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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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Hom B, Boyd NK, Vogel BN, Nishimori N, Khoshnood MM, Jafarpour S, Nagesh D, Santoro JD. Down Syndrome and Autoimmune Disease. Clin Rev Allergy Immunol 2024:10.1007/s12016-024-08996-2. [PMID: 38913142 DOI: 10.1007/s12016-024-08996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 06/25/2024]
Abstract
Down syndrome is the most common genetic cause of intellectual disability and has previously been associated with a variety of autoimmune disorders affecting multiple organ systems. The high prevalence of autoimmune disease, in conjunction with other inflammatory and infectious diseases, in this population suggests an intrinsic immune dysregulation associated with triplication of chromosome 21. Emerging data on the role of chromosome 21 in interferon activation, cytokine production, and activation of B-cell mediated autoimmunity are emerging hypotheses that may explain the elevated prevalence of autoimmune thyroid disease, celiac disease, type I diabetes, autoimmune skin disease, and a variety of autoimmune neurologic conditions. As the life expectancy for individuals with Down syndrome increases, knowledge of the epidemiology, clinical features, management and underlying causes of these conditions will become increasingly important. Disorders such as Hashimoto's thyroiditis are prevalent in between 13 and 34% of individuals with Down syndrome but only 3% of the neurotypical population, a pattern similarly recognized in individuals with Celiac Disease (5.8% v 0.5-2%), alopecia areata (27.7% v. 2%), and vitiligo (4.4% v. 0.05-1.55%), respectively. Given the chronicity of autoimmune conditions, early identification and management can significantly impact the quality of life of individuals with Down syndrome. This comprehensive review will highlight common clinical autoimmune conditions observed in individuals with Down syndrome and explore our current understanding of the mechanisms of disease in this population.
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Affiliation(s)
- Brian Hom
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Natalie K Boyd
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA90027, USA
| | - Benjamin N Vogel
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA90027, USA
| | - Nicole Nishimori
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA90027, USA
| | - Mellad M Khoshnood
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA90027, USA
| | - Saba Jafarpour
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA90027, USA
| | - Deepti Nagesh
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA90027, USA
- Department of Neurology, Keck School of Medicineat the, University of Southern California , Los Angeles, CA, USA
| | - Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS82, Los Angeles, CA90027, USA.
- Department of Neurology, Keck School of Medicineat the, University of Southern California , Los Angeles, CA, 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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Granholm ACE, Englund E, Gilmore A, Head E, Yong WH, Perez SE, Guzman SJ, Hamlett ED, Mufson EJ. Neuropathological findings in Down syndrome, Alzheimer's disease and control patients with and without SARS-COV-2: preliminary findings. Acta Neuropathol 2024; 147:92. [PMID: 38801558 PMCID: PMC11130011 DOI: 10.1007/s00401-024-02743-9] [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: 02/20/2024] [Revised: 05/11/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
The SARS-CoV-2 virus that led to COVID-19 is associated with significant and long-lasting neurologic symptoms in many patients, with an increased mortality risk for people with Alzheimer's disease (AD) and/or Down syndrome (DS). However, few studies have evaluated the neuropathological and inflammatory sequelae in postmortem brain tissue obtained from AD and people with DS with severe SARS-CoV-2 infections. We examined tau, beta-amyloid (Aβ), inflammatory markers and SARS-CoV-2 nucleoprotein in DS, AD, and healthy non-demented controls with COVID-19 and compared with non-infected brain tissue from each disease group (total n = 24). A nested ANOVA was used to determine regional effects of the COVID-19 infection on arborization of astrocytes (Sholl analysis) and percent-stained area of Iba-1 and TMEM 119. SARS-CoV-2 antibodies labeled neurons and glial cells in the frontal cortex of all subjects with COVID-19, and in the hippocampus of two of the three DS COVID-19 cases. SARS-CoV-2-related alterations were observed in peri-vascular astrocytes and microglial cells in the gray matter of the frontal cortex, hippocampus, and para-hippocampal gyrus. Bright field microscopy revealed scattered intracellular and diffuse extracellular Aβ deposits in the hippocampus of controls with confirmed SARS-CoV-2 infections. Overall, the present preliminary findings suggest that SARS-CoV-2 infections induce abnormal inflammatory responses in Down syndrome.
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Affiliation(s)
- Ann-Charlotte E Granholm
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Research Complex II, Aurora, CO, USA.
| | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anah Gilmore
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Research Complex II, Aurora, CO, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - William H Yong
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, CA, USA
| | - Sylvia E Perez
- Department of Translational Neuroscience and Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Samuel J Guzman
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Eric D Hamlett
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Elliott J Mufson
- Department of Translational Neuroscience and Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
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Zand MS, Spallina S, Ross A, Zandi K, Pawlowski A, Seplaki CL, Herington J, Corbett AM, Kaukeinen K, Holden-Wiltse J, Freedman EG, Alcantara L, Li D, Cameron A, Beaumont N, Dozier A, Dewhurst S, Foxe JJ. Ventilation during COVID-19 in a school for students with intellectual and developmental disabilities (IDD). PLoS One 2024; 19:e0291840. [PMID: 38568915 PMCID: PMC10990219 DOI: 10.1371/journal.pone.0291840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/21/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 ≥1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure proposed to help mitigate the risk of SARS-CoV-2 infection in schools is increased ventilation. METHODS We established a community-engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 school rooms, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months. RESULTS 97% of rooms had an estimated ACH ≤4.0, with 7% having CO2 levels ≥2,000 ppm for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels ≥1,000 ppm and SARS-CoV-2 PCR tests normalized to room occupancy, accounting for 43% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. Rooms with ventilation systems using MERV-13 filters had lower SARS-CoV-2-positive PCR counts. These findings led to ongoing efforts to upgrade the ventilation systems in this community-engaged research project. CONCLUSIONS There was a statistically significant correlation between the total time of room CO2 concentrations ≥1,000 and SARS-CoV-2 cases in an IDD school. Merv-13 filters appear to decrease the incidence of SARS-CoV-2 infection. This research partnership identified areas for improving in-school ventilation.
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Affiliation(s)
- Martin S. Zand
- Department of Medicine, Division of Nephrology, University of Rochester, Rochester, NY, United States of America
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, United States of America
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States of America
| | - Samantha Spallina
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Alexis Ross
- The Mary Cariola Center, Rochester, NY, United States of America
| | - Karen Zandi
- The Mary Cariola Center, Rochester, NY, United States of America
| | - Anne Pawlowski
- The Mary Cariola Center, Rochester, NY, United States of America
| | - Christopher L. Seplaki
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States of America
- Department of Psychiatry, University of Rochester, Rochester, NY, United States of America
| | - Jonathan Herington
- Department of Health Humanities and Bioethics, University of Rochester, Rochester, NY, United States of America
| | - Anthony M. Corbett
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, United States of America
| | - Kimberly Kaukeinen
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, United States of America
| | - Jeanne Holden-Wiltse
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, United States of America
| | - Edward G. Freedman
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Lisette Alcantara
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, United States of America
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, United States of America
| | - Andrew Cameron
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, United States of America
| | - Nicole Beaumont
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States of America
| | - Stephen Dewhurst
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States of America
| | - John J. Foxe
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
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Magnarelli A, Shalen J, Gutierrez MJ. Cytokine Storm Syndrome Responsive to IL-1 Inhibition in Trisomy 21. Case Rep Pediatr 2024; 2024:9946401. [PMID: 38577256 PMCID: PMC10994700 DOI: 10.1155/2024/9946401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/02/2024] [Accepted: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
Background Cytokine storm syndromes (CSS) are life-threatening systemic inflammatory disorders caused by immune system dysregulation. They can lead to organ failure and are triggered by various factors, including infections, malignancy, inborn errors of immunity, and autoimmune conditions. Trisomy 21 (TS21), also known as Down syndrome, is a genetic disorder associated with immune dysfunction, increased infection susceptibility, and inflammation. While TS21 has been linked to infectious-triggered hyperinflammation, its role as a primary cause of CSS has not been confirmed. Case Presentation. We present a case of a 16-year-old male with TS21 with fever, rash, joint pain, and abdominal symptoms. Extensive investigations ruled out infections, autoimmune conditions, malignancies, and inborn errors of immunity as triggers for a CSS. The patient's symptoms improved with treatment using IL-1 inhibition and corticosteroids. Conclusions This case reinforces that TS21 is an immune dysregulation disorder and highlights the importance of considering CSS in TS21 patients, even when triggers are unclear. The positive response to IL-1 inhibition in this patient suggests that dysregulation of the IL-1 superfamily and the NLRP3 inflammasome may contribute to CSS in TS21. This finding raises the possibility of using IL-1 inhibition as a treatment approach for CSS in TS21 patients.
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Affiliation(s)
- Aimee Magnarelli
- Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Shalen
- Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria J. Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bardhan S, Li H, Tarver E, Schramm C, Brown M, Garcia L, Schwartz B, Mazzucco A, Natarajan N, Walsh E, Ryan L, Pearson G, Parisi MA. The National Institutes of Health INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE (INCLUDE) Project: Accelerating research discoveries for people with Down syndrome across the lifespan. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32081. [PMID: 38197535 PMCID: PMC10939900 DOI: 10.1002/ajmg.c.32081] [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: 10/04/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
The National Institutes of Health (NIH) has a long-standing history of support for research in Down syndrome (DS). In response to a 2018 congressional directive for a trans-NIH initiative to address medical issues in DS, NIH launched the INCLUDE Project (INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE). Reflecting the three INCLUDE components of basic science research, cohort development, and clinical trials, the Project has published funding opportunities to address conditions such as immune disorders and Alzheimer's disease. Due to a steady expansion in dedicated funding over its first 5 years, INCLUDE has invested $258 M in over 250 new research projects. INCLUDE also supports training initiatives to expand the number and diversity of investigators studying DS. NIH has funded an INCLUDE Data Coordinating Center that is collecting de-identified clinical information and multi-omics data from research participants for broad data sharing and secondary analyses. Through the DS-Connect® registry, INCLUDE investigators can access recruitment support. The INCLUDE Research Plan articulates research goals for the program, with an emphasis on diversity of research participants and investigators. Finally, a new Cohort Development Program is poised to increase the impact of the INCLUDE Project by recruiting a large DS cohort across the lifespan.
