p = 0.0003 and p = 0.0001). At T180 both groups showed a significant reduction of anti-S trimeric Ab levels compared to T28 (p = 0.0004 and p < 0.0001 for DS and HC, respectively). Individuals with DS exhibit a good humoral response to the BNT162b2 vaccine; however, similarly to in HC, the immune response wanes over time.
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Biselli JM, Zampieri BL, Biselli-Chicote PM, de Souza JES, Bürger MC, da Silva WA, Goloni-Bertollo EM, Pavarino ÉC. Differential microRNA expression profile in blood of children with Down syndrome suggests a role in immunological dysfunction. Hum Cell 2022; 35:639-648. [PMID: 35060072 PMCID: PMC8773395 DOI: 10.1007/s13577-022-00672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/09/2022] [Indexed: 11/18/2022]
Abstract
Down syndrome (DS), caused by trisomy of chromosome 21 (HSA21), results in a broad range of phenotypes. However, the determinants contributing to the complex and variable phenotypic expression of DS are still not fully known. Changes in microRNAs (miRNAs), short non-coding RNA molecules that regulate gene expression post-transcriptionally, have been associated with some DS phenotypes. Here, we investigated the genome-wide mature miRNA expression profile in peripheral blood mononuclear cells (PBMCs) of children with DS and controls and identified biological processes and pathways relevant to the DS pathogenesis. The expression of 754 mature miRNAs was profiled in PBMCs from six children with DS and six controls by RT-qPCR using TaqMan® Array Human MicroRNA Cards. Functions and signaling pathways analyses were performed using DIANA-miRPath v.3 and DIANA-microT-CDS software. Children with DS presented six differentially expressed miRNAs (DEmiRs): four overexpressed (miR-378a-3p, miR-130b-5p, miR-942-5p, and miR-424-3p) and two downregulated (miR-452-5p and miR-668-3p). HSA21-derived miRNAs investigated were not found to be differentially expressed between the groups. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses showed potential target genes involved in biological processes and pathways pertinent to immune response, e.g., toll-like receptors (TLRs) signaling, Hippo, and transforming growth factor β (TGF-β) signaling pathways. These results suggest that altered miRNA expression could be contributing to the well-known immunological dysfunction observed in individuals with DS.
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Affiliation(s)
- Joice Matos Biselli
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
| | - Bruna Lancia Zampieri
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Patrícia Matos Biselli-Chicote
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
| | - Jorge Estefano Santana de Souza
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Metrópole Digital Institute (IMD), UFRN, Natal, RN, Brazil
- National Institute of Science and Technology in Stem Cell and Cell Therapy and Center for Cell Based Therapy, Ribeirao Preto, São Paulo, Brazil
| | - Matheus Carvalho Bürger
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute of Science and Technology in Stem Cell and Cell Therapy and Center for Cell Based Therapy, Ribeirao Preto, São Paulo, Brazil
| | - Wilson Araújo da Silva
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute of Science and Technology in Stem Cell and Cell Therapy and Center for Cell Based Therapy, Ribeirao Preto, São Paulo, Brazil
| | - Eny Maria Goloni-Bertollo
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
| | - Érika Cristina Pavarino
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil.
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