Increased risk of leukaemia in children with Down syndrome: a somatic evolutionary view

Immediate effects of Vojta Therapy on gait ability