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Affiliation(s)
- Sujata Bardhan
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, Maryland, USA
| | - Huiqing Li
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Erika Tarver
- National Institute on Aging (NIA), NIH, Bethesda, Maryland, USA
| | - Charlene Schramm
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Marishka Brown
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Linda Garcia
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, Maryland, USA
| | - Bryanna Schwartz
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Anna Mazzucco
- Office of the Director, NIH, Bethesda, Maryland, USA
| | | | - Elizabeth Walsh
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, Maryland, USA
| | - Laurie Ryan
- National Institute on Aging (NIA), NIH, Bethesda, Maryland, USA
| | - Gail Pearson
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Melissa A Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, Maryland, USA
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Pitchan Velammal PNK, Balasubramanian S, Ayoobkhan FS, Mohan GVK, Aggarwal P, Rabaan AA, Khan SA, Yasmin F, Koritala T, Surani SR. COVID-19 in patients with Down syndrome: A systematic review. Immun Inflamm Dis 2024; 12:e1219. [PMID: 38501534 PMCID: PMC10949394 DOI: 10.1002/iid3.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/24/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Down syndrome (DS) is associated with multiple comorbid conditions and chronic immune dysfunction. Persons with DS who contract COVID-19 are at high risk for complications and have a poor prognosis. We aimed to study the clinical symptoms, laboratory and biochemical profiles, radiologic findings, treatment, and outcomes of patients with DS and COVID-19. METHOD We systematically searched PubMed, MEDLINE, Web of Science, Scopus, and the Cochrane Library using the keywords COVID-19 or coronavirus or SARS-CoV-2 and DS or trisomy 21. Seventeen articles were identified: eight case reports and nine case series published from December 2019 through March 2022, with a total of 55 cases. RESULTS Patients averaged 24.8 years (26 days to 60 years); 29 of the patients were male. The most common symptoms were fever, dyspnea, and cough. Gastrointestinal and upper respiratory tract symptoms were commonly reported for pediatric patients. The most common comorbidities present in patients with DS were obesity (49.0%), hypothyroidism (21.6%) and obstructive sleep apnea (15.6%). The patients were hospitalized for a mean of 14.8 days. When the patients were compared with the general COVID-19 population, the mean number of hospitalized days was higher. Most patients had leukopenia, lymphopenia, and elevated inflammatory markers (d-dimer and C-reactive protein). Bilateral infiltrations and bilateral ground-glass opacifications were frequently seen in chest radiographs and chest computed tomographic imaging. Most of the patients were treated with methylprednisolone, macrolides, and hydroxychloroquine. Of the 55 patients, 22 died. The mean age of the patients who died was 42.8 years. Mortality rate was higher in individuals with DS over 40 years of age. CONCLUSION More studies are needed to better understand COVID-19 infections among persons with DS. In addition, the study was limited by a lack of statistical analyses and a specific comparison group.
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Affiliation(s)
| | | | | | - Gautham V. K. Mohan
- Department of MedicineTirunelveli Medical College and HospitalTirunelveliIndia
| | - Pearl Aggarwal
- Department of MedicineSt Vincent Charity Medical CenterClevelandOhioUSA
| | - Ali A. Rabaan
- Department of MedicineJohns Hopkins Aramco HealthcareDhahranSaudi Arabia
- Department of MedicineAlfaisal UniversityRiyadhSaudi Arabia
- Department of MedicineThe University of HaripurHaripurPakistan
| | - Syed A. Khan
- Critical Care MedicineMayo Clinic Health SystemMankatoMinnesotaUSA
| | - Farah Yasmin
- Department of MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Thoyaja Koritala
- Critical Care MedicineMayo Clinic Health SystemMankatoMinnesotaUSA
| | - Salim R. Surani
- Department of Medicine & PharmacologyTexas A&M UniversityCollege StationTexasUSA
- Department of Medicine & PharmacologyResearch Collaborator, Mayo ClinicRochesterMinnesotaUSA
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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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10
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Zand MS, Spallina S, Ross A, Zandi K, Pawlowski A, Seplaki CL, Herington J, Corbett AM, Kaukeinen K, Holden-Wiltse J, Freedman EG, Alcantara L, Li D, Cameron A, Beaumont N, Dozier A, Dewhurst S, Foxe JJ. Ventilation during COVID-19 in a school for students with intellectual and developmental disabilities (IDD). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.08.23295268. [PMID: 37732178 PMCID: PMC10508805 DOI: 10.1101/2023.09.08.23295268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Background This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 ≥1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure proposed to help mitigate the risk of SARS-CoV-2 infection in schools is increased ventilation. Methods We established a community-engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 school rooms, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months. Results 97% of rooms had an estimated ACH ≤4.0, with 7% having CO2 levels ≥2,000 ppm for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels ≥1,000 ppm and SARS-CoV-2 PCR tests normalized to room occupancy, accounting for 43% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. Rooms with ventilation systems using MERV-13 filters had lower SARS-CoV-2-positive PCR counts. These findings led to ongoing efforts to upgrade the ventilation systems in this community-engaged research project. Conclusions There was a statistically significant correlation between the total time of room CO2 concentrations ≥1,000 and SARS-CoV-2 cases in an IDD school. Merv-13 filters appear to decrease the incidence of SARS-CoV-2 infection. This research partnership identified areas for improving in-school ventilation.
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Affiliation(s)
- Martin S. Zand
- Department of Medicine, Division of Nephrology, University of Rochester, Rochester, NY, USA
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Samantha Spallina
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Alexis Ross
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | | | - Christopher L. Seplaki
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
- Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Jonathan Herington
- Department of Health Humanities and Bioethics, University of Rochester, Rochester, NY, USA
| | - Anthony M. Corbett
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Kimberly Kaukeinen
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Jeanne Holden-Wiltse
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Edward G. Freedman
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Lisette Alcantara
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Andrew Cameron
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
| | - Nicole Beaumont
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Stephen Dewhurst
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - John J. Foxe
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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11
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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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12
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Mansfield LM, Lapidus SK, Romero SN, Moorthy LN, Adler-Shohet FC, Hollander M, Cherian J, Twilt M, Lionetti G, Mohan S, DeLaMora PA, Durrant KL, Muskardin TW, Correia Marques M, Onel KB, Dedeoglu F, Gutierrez MJ, Schulert G. Increase in pediatric recurrent fever evaluations during the first year of the COVID-19 pandemic in North America. Front Pediatr 2023; 11:1240242. [PMID: 37601132 PMCID: PMC10435740 DOI: 10.3389/fped.2023.1240242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
The impact of the COVID-19 pandemic on new diagnoses of recurrent fevers and autoinflammatory diseases is largely unknown. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) PFAPA/AID Working Group aimed to investigate the impact of the COVID-19 pandemic on the number of pediatric patients evaluated for recurrent fevers and autoinflammatory diseases in North America. The absolute number of new outpatient visits and the proportion of these visits attributed to recurrent fever diagnoses during the pre-pandemic period (1 March 2019-29 February 2020) and the first year of the COVID-19 pandemic (1 March 2020-28 February 2021) were examined. Data were collected from 27 sites in the United States and Canada. Our results showed an increase in the absolute number of new visits for recurrent fever evaluations in 21 of 27 sites during the COVID-19 pandemic compared to the pre-pandemic period. The increase was observed across different geographic regions in North America. Additionally, the proportion of new visits to these centers for recurrent fever in relation to all new patient evaluations was significantly higher during the first year of the pandemic, increasing from 7.8% before the pandemic to 10.9% during the pandemic year (p < 0.001). Our findings showed that the first year of the COVID-19 pandemic was associated with a higher number of evaluations by pediatric subspecialists for recurrent fevers. Further research is needed to understand the reasons behind these findings and to explore non-infectious triggers for recurrent fevers in children.
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Affiliation(s)
- Leanne M. Mansfield
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Sivia K. Lapidus
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian Health, Hackensack, NJ, United States
| | - Samira Nazzar Romero
- Department of Rheumatology, Nemours Children’s Hospital, Orlando, FL, United States
| | - Lakshmi N. Moorthy
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | | | - Matthew Hollander
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Julie Cherian
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Marinka Twilt
- Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Geraldina Lionetti
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospitals, San Francisco, CA, United States
| | - Smriti Mohan
- Department of Pediatrics, University of Michigan, CS Mott Children’s Hospital, Ann Arbor, MI, United States
| | | | | | | | - Mariana Correia Marques
- National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Karen B. Onel
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Fatma Dedeoglu
- Division of Immunology, Department of Medicine, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Maria J. Gutierrez
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Grant Schulert
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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13
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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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14
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Sellami M, Puce L, Bragazzi NL. Immunological Response to Exercise in Athletes with Disabilities: A Narrative Review of the Literature. Healthcare (Basel) 2023; 11:1692. [PMID: 37372810 DOI: 10.3390/healthcare11121692] [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: 03/14/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
For a person with a disability, participating in sports activities and/or competitions can be a challenge for the immune system. The relationship between exercise and immunity response in disabled athletes is, indeed, extremely complex for several reasons, including (1) the chronic low-grade inflammatory and immunodepression-"secondary immune deficiency"-state imposed by the disability/impairment; (2) the impact of the disability on an array of variables, spanning from physical fitness to well-being, quality of life, sleep, and nutritional aspects, among others, which are known to mediate/modulate the effects of exercise on human health; (3) the variability of the parameters related to the exercise/physical activity (modality, frequency, intensity, duration, training versus competition, etc.); and (4) the intra- and inter-individual variability of the immunological response to exercise. In able-bodied athletes, previously published data described several exercise-induced changes affecting various immunological subsets and subpopulations, ranging from neutrophils to lymphocytes, and monocytes. Broadly, moderate intensity workout is accompanied by optimal immunity and resistance to infections such as upper respiratory tract infections (URTI) in athletes. Periods of intense training with insufficient recovery can cause a temporary state of immunosuppression, which should end with a few days of rest/recovery from exercise. Disabled athletes are relatively overlooked and understudied with respect to their able-bodied counterparts. Findings from the few studies available on paralympic and disabled athletes are here summarized and analyzed utilizing a narrative approach to review and determine the major features of the immunological and inflammatory responses to exercise in this specific population. Moreover, a few studies have reported behavioral, dietary, and training strategies that can be adopted to limit exercise-induced immunosuppression and reduce the risk of infection in people with disabilities. However, given the paucity of data and contrasting findings, future high-quality investigations on paralympic and disabled athletes are urgently needed.
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Affiliation(s)
- Maha Sellami
- Physical Education Department, College of Education, Qatar University, Doha P.O. Box 2713, Qatar
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
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15
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Granholm AC. Long-Term Effects of SARS-CoV-2 in the Brain: Clinical Consequences and Molecular Mechanisms. J Clin Med 2023; 12:3190. [PMID: 37176630 PMCID: PMC10179128 DOI: 10.3390/jcm12093190] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Numerous investigations have demonstrated significant and long-lasting neurological manifestations of COVID-19. It has been suggested that as many as four out of five patients who sustained COVID-19 will show one or several neurological symptoms that can last months after the infection has run its course. Neurological symptoms are most common in people who are less than 60 years of age, while encephalopathy is more common in those over 60. Biological mechanisms for these neurological symptoms need to be investigated and may include both direct and indirect effects of the virus on the brain and spinal cord. Individuals with Alzheimer's disease (AD) and related dementia, as well as persons with Down syndrome (DS), are especially vulnerable to COVID-19, but the biological reasons for this are not clear. Investigating the neurological consequences of COVID-19 is an urgent emerging medical need, since close to 700 million people worldwide have now had COVID-19 at least once. It is likely that there will be a new burden on healthcare and the economy dealing with the long-term neurological consequences of severe SARS-CoV-2 infections and long COVID, even in younger generations. Interestingly, neurological symptoms after an acute infection are strikingly similar to the symptoms observed after a mild traumatic brain injury (mTBI) or concussion, including dizziness, balance issues, anosmia, and headaches. The possible convergence of biological pathways involved in both will be discussed. The current review is focused on the most commonly described neurological symptoms, as well as the possible molecular mechanisms involved.
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Affiliation(s)
- Ann-Charlotte Granholm
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Denver, CO 80045-0511, USA
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16
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Wolf MH, Haugh KL, Taha AA. Down Syndrome Outreach During the COVID-19 Pandemic: An Interprofessional Zoom WhatsApp Collaboration in Syria. J Pediatr Health Care 2023; 37:103-105. [PMID: 36400626 PMCID: PMC9574945 DOI: 10.1016/j.pedhc.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Margaret H Wolf
- Margaret H. Wolf, Assistant Professor of Pediatrics, Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, OR.
| | - Kerry L Haugh
- Margaret H. Wolf, Assistant Professor of Pediatrics, Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, OR.
| | - Asma A Taha
- Asma A. Taha, Professor, School of Nursing & Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, OR.
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17
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Muthuka JK, Oluoch K, Wambura FM, Nzioki JM, Nabaweesi R. HIV and Associated Indicators of COVID-19 Cytokine Release Syndrome: A Meta-Analysis and Meta-Regression. Cureus 2023; 15:e34688. [PMID: 36909058 PMCID: PMC9994766 DOI: 10.7759/cureus.34688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
The aim of this review was to evaluate the risk of COVID-19 cytokine release syndrome (CRS) with HIV infection and meta-regress for indicator covariates. Electronic databases, including Google Scholar, Cochrane Library, Web of Sciences (WOS), EMBASE, Medline/PubMed, COVID-19 Research Database, and Scopus, were systematically searched till February 30, 2022. All human studies were included, irrespective of publication date or region. Eleven studies, with a total of 2,005,274 detailing cytokine release syndrome defined by specific parameters, were included. To pool the estimate, a random-effects model with risk ratio (RR) as the effect measure was used. Moreover, publication bias and sensitivity analysis were evaluated followed by meta-regression analysis to account for any possible covariates. This systematic review, meta-analysis, and meta-regression trial was registered (CRD42021264761) on the PROSPERO register. HIV infection showed an increased risk for COVID-19 cytokine release syndrome (RR= 1.48, 95% CI (1.16, 1.88) (P=0.002)) with substantial heterogeneity (I2 > 80%) and a 4.6% cumulative incidence. The true effects size in 95% of all the comparable populations (prediction interval) fell between 0.67 to 3.29. HIV infection further showed an increased risk for intensive care unit (ICU) admission ((P<0.0001) (I² = 0%)] and mechanical ventilation (MV) ((P=0.04) (I² = 0%)) as the key indicators of cytokine release syndrome. Meta-regression analysis demonstrated that COVID-19 cytokine release syndrome was influenced by the year a study was published (R² = 0.55) and the region from where the study was conducted (R² = 0.11). On meta-regression analysis, the combined impact of all covariates in the model explained at least some of the variance in effect size (Q = 16.21, df = 6, P= 0.0127), and the proportion of variance explained by covariates on comparing the model with and without the covariates was 73 % and highly significant (Tau² = 0.1100, Tau = 0.3317, I² = 86.5%, Q = .99, df = 10, P<0.0001) (R² = 0.73). Our updated meta-analysis indicated that HIV infection was significantly associated with an increased risk for COVID-19 cytokine release syndrome, which, in addition, might be moderated by the year a study was published and the region in which the study was conducted. Further, the risk for intensive care unit (ICU) admission and mechanical ventilation (MV) were identified as the key indicators of cytokine release syndrome. We believe the updated data anchoring cytokine release syndrome will contribute to more substantiation of the findings reported by similar earlier studies.
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Affiliation(s)
- John K Muthuka
- Epidemiology, Public Health & Biostatistics, Jomo Kenyatta University of Agriculture & Technology, Nairobi, KEN.,Public Health Sciences, Kenya Medical Training College, Nairobi, KEN
| | - Kelly Oluoch
- Pharmacy, Kenya Medical Training College, Nairobi, KEN
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18
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Akgun A, Gokcay G, Mungan NO, Sivri HS, Tezer H, Zeybek CA, Ezgu F. Expert-opinion-based guidance for the care of children with lysosomal storage diseases during the COVID-19 pandemic: An experience-based Turkey perspective. Front Public Health 2023; 11:1092895. [PMID: 36794069 PMCID: PMC9922761 DOI: 10.3389/fpubh.2023.1092895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Abstract
This expert-opinion-based document was prepared by a group of specialists in pediatric inherited metabolic diseases and infectious diseases including administrative board members of Turkish Society for Pediatric Nutrition and Metabolism to provide guidance for the care of children with lysosomal storage disorders (LSDs) during the COVID-19 pandemic in Turkey. The experts reached consensus on key areas of focus regarding COVID-19-based risk status in relation to intersecting immune-inflammatory mechanisms and disease patterns in children with LSDs, diagnostic virus testing, particularly preventive measures and priorities during the pandemic, routine screening and diagnostic interventions for LSDs, psychological and socioeconomic impact of confinement measures and quarantines and optimal practice patterns in managing LSDs and/or COVID-19. The participating experts agreed on the intersecting characteristics of immune-inflammatory mechanisms, end-organ damage and prognostic biomarkers in LSD and COVID-19 populations, emphasizing the likelihood of enhanced clinical care when their interaction is clarified via further studies addressing certain aspects related to immunity, lysosomal dysfunction and disease pathogenesis. In the context of the current global COVID-19 pandemic, this expert-opinion-based document provides guidance for the care of children with LSDs during the COVID-19 pandemic based on the recent experience in Turkey.
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Affiliation(s)
- Abdurrahman Akgun
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Gulden Gokcay
- Division of Nutrition and Metabolism, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Onenli Mungan
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Hatice Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Tezer
- Department of Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Cigdem Aktuglu Zeybek
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Fatih Ezgu
- Division of Pediatric Metabolism and Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey,*Correspondence: Fatih Ezgu ✉
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19
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Harasym MC, Raju E, Ayeb-Karlsson S. A global mental health opportunity: How can cultural concepts of distress broaden the construct of immobility? GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2022; 77:102594. [PMID: 36407678 PMCID: PMC9651962 DOI: 10.1016/j.gloenvcha.2022.102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/28/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
(Im)mobility studies often focus on people on the move, neglecting those who stay, are immobile, or are trapped. The duality of the COVID-19 pandemic and the climate crisis creates a global mental health challenge, impacting the most structurally oppressed, including immobile populations. The construct of immobility is investigated in the context of socio-political variables but lacks examination of the clinical psychological factors that impact immobility. Research is beginning to identify self-reported emotions that immobile populations experience through describing metaphors like feeling trapped. This article identifies links in the literature between Cultural Concepts of Distress drawn from transcultural psychiatry and immobility studies. Feeling trapped is described in mental health research widely. Among (im)mobile people and non-mobility contexts, populations experience various mental health conditions from depression to the cultural syndrome, nervios. The connection of feeling trapped to CCD research lends itself to potential utility in immobility research. The conceptualisation can support broadening and deepening the comprehension of this global mental health challenge - how immobile populations' experience feeling trapped. To broaden the analytical framework of immobility and incorporate CCD, evidence is needed to fill the gaps on the psychological aspects of immobility research.
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Affiliation(s)
- Mary C Harasym
- United Nations University Institute for Environment and Human Security (UNU-EHS), Bonn, Germany
| | - Emmanuel Raju
- Global Health Section and Copenhagen Centre for Disaster Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- African Centre for Disaster Studies, North-West University, Potchefstroom, South Africa
| | - Sonja Ayeb-Karlsson
- Institute for Risk and Disaster Reduction, University College London (IRDR), University College London (UCL), London, UK
- United Nations University Institute for Environment and Human Security (UNU-EHS), Bonn, Germany
- School of Global Studies, University of Sussex, Falmer Brighton, UK
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20
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Wang Q, Deng J, Sun J, Zhang H, Liu D, Gao C, Qiu J, Liu W, Qu G, Wen D, Du J, Zhang A, Zeng L, Jiang J. PDGFR kinase inhibitor protects against septic death via regulation of BTLA. SCIENCE CHINA. LIFE SCIENCES 2022; 65:1917-1928. [PMID: 35918604 PMCID: PMC9345782 DOI: 10.1007/s11427-021-2136-y] [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: 03/17/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Sepsis, defined as life-threatening organ failure caused by a dysregulated host response to severe infection, is a major cause of death among intensive care unit patients. Therapies targeting on immunomodulatory is a new research field in sepsis treatment. B- and T-lymphocyte attenuator (BTLA) is an inhibitory costimulatory factor molecule of B and T lymphocytes. Studies have shown that elevated expression of BTLA in lymphocytes can reduce mortality in sepsis, but its regulatory compounds and the underlying mechanism remains to be elucidated. Here, we show that treatment with CP-673451 significantly decreases mortality of septic mouse. CP-673451 is a PDGFR kinase inhibitor which can promote the expression of BTLA, inhibit the release of chemokines such as CXCL13, and reduce first the chemotaxis of B cells to the peripheral blood and vital organs. CP-673451 also inhibits both the release of cytokines and chemokines such as IL-1β, IL-6, IL-10, TNF-α, CCL1, CCL2 and CCL7 and reduces both the chemotactic ability of T cells. This suggests that CP-673451 may prevent septic death by inhibiting lymphocyte chemotaxis and alleviating "cytokine storm". In conclusion, our study provides a new therapeutic target and an effective compound for sepsis treatment.
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Affiliation(s)
- Qiang Wang
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
- Department of Emergency, the Affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, 550001, China
| | - Jin Deng
- Department of Emergency, the Affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, 550001, China
| | - Jianhui Sun
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Huacai Zhang
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Di Liu
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Chu Gao
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Jinchao Qiu
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
- Department of Emergency, the Affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, 550001, China
| | - Wenyi Liu
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Guoxin Qu
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
- Department of Emergency, the Affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, 550001, China
| | - Dalin Wen
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Juan Du
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Anqiang Zhang
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Ling Zeng
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China.
| | - Jianxin Jiang
- Department of Trauma Medical Center, Daping Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China.
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21
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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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22
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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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Magalhães BK, Queiroz F, Salomão MLM, de Godoy MF. The impact of chronic cardiovascular disease on COVID-19 clinical course. J Clin Transl Res 2022; 8:308-322. [PMID: 35991082 PMCID: PMC9389575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background According to previous univariate analyses, chronic cardiovascular disease (CVD) has been associated with worse prognoses in severe cases of coronavirus disease 2019 (COVID-19). However, in the presence of a complex system, such as a human organism, the use of multivariate analyses is more appropriate and there are still few studies with this approach. Aim Using a significant sample of patients hospitalized in a single center, this study aimed to evaluate, whether the presence of CVD was an independent factor in death due to COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We also aimed to identify the clinical and laboratory predictors of death in an isolated group of cardiac patients. Methods This case-control study was conducted with patients admitted to a tertiary hospital and affected by COVID-19 in 2020. Variables were collected from the Brazilian surveillance system of hospitalized cases (SIVEP-Gripe) and electronic medical records. Multivariate logistic regressions with backward elimination were performed to analyze, whether CVD was an independent risk factor for death, and variables with P < 0.05 remained in the final model. Results A total of 2675 patients were analyzed. The median age was 60.4 years, and 55.33% of the patients were male. Odds ratios showed that age (OR 1.059), male sex (OR 1.471), Down syndrome (OR 54.980), diabetes (OR 1.626), asthma (OR 1.995), immunosuppression (OR 2.871), obesity (OR 1.432), chronic lung disease (OR 1.803), kidney disease (OR 1.789), and neurological diseases (OR 2.515) were independently associated with death. Neither the presence of heart disease nor the isolated analysis of each chronic CVD element (systemic arterial hypertension, congenital heart disease, previous acute myocardial infarction and cardiac surgery, obstructive coronary artery disease, valvular heart disease, and pacemaker use) showed as independent risk factors for death. However, an analysis restricted to 489 patients with chronic CVD showed troponin T (TnT) as an independent predictor of death (OR 4.073). Conclusions Neither chronic CVD nor its subcomponents proved to be independent risk factors for death due to SARS-CoV-2 infection. A TnT level of 14 pg/mL was associated with a higher occurrence of death in the isolated group of patients with chronic heart disease. Relevance for Patients Patients with chronic CVD may require more attention in the context of COVID-19 due to higher proportions of these individuals having a more severe progression of disease. However, regarding mortality in these patients, further studies should be conducted concerning comorbidities and acute myocardial injury.
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Affiliation(s)
- Bianca Kajimoto Magalhães
- 1São José do Rio Preto Medical School, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, Brazil,Corresponding author: Bianca Kajimoto Magalhães, Brigadeiro Faria Lima Avenue, 5416 - Vila São Pedro, São José do Rio Preto - SP, 15090-000, Brazil.
| | - Flávia Queiroz
- 2Hospital Epidemiology Center, São José do Rio Preto Foundation Medical School, São José do Rio Preto, Brazil
| | - Maria Lúcia Machado Salomão
- 3Department of Collective Health, São José do Rio Preto Medical School, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, Brazil
| | - Moacir Fernandes de Godoy
- 4Department of Cardiology and Cardiovascular Surgery, São José do Rio Preto Medical School, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, Brazil
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24
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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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25
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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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27
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Atkinson TP. Defective immune response to SARS-CoV-2 immunization in Down syndrome correlates with increased susceptibility to severe illness with infection. J Infect Dis 2022; 226:755-756. [PMID: 35749348 PMCID: PMC9450085 DOI: 10.1093/infdis/jiac237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Prescott Atkinson
- Professor and Director Division of Pediatric Allergy & Immunology University of Alabama at Birmingham
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28
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COVID-19 in an Adult with Down Syndrome: Impact on Autoimmune Response. Case Rep Infect Dis 2022; 2022:6128496. [PMID: 35433064 PMCID: PMC9006075 DOI: 10.1155/2022/6128496] [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: 12/29/2021] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
We here report a case of COVID-19 with effusion prior to the development of pneumonia in an adult with Down syndrome. Serositis due to rheumatic disease was initially suspected because of a high titer of serum autoantibodies and leukocytopenia; however, SARS-CoV-2 infection was confirmed by reverse transcription polymerase chain reaction on admission after previous negative tests. Several cases of COVID-19 have been associated with autoimmune responses along with some cases of COVID-19 with autoimmune manifestations. Furthermore, patients with Down syndrome have a higher mortality risk from COVID-19 than the general population, and it is believed that a high sensitivity to the interferon response may contribute to the increased severity of the disease. Thus, careful attention should be paid to autoimmune manifestations due to SARS-CoV-2 infection for ensuring a proper and timely diagnosis, especially in patients with Down syndrome.
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29
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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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Abstract
The rapid pace of the COVID-19 pandemic precluded traditional approaches to evaluating clinical research and guidelines. We highlight notable successes and pitfalls of clinicians' new approaches to managing evidence amidst an unprecedented crisis. In "Era 1" (early 2020), clinicians relied on anecdote and social media, which democratized conversations on guidelines, but also led clinicians astray. "Era 2" (approximately late 2020 to early 2021) saw preprints that accelerated new interventions but suffered from a surfeit of poor-quality data. In the current era, clinicians consolidate the evidentiary gains of Era 2 with living, online clinical guidelines, but the public suffers from misinformation. The COVID-19 pandemic is a laboratory on how clinicians adapt to an absence of clinical guidance amidst an informational and healthcare crisis. Challenges remain as we integrate new approaches to innovations made in the traditional guideline process to confront both the long tail of COVID-19 and future pandemics.
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31
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Catala A, Stone M, Busch MP, D'Alessandro A. Reprogramming of red blood cell metabolism in Zika virus–infected donors. Transfusion 2022; 62:1045-1064. [PMID: 35285520 PMCID: PMC9086146 DOI: 10.1111/trf.16851] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diseases caused by arthropod-borne viruses remain a burden to global health; in particular, Zika virus (ZIKV) has been reported in 87 countries and territories. In healthy blood donors, ZIKV RNA can be detected in red blood cells (RBCs) months after infection, clearance of detectable nucleic acid in plasma, and seroconversion. However, little information is available on the impact of ZIKV infection to metabolism. STUDY DESIGN AND METHODS We applied mass spectrometry-based metabolomics and lipidomics approaches to investigate the impact of ZIKV infection on RBCs over the course of infection. ZIKV-infected blood donors (n = 25) were identified through molecular and serologic methods, which included nucleic acid amplification testing and real-time polymerase chain reaction (PCR) for detection of ZIKV RNA and enzyme-linked immunosorbent assay (ELISA) for detection of flavivirus-specific IgM and IgG. RESULTS In ZIKV RNA-positive donors, we observed lower glucose and lactate levels, and higher levels of ribose phosphate, suggestive of the activation of the pentose phosphate pathway. The top pathways altered in RBCs from ZIKV-IgM-positive donors include amino acid metabolism and biosynthesis, fatty acid metabolism and biosynthesis, linoleic acid and arachidonate metabolism and glutathione metabolism. RBCs from ZIKV-infected donors had increased levels of early glycolytic metabolites, and higher levels of metabolites of the pentose phosphate pathway. Alterations in acyl-carnitine and fatty acid metabolism are consistent with impaired membrane lipid homeostasis in RBCs from ZIKV IgM positive donors. CONCLUSION RBC from healthy blood donors who had been infected by ZIKV are characterized by long-lasting metabolic alterations even months after infection has resolved.
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Affiliation(s)
- Alexis Catala
- Department of Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora Colorado USA
- Program in Structural Biology and Biochemistry University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Mars Stone
- Vitalant Research Institute San Francisco California USA
- Department of Laboratory Medicine University of California San Francisco San Francisco California USA
| | - Michael P. Busch
- Vitalant Research Institute San Francisco California USA
- Department of Laboratory Medicine University of California San Francisco San Francisco California USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora Colorado USA
- Program in Structural Biology and Biochemistry University of Colorado Anschutz Medical Campus Aurora Colorado USA
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32
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Aghamirza Moghim Aliabadi H, Eivazzadeh‐Keihan R, Beig Parikhani A, Fattahi Mehraban S, Maleki A, Fereshteh S, Bazaz M, Zolriasatein A, Bozorgnia B, Rahmati S, Saberi F, Yousefi Najafabadi Z, Damough S, Mohseni S, Salehzadeh H, Khakyzadeh V, Madanchi H, Kardar GA, Zarrintaj P, Saeb MR, Mozafari M. COVID-19: A systematic review and update on prevention, diagnosis, and treatment. MedComm (Beijing) 2022; 3:e115. [PMID: 35281790 PMCID: PMC8906461 DOI: 10.1002/mco2.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 01/09/2023] Open
Abstract
Since the rapid onset of the COVID-19 or SARS-CoV-2 pandemic in the world in 2019, extensive studies have been conducted to unveil the behavior and emission pattern of the virus in order to determine the best ways to diagnosis of virus and thereof formulate effective drugs or vaccines to combat the disease. The emergence of novel diagnostic and therapeutic techniques considering the multiplicity of reports from one side and contradictions in assessments from the other side necessitates instantaneous updates on the progress of clinical investigations. There is also growing public anxiety from time to time mutation of COVID-19, as reflected in considerable mortality and transmission, respectively, from delta and Omicron variants. We comprehensively review and summarize different aspects of prevention, diagnosis, and treatment of COVID-19. First, biological characteristics of COVID-19 were explained from diagnosis standpoint. Thereafter, the preclinical animal models of COVID-19 were discussed to frame the symptoms and clinical effects of COVID-19 from patient to patient with treatment strategies and in-silico/computational biology. Finally, the opportunities and challenges of nanoscience/nanotechnology in identification, diagnosis, and treatment of COVID-19 were discussed. This review covers almost all SARS-CoV-2-related topics extensively to deepen the understanding of the latest achievements (last updated on January 11, 2022).
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Affiliation(s)
- Hooman Aghamirza Moghim Aliabadi
- Protein Chemistry LaboratoryDepartment of Medical BiotechnologyBiotechnology Research CenterPasteur Institute of IranTehranIran
- Advance Chemical Studies LaboratoryFaculty of ChemistryK. N. Toosi UniversityTehranIran
| | | | - Arezoo Beig Parikhani
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | | | - Ali Maleki
- Department of ChemistryIran University of Science and TechnologyTehranIran
| | | | - Masoume Bazaz
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | | | | | - Saman Rahmati
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | - Fatemeh Saberi
- Department of Medical BiotechnologySchool of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Zeinab Yousefi Najafabadi
- Department of Medical BiotechnologySchool of Advanced Technologies in MedicineTehran University of Medical SciencesTehranIran
- ImmunologyAsthma & Allergy Research InstituteTehran University of Medical SciencesTehranIran
| | - Shadi Damough
- Department of Medical BiotechnologyBiotechnology Research CenterPasteur InstituteTehranIran
| | - Sara Mohseni
- Non‐metallic Materials Research GroupNiroo Research InstituteTehranIran
| | | | - Vahid Khakyzadeh
- Department of ChemistryK. N. Toosi University of TechnologyTehranIran
| | - Hamid Madanchi
- School of MedicineSemnan University of Medical SciencesSemnanIran
- Drug Design and Bioinformatics UnitDepartment of Medical BiotechnologyBiotechnology Research CenterPasteur Institute of IranTehranIran
| | - Gholam Ali Kardar
- Department of Medical BiotechnologySchool of Advanced Technologies in MedicineTehran University of Medical SciencesTehranIran
- ImmunologyAsthma & Allergy Research InstituteTehran University of Medical SciencesTehranIran
| | - Payam Zarrintaj
- School of Chemical EngineeringOklahoma State UniversityStillwaterOklahomaUSA
| | - Mohammad Reza Saeb
- Department of Polymer TechnologyFaculty of ChemistryGdańsk University of TechnologyGdańskPoland
| | - Masoud Mozafari
- Department of Tissue Engineering & Regenerative MedicineIran University of Medical SciencesTehranIran
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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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34
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Kuczborska K, Buda P, Książyk JB. Different Course of SARS-CoV-2 Infection in Two Adolescents With Other Immunosuppressive Factors. Cureus 2022; 14:e22710. [PMID: 35386177 PMCID: PMC8967115 DOI: 10.7759/cureus.22710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 12/31/2022] Open
Abstract
Even after two years of the Coronavirus Disease 2019 (COVID-19) pandemic, despite known risk factors, we are still unable to predict the severity of the infection in specific patients. Due to the contradictory data, the protective role of immunosuppression in preventing the severe course of the infection remains uncertain. Therefore, we want to discuss the influence of several immunosuppressive factors on the COVID-19 pattern in children, based on two case reports regarding 17-year-old boys with other immunosuppressive factors and a completely different course of the disease. The first patient suffered from AIDS, syphilis and primary central nervous system B-cell lymphoma, treated with radiotherapy. He experienced a light path of the infection, presenting only periodically appearing cough with no X-ray inflammatory changes. Nevertheless, due to the risk of severe COVID-19 and transient hypoxia, remdesivir was administered. He remained in a generally good condition and his follow-up did not reveal any noticeable complications. The second patient was characterised by Down syndrome, obesity, polyarteritis nodosa and chronic immunosuppressive therapy. He developed massive pneumonia, required treatment in the intensive care unit with the use of mechanical ventilation, remdesivir and anakinra. Despite the initial improvement of his general condition, including the degree of lung involvement and respiratory function, he developed an intracerebral haemorrhage, leading to brain herniation and ultimately death. In conclusion, HIV infection, oncological and immunosuppressive treatment do not seem to predispose to the severe course of COVID-19, whereas Down syndrome and obesity do.
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Affiliation(s)
- Karolina Kuczborska
- Pediatrics, Nutrition and Metabolic Disorders, Children's Memorial Health Institute, Warsaw, POL
| | - Piotr Buda
- Pediatrics, Nutrition and Metabolic Disorders, Children's Memorial Health Institute, Warsaw, POL
| | - Janusz B Książyk
- Pediatrics, Nutrition and Metabolic Disorders, Children's Memorial Health Institute, Warsaw, POL
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35
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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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Illouz T, Biragyn A, Frenkel-Morgenstern M, Weissberg O, Gorohovski A, Merzon E, Green I, Iulita F, Flores-Aguilar L, Dierssen M, De Toma I, Lifshitz H, Antonarakis SE, Yu E, Herault Y, Potier MC, Botté A, Roper R, Sredni B, Sarid R, London J, Mobley W, Strydom A, Okun E. Specific Susceptibility to COVID-19 in Adults with Down Syndrome. Neuromolecular Med 2021; 23:561-571. [PMID: 33660221 PMCID: PMC7929736 DOI: 10.1007/s12017-021-08651-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022]
Abstract
The current SARS-CoV-2 outbreak, which causes COVID-19, is particularly devastating for individuals with chronic medical conditions, in particular those with Down Syndrome (DS) who often exhibit a higher prevalence of respiratory tract infections, immune dysregulation and potential complications. The incidence of Alzheimer's disease (AD) is much higher in DS than in the general population, possibly increasing further the risk of COVID-19 infection and its complications. Here we provide a biological overview with regard to specific susceptibility of individuals with DS to SARS-CoV-2 infection as well as data from a recent survey on the prevalence of COVID-19 among them. We see an urgent need to protect people with DS, especially those with AD, from COVID-19 and future pandemics and focus on developing protective measures, which also include interventions by health systems worldwide for reducing the negative social effects of long-term isolation and increased periods of hospitalization.
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Affiliation(s)
- Tomer Illouz
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, 5290002, Ramat-Gan, Israel
- The Paul Feder Laboratory On Alzheimer's Disease Research, Bar-Ilan University, 5290002, Ramat-Gan, Israel
| | - Arya Biragyn
- Laboratory of Molecular Biology and Immunology, NIA, Baltimore, MD, 21224, USA
| | - Milana Frenkel-Morgenstern
- Cancer Genomics and BioComputing of Complex Diseases Lab, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orly Weissberg
- Cancer Genomics and BioComputing of Complex Diseases Lab, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alessandro Gorohovski
- Cancer Genomics and BioComputing of Complex Diseases Lab, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eugene Merzon
- Leumit Health Services, Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Ilan Green
- Leumit Health Services, Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Alzheimer-Down Unit, Fundación Catalana Síndrome de Down, Barcelona, Spain
| | | | - Mara Dierssen
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), Barcelona, Spain
| | - Ilario De Toma
- Cellular & Systems Neurobiology, Systems Biology Program, The Barcelona Institute of Science and Technology, Centre for Genomic Regulation (CRG), Dr. Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Hefziba Lifshitz
- School of Education, Bar-Ilan University, 5290002, Ramat-Gan, Israel
| | - Stylianos E Antonarakis
- Department of Genetic Medicine and Development, University of Geneva, 1211, Geneva, Switzerland
- Medigenome, Swiss Institute of Genomic Medicine, 1207, Geneva, Switzerland
- iGE3 Institute of Genetics and Genomics of Geneva, 1211, Geneva, Switzerland
| | - Eugene Yu
- The Children's Guild Foundation Down Syndrome Research Program, Genetics and Genomics Program and Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Genetics, Genomics and Bioinformatics Program, State University of New York At Buffalo, Buffalo, NY, USA
| | - Yann Herault
- Université de Strasbourg, CNRS, INSERM, Institut de Génétique Biologie Moléculaire Et Cellulaire, IGBMC-UMR, 7104 - Inserm U1258, 1 rue Laurent Fries, ILLKIRCH, 67404, Cedex, France
| | - Marie-Claude Potier
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de La Pitié-Salpêtrière, Paris, France
| | - Alexandra Botté
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de La Pitié-Salpêtrière, Paris, France
| | - Randall Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, USA
| | - Benjamin Sredni
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, 5290002, Ramat-Gan, Israel
| | - Ronit Sarid
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de La Pitié-Salpêtrière, Paris, France
| | | | - William Mobley
- Department of Neurosciences, University of California, San Diego, USA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Eitan Okun
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, 5290002, Ramat-Gan, Israel.
- The Paul Feder Laboratory On Alzheimer's Disease Research, Bar-Ilan University, 5290002, Ramat-Gan, Israel.
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, 5290002, Ramat-Gan, Israel.
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Multiple Organ Failure Associated with SARS-CoV-2 Infection in a Child with Down Syndrome: Is Trisomy 21 Associated with an Unfavourable Clinical Course? Case Rep Pediatr 2021; 2021:5893242. [PMID: 34760326 PMCID: PMC8575596 DOI: 10.1155/2021/5893242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Down syndrome (DS) is one of the most frequent genomic disorders around the globe (∼1:700 births). During the COVID-19 pandemic, it has been recognized that children with DS are patients with a greater risk of presenting SARS-CoV-2 infection-related poor outcomes. Nonetheless, a few cases with DS and SARS-CoV-2 infection have been reported. Our aim is to describe the unfavorable clinical course of a child with DS infected with SARS-CoV-2 virus. Case Female, 2 years old, karyotype 47,XX,+21[30], previously diagnosed with a cyanotic congenital heart disease (tricuspid atresia and infundibular pulmonary stenosis, type Ib) who started with diarrhea, developed shortness of breath, and cyanosis and was admitted to the hospital presenting low-oxygen saturation (33%) requiring invasive mechanical ventilation support. The patient tested positive for SARS-CoV-2 infection. During hospitalization, the patient presented hypotension, anuria, retarded capillary filling, and metabolic acidosis; management with vasoactive drugs was needed. Nonetheless, the patient developed respiratory and cardiac failure, acute renal injury (AKIN-III), and septic shock. After 24 days of hospitalization, the patient died. Conclusions Multiple organ failure observed in the patient presented could be related to the triple gene dose of four interferon receptors (IFNAR1, IFNAR2, IFNGR2, and IL10RB) located at 21q22.11. Additionally, overexpression of TMPRSS2 at the pulmonary level, located also at 21q22.3, could be related with an increased susceptibility for the development of SARS-CoV-2 infection in DS patients.
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Danopoulos S, Deutsch GH, Dumortier C, Mariani TJ, Al Alam D. Lung disease manifestations in Down syndrome. Am J Physiol Lung Cell Mol Physiol 2021; 321:L892-L899. [PMID: 34469245 DOI: 10.1152/ajplung.00434.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Down syndrome (DS) is one of the most prevalent chromosomal abnormalities worldwide, affecting 1 in 700 live births. Although multiple organ systems are affected by the chromosomal defects, respiratory failure and lung disease are the leading causes of morbidity and mortality observed in DS. Manifestations of DS in the respiratory system encompass the entire lung starting from the nasopharynx to the trachea/upper airways to the lower airways and alveolar spaces, as well as vascular and lymphatic defects. Most of our knowledge on respiratory illness in persons with DS arises from pediatric studies; however, many of these disorders present early in infancy, supporting developmental mechanisms. In this review, we will focus on the different lung phenotypes in DS, as well as the genetic and molecular pathways that may be contributing to these complications during development.
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Affiliation(s)
- Soula Danopoulos
- Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
| | - Gail H Deutsch
- Seattle Children's Research Institute, Seattle, Washington
| | - Claire Dumortier
- Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
| | - Thomas J Mariani
- Pediatric Molecular and Personalized Medicine Program, University of Rochester, Rochester, New York
| | - Denise Al Alam
- Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
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39
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Pawar RS, Tarkasband VA, Patil RK, Naik AV. Second Episode of Multisystem Inflammatory Syndrome in Children: Relapse, Rebound, or Recurrence? Pediatr Infect Dis J 2021; 40:e452. [PMID: 34232920 DOI: 10.1097/inf.0000000000003249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Rupali Kapil Patil
- Department of Pediatrics, Apple Saraswati Multispeciality Hospital, Kolhapur, Maharashtra, India
| | - Amar Vilas Naik
- Department of Pediatrics, Apple Saraswati Multispeciality Hospital, Kolhapur, Maharashtra, India
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40
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Emes D, Hüls A, Baumer N, Dierssen M, Puri S, Russell L, Sherman SL, Strydom A, Bargagna S, Brandão AC, Costa ACS, Feany PT, Chicoine BA, Ghosh S, Rebillat AS, Sgandurra G, Valentini D, Rohrer TR, Levin J, Lakhanpaul M. COVID-19 in Children with Down Syndrome: Data from the Trisomy 21 Research Society Survey. J Clin Med 2021; 10:5125. [PMID: 34768645 PMCID: PMC8584980 DOI: 10.3390/jcm10215125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022] Open
Abstract
Adults with Down Syndrome (DS) are at higher risk for severe outcomes of coronavirus disease 2019 (COVID-19) than the general population, but evidence is required to understand the risks for children with DS, which is necessary to inform COVID-19 shielding advice and vaccination priorities. We aimed to determine the epidemiological and clinical characteristics of COVID-19 in children with DS. Using data from an international survey obtained from a range of countries and control data from the United States, we compared the prevalence of symptoms and medical complications and risk factors for severe outcomes between DS and non-DS paediatric populations with COVID-19. Hospitalised COVID-19 patients <18 years with DS had a higher incidence of respiratory symptoms, fever, and several medical complications from COVID-19 than control patients without DS <18 years. Older age, obesity, and epilepsy were significant risk factors for hospitalisation among paediatric COVID-19 patients with DS, and age and thyroid disorder were significant risk factors for acute respiratory distress syndrome. Mortality rates were low in all paediatric COVID-19 patients (with and without DS), contrasting with previous findings in adults with DS (who exhibit higher mortality than those without DS). Children with DS are at increased risk for more severe presentations of COVID-19. Efforts should be made to ensure the comprehensive and early detection of COVID-19 in this population and to identify children with DS who present comorbidities that pose a risk for a severe course of COVID-19. Our results emphasize the importance of vaccinating children with DS as soon as they become eligible.
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Affiliation(s)
- David Emes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.H.); (L.R.); (P.T.F.)
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Nicole Baumer
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Mara Dierssen
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, 08003 Barcelona, Spain;
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Shiela Puri
- Down Syndrome Medical Interest Group UK, Leeds Community Healthcare NHS Trust, Teddington TW11 9PS, UK;
| | - Lauren Russell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.H.); (L.R.); (P.T.F.)
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London WC2R 2LS, UK;
- The London Down Syndrome (LonDownS) Consortium, London WC2R 2LS, UK
- South London and the Maudsley NHS Foundation Trust, London WC2R 2LS, UK
| | - Stefania Bargagna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (S.B.); (G.S.)
| | | | - Alberto C. S. Costa
- Departments of Pediatrics and of Psychiatry, School of Medicine, Case Western Reserve University, ACSC, Cleveland, OH 44106, USA;
| | - Patrick T. Feany
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (A.H.); (L.R.); (P.T.F.)
| | | | - Sujay Ghosh
- Cytogenetics and Genomics Research Unit, Department of Zoology, University of Calcutta, Kolkata 700 073, West Bengal, India;
| | | | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy; (S.B.); (G.S.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Diletta Valentini
- Pediatric Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Tilman R. Rohrer
- Division of Pediatric Endocrinology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, 80539 Munich, Germany;
- German Center for Neurodegenerative Diseases, Site Munich, 81377 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Monica Lakhanpaul
- Population, Policy and Practice Department, Great Ormond Street Institute of Child Health, UCL, London WC1N 1EH, UK
- Whittington NHS Trust, London N19 5NF, UK
- Down Syndrome Medical Interest Group, Teddington TW11 9PS, UK
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41
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Chung H, Green PHR, Wang TC, Kong XF. Interferon-Driven Immune Dysregulation in Down Syndrome: A Review of the Evidence. J Inflamm Res 2021; 14:5187-5200. [PMID: 34675597 PMCID: PMC8504936 DOI: 10.2147/jir.s280953] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023] Open
Abstract
Down syndrome (DS) is a unique genetic disease caused by the presence of an extra copy of chromosome 21, which carries four of the six interferon receptor (IFN-R) genes on its long arm. Recent studies reporting higher levels of interferon-stimulated gene (ISG) expression in primary immune cells studied ex vivo have suggested that the additional copies of the IFN-R genes in DS result in mild interferonopathy. In this review, we analyze the potential clinical and immunological impacts of this interferonopathy in DS. We performed a literature review to explore the epidemiology and risks of celiac disease, type 1 diabetes, thyroid dysfunction, mucocutaneous manifestations, infectious diseases (including COVID-19), and Alzheimer’s disease in individuals with DS relative to the general population with or without iatrogenic exposure to interferons. We analyzed immunophenotyping data and the current experimental evidence concerning IFN-R expression, constitutive JAK-STAT activation, and ISG overexpression in DS. Despite the lack of direct evidence that implicating this mild interferonopathy directly in illnesses in individuals with DS, we highlight the challenges ahead and directions that could be taken to determine more clearly the biological impact of interferonopathy on various immune-related conditions in DS.
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Affiliation(s)
- Howard Chung
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens (Queens Hospital Center), Jamaica, NY, 11432, USA
| | - Peter H R Green
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - Timothy C Wang
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Xiao-Fei Kong
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA
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42
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Alldred MJ, Martini AC, Patterson D, Hendrix J, Granholm AC. Aging with Down Syndrome-Where Are We Now and Where Are We Going? J Clin Med 2021; 10:4687. [PMID: 34682809 PMCID: PMC8539670 DOI: 10.3390/jcm10204687] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022] Open
Abstract
Down syndrome (DS) is a form of accelerated aging, and people with DS are highly prone to aging-related conditions that include vascular and neurological disorders. Due to the overexpression of several genes on Chromosome 21, for example genes encoding amyloid precursor protein (APP), superoxide dismutase (SOD), and some of the interferon receptors, those with DS exhibit significant accumulation of amyloid, phospho-tau, oxidative stress, neuronal loss, and neuroinflammation in the brain as they age. In this review, we will summarize the major strides in this research field that have been made in the last few decades, as well as discuss where we are now, and which research areas are considered essential for the field in the future. We examine the scientific history of DS bridging these milestones in research to current efforts in the field. We extrapolate on comorbidities associated with this phenotype and highlight clinical networks in the USA and Europe pursuing clinical research, concluding with funding efforts and recent recommendations to the NIH regarding DS research.
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Affiliation(s)
- Melissa J. Alldred
- Nathan Kline Institute, NYU Grossman Medical School, 140 Old Orangeburg Rd, Orangeburg, NY 10962, USA;
| | - Alessandra C. Martini
- Department of Pathology and Lab. Medicine, University of California Irvine, Irvine, CA 92697, USA;
| | - David Patterson
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO 80208, USA;
| | - James Hendrix
- LuMind IDSC Foundation, 20 Mall Road, Suite 200, Burlington, MA 01801, USA;
| | - Ann-Charlotte Granholm
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO 80208, USA;
- Department of Neurosurgery, CU Anschutz, 12631 East 17th Avenue, Aurora, CO 80045, USA
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43
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Real de Asua D, Mayer MA, Ortega MDC, Borrel JM, Bermejo TDJ, González-Lamuño D, Manso C, Moldenhauer F, Carmona-Iragui M, Hüls A, Sherman SL, Strydom A, de la Torre R, Dierssen M. Comparison of COVID-19 and Non-COVID-19 Pneumonia in Down Syndrome. J Clin Med 2021; 10:3748. [PMID: 34442043 PMCID: PMC8397064 DOI: 10.3390/jcm10163748] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/02/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022] Open
Abstract
Whether the increased risk for coronavirus disease 2019 (COVID-19) hospitalization and death observed in Down syndrome (DS) are disease specific or also occur in individuals with DS and non-COVID-19 pneumonias is unknown. This retrospective cohort study compared COVID-19 cases in persons with DS hospitalized in Spain reported to the Trisomy 21 Research Society COVID-19 survey (n = 86) with admissions for non-COVID-19 pneumonias from a retrospective clinical database of the Spanish Ministry of Health (n = 2832 patients). In-hospital mortality rates were significantly higher for COVID-19 patients (26.7% vs. 9.4%), especially among individuals over 40 and patients with obesity, dementia, and/or epilepsy. The mean length of stay of deceased patients with COVID-19 was significantly shorter than in those with non-COVID-19 pneumonias. The rate of admission to an ICU in patients with DS and COVID-19 (4.3%) was significantly lower than that reported for the general population with COVID-19. Our findings confirm that acute SARS-CoV-2 infection leads to higher mortality than non-COVID-19 pneumonias in individuals with DS, especially among adults over 40 and those with specific comorbidities. However, differences in access to respiratory support might also account for some of the heightened mortality of individuals with DS with COVID-19.
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Affiliation(s)
- Diego Real de Asua
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (D.R.d.A.); (F.M.)
- Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Miguel A. Mayer
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - María del Carmen Ortega
- Department of Psychiatry, Research Institute i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | | | | | - Domingo González-Lamuño
- Department of Pediatrics, University Hospital Marqués de Valdecilla-Universidad de Cantabria, 39008 Santander, Spain;
| | | | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Unit, Department of Internal Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (D.R.d.A.); (F.M.)
- Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - María Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain;
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, 08029 Barcelona, Spain
| | - Anke Hüls
- Department of Epidemiology and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Stephanie L. Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK;
- The London Down Syndrome (LonDownS) Consortium, London, United Kingdom and South London and the Maudsley NHS Foundation Trust, London SE5 8AF, UK
| | - Rafael de la Torre
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Neurosciences Research Programme, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), 08003 Barcelona, Spain
| | - Mara Dierssen
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain;
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, 08003 Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), 08003 Barcelona, Spain
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44
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Robayo-Amortegui H, Valenzuela-Faccini N, Quecano-Rosas C, Zabala-Muñoz D, Perez-Garzon M. Cerebral venous thrombosis in a patient with Down syndrome and coronavirus disease 2019: a case report. J Med Case Rep 2021; 15:364. [PMID: 34253238 PMCID: PMC8273564 DOI: 10.1186/s13256-021-02908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The new coronavirus disease 2019 pandemic has spread throughout most of the world. Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. CASE PRESENTATION We report the case of a Hispanic woman with Down syndrome who has coronavirus disease 2019 and presents as a complication extensive cerebral venous thrombosis. CONCLUSIONS Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. In the absence of clinical and epidemiological data, it is important to carry out further investigation of the risk factors and pathophysiological causes related to the development of cerebrovascular thrombotic events in patients with Down syndrome with coronavirus disease 2019 infection.
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Affiliation(s)
- Henry Robayo-Amortegui
- Critical Medicine and Intensive Care Resident, Universidad de la SabanaFundación Clínica Shaio, Bogotá, Colombia
| | - Natalia Valenzuela-Faccini
- Critical Medicine and Intensive Care Resident, Universidad de la SabanaFundación Clínica Shaio, Bogotá, Colombia
| | - Cesar Quecano-Rosas
- Critical Medicine and Intensive Care Resident, Universidad de la SabanaFundación Clínica Shaio, Bogotá, Colombia
| | - Darlyng Zabala-Muñoz
- Critical Medicine and Intensive Care Resident, Universidad de la SabanaFundación Clínica Shaio, Bogotá, Colombia
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45
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Chen XQ, Xing Z, Chen QD, Salvi RJ, Zhang X, Tycko B, Mobley WC, Yu YE. Mechanistic Analysis of Age-Related Clinical Manifestations in Down Syndrome. Front Aging Neurosci 2021; 13:700280. [PMID: 34276349 PMCID: PMC8281234 DOI: 10.3389/fnagi.2021.700280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/09/2021] [Indexed: 12/15/2022] Open
Abstract
Down syndrome (DS) is the most common genetic cause of Alzheimer's disease (AD) due to trisomy for all or part of human chromosome 21 (Hsa21). It is also associated with other phenotypes including distinctive facial features, cardiac defects, growth delay, intellectual disability, immune system abnormalities, and hearing loss. All adults with DS demonstrate AD-like brain pathology, including amyloid plaques and neurofibrillary tangles, by age 40 and dementia typically by age 60. There is compelling evidence that increased APP gene dose is necessary for AD in DS, and the mechanism for this effect has begun to emerge, implicating the C-terminal APP fragment of 99 amino acid (β-CTF). The products of other triplicated genes on Hsa21 might act to modify the impact of APP triplication by altering the overall rate of biological aging. Another important age-related DS phenotype is hearing loss, and while its mechanism is unknown, we describe its characteristics here. Moreover, immune system abnormalities in DS, involving interferon pathway genes and aging, predispose to diverse infections and might modify the severity of COVID-19. All these considerations suggest human trisomy 21 impacts several diseases in an age-dependent manner. Thus, understanding the possible aging-related mechanisms associated with these clinical manifestations of DS will facilitate therapeutic interventions in mid-to-late adulthood, while at the same time shedding light on basic mechanisms of aging.
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Affiliation(s)
- Xu-Qiao Chen
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
| | - Zhuo Xing
- The Children's Guild Foundation Down Syndrome Research Program, Genetics and Genomics Program and Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Quang-Di Chen
- Department of Communicative Disorders and Sciences and Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, United States
| | - Richard J Salvi
- Department of Communicative Disorders and Sciences and Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, United States
| | - Xuming Zhang
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Benjamin Tycko
- Hackensack-Meridian Health Center for Discovery and Innovation, Nutley, NJ, United States.,Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States
| | - William C Mobley
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
| | - Y Eugene Yu
- The Children's Guild Foundation Down Syndrome Research Program, Genetics and Genomics Program and Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.,Genetics, Genomics and Bioinformatics Program, State University of New York at Buffalo, Buffalo, NY, United States
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46
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Barrantes FJ. The unfolding palette of COVID-19 multisystemic syndrome and its neurological manifestations. Brain Behav Immun Health 2021; 14:100251. [PMID: 33842898 PMCID: PMC8019247 DOI: 10.1016/j.bbih.2021.100251] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 02/07/2023] Open
Abstract
Although our current knowledge of the pathophysiology of COVID-19 is still fragmentary, the information so far accrued on the tropism and life cycle of its etiological agent SARS-CoV-2, together with the emerging clinical data, suffice to indicate that the severe acute pulmonary syndrome is the main, but not the only manifestation of COVID-19. Necropsy studies are increasingly revealing underlying endothelial vasculopathies in the form of micro-haemorrhages and micro-thrombi. Intertwined with defective antiviral responses, dysregulated coagulation mechanisms, abnormal hyper-inflammatory reactions and responses, COVID-19 is disclosing a wide pathophysiological palette. An additional property in categorising the disease is the combination of tissue (e.g. neuro- and vasculo-tropism) with organ tropism, whereby the virus preferentially attacks certain organs with highly developed capillary beds, such as the lungs, gastrointestinal tract, kidney and brain. These multiple clinical presentations confirm that the acute respiratory syndrome as described initially is increasingly unfolding as a more complex nosological entity, a multiorgan syndrome of systemic breadth. The neurological manifestations of COVID-19, the focus of this review, reflect this manifold nature of the disease.
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Affiliation(s)
- Francisco J. Barrantes
- Institute of Biomedical Research (BIOMED), UCA-CONICET, Av. Alicia Moreau de Justo 1600, C1107AFF, Buenos Aires, Argentina
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47
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Arafat A, Sadykova D, Ziatdinov A, Senek S, Samoilova N, Makarova T. COVID-19, Acute Lymphoblastic Leukemia, and Down Syndrome: A Short Review and a Case Report. Case Rep Oncol 2021; 14:1031-1039. [PMID: 34326739 PMCID: PMC8299389 DOI: 10.1159/000516442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 which causes COVID-19 has been a great challenge to treat and deal with; despite strict measures that had been implemented by governments and organizations, worrying rates of morbidity and mortality are still being reported. Although available data have expressed that moderate or even mild forms of the disease are expected amongst most pediatrics cases, minimal data are available on the prognosis and the disease's complications on the immunocompromised, especially oncology patients. We report a case of relapsed precursor B-cell acute lymphoblastic leukemia of a child with Down syndrome and COVID-19 and outline the treatment regimen that we used.
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Affiliation(s)
- Ahmed Arafat
- Kazan State Medical University, Kazan, Russian Federation.,Children's Republican Clinical Hospital, Kazan, Russian Federation
| | - Dinara Sadykova
- Kazan State Medical University, Kazan, Russian Federation.,Children's Republican Clinical Hospital, Kazan, Russian Federation
| | - Ayrat Ziatdinov
- Kazan State Medical University, Kazan, Russian Federation.,Children's Republican Clinical Hospital, Kazan, Russian Federation
| | - Svetlana Senek
- Kazan State Medical University, Kazan, Russian Federation.,Children's Republican Clinical Hospital, Kazan, Russian Federation
| | - Natalya Samoilova
- Kazan State Medical University, Kazan, Russian Federation.,Children's Republican Clinical Hospital, Kazan, Russian Federation
| | - Tamara Makarova
- Kazan State Medical University, Kazan, Russian Federation.,Children's Republican Clinical Hospital, Kazan, Russian Federation
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48
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Illouz T, Biragyn A, Iulita MF, Flores-Aguilar L, Dierssen M, De Toma I, Antonarakis SE, Yu E, Herault Y, Potier MC, Botté A, Roper R, Sredni B, London J, Mobley W, Strydom A, Okun E. Immune Dysregulation and the Increased Risk of Complications and Mortality Following Respiratory Tract Infections in Adults With Down Syndrome. Front Immunol 2021; 12:621440. [PMID: 34248930 PMCID: PMC8267813 DOI: 10.3389/fimmu.2021.621440] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
The risk of severe outcomes following respiratory tract infections is significantly increased in individuals over 60 years, especially in those with chronic medical conditions, i.e., hypertension, diabetes, cardiovascular disease, dementia, chronic respiratory disease, and cancer. Down Syndrome (DS), the most prevalent intellectual disability, is caused by trisomy-21 in ~1:750 live births worldwide. Over the past few decades, a substantial body of evidence has accumulated, pointing at the occurrence of alterations, impairments, and subsequently dysfunction of the various components of the immune system in individuals with DS. This associates with increased vulnerability to respiratory tract infections in this population, such as the influenza virus, respiratory syncytial virus, SARS-CoV-2 (COVID-19), and bacterial pneumonias. To emphasize this link, here we comprehensively review the immunobiology of DS and its contribution to higher susceptibility to severe illness and mortality from respiratory tract infections.
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Affiliation(s)
- Tomer Illouz
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar-Ilan University, Ramat Gan, Israel
| | - Arya Biragyn
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institute of Health, Baltimore, MD, United States
| | - Maria Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Lisi Flores-Aguilar
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada
| | - Mara Dierssen
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), Barcelona, Spain
| | - Ilario De Toma
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), Barcelona, Spain
| | - Stylianos E. Antonarakis
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
- iGE3 Institute of Genetics and Genomics of Geneva, Geneva, Switzerland
| | - Eugene Yu
- The Children’s Guild Foundation Down Syndrome Research Program, Genetics and Genomics Program and Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Genetics, Genomics and Bioinformatics Program, State University of New York at Buffalo, Buffalo, NY, United States
| | - Yann Herault
- Université de Strasbourg, CNRS, INSERM, Institut de Génétique Biologie Moléculaire et Cellulaire, IGBMC - UMR 7104 - Inserm U1258, Illkirch, France
| | - Marie-Claude Potier
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Alexandra Botté
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Randall Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Benjamin Sredni
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | - William Mobley
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Eitan Okun
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar-Ilan University, Ramat Gan, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
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Abstract
BACKGROUND The COVID-19 pandemic necessitated sweeping changes in a neonatal nurse practitioner (NNP) program's approach to distance-accessible learning. Prioritizing student learning and safety, we developed a new alternative model for individualized simulation. METHOD The scenario created for a student to deliver an unexpected diagnosis of trisomy 21, or Down syndrome, to a postpartum mother was redesigned to take place using web-conference technology. RESULTS We successfully transitioned the planned in-person individualized simulation for NNP students delivering an unexpected diagnosis to a web-conference environment and added nurse-midwifery (NM) students. CONCLUSION This simulation presented an authentic clinical situation encountered in practice, supporting the specialty-specific competencies for the NNP, NM, and core competencies for interprofessional collaborative practice. The web-conference platform is an effective strategy for simulation. Advanced practice nurses completing individualized simulation through technology are uniquely poised to leverage these skills as telemedicine increasingly influences their future clinical practice. [J Nurs Educ. 2021;60(6):346-351.].
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Landes SD, Turk MA, Damiani MR, Proctor P, Baier S. Risk Factors Associated With COVID-19 Outcomes Among People With Intellectual and Developmental Disabilities Receiving Residential Services. JAMA Netw Open 2021; 4:e2112862. [PMID: 34100935 PMCID: PMC8188265 DOI: 10.1001/jamanetworkopen.2021.12862] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Although there is evidence of more severe COVID-19 outcomes, there is no information describing the risk factors for COVID-19 diagnosis and/or mortality among people with intellectual and developmental disabilities (IDD) receiving residential support services in the US. OBJECTIVE To identify associations between demographic characteristics, residential characteristics, and/or preexisting health conditions and COVID-19 diagnosis and mortality for people with IDD receiving residential support services. DESIGN, SETTING, AND PARTICIPANTS This cohort study tracked COVID-19 outcomes for 543 individuals with IDD. Participants were receiving support services from a single organization providing residential services in the 5 boroughs of New York City from March 1 to October 1, 2020. Statistical analysis was performed from December 2020 to February 2021. EXPOSURES Resident-level characteristics, including age, sex, race/ethnicity, disability status, residential characteristics, and preexisting medical conditions. MAIN OUTCOMES AND MEASURES COVID-19 diagnosis was confirmed by laboratory test. COVID-19 mortality indicated that the individual died from COVID-19 during the course of the study. Logistic regression models were used to evaluate associations between demographic characteristics, residential characteristics, and preexisting health conditions and COVID-19 diagnosis and mortality. RESULTS Among the 543 individuals with IDD in the study, the median (interquartile range) age was 57.0 (45-65) years; 217 (40.0%) were female, and 274 (50.5%) were Black, Asian/Pacific Islander, American Indian or Alaskan Native, or Hispanic. The case rate was 16 759 (95% CI, 13 853-20 131) per 100 000; the mortality rate was 6446 (95% CI, 4671-8832) per 100 000; and the case-fatality rate was 38.5% (95% CI, 29.1%-48.7%). Increased age (odds ratio [OR], 1.04; 95% CI, 1.02-1.06), Down syndrome (OR, 2.91; 95% CI, 1.49-5.69), an increased number of residents (OR, 1.07; 95% CI, 1.00-1.14), and chronic kidney disease (OR, 4.17; 95% CI, 1.90-9.15) were associated with COVID-19 diagnosis. Heart disease (OR, 10.60; 95% CI, 2.68-41.90) was associated with COVID-19 mortality. CONCLUSIONS AND RELEVANCE This study found that, similar to the general population, increased age and preexisting health conditions were associated with COVID-19 outcomes for people with IDD receiving residential support services in New York City. As with older adults living in nursing homes, number of residents was also associated with more severe COVID-19 outcomes. Unique to people with IDD was an increased risk of COVID-19 diagnosis for people with Down syndrome.
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Affiliation(s)
- Scott D. Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
| | - Margaret A. Turk
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, New York
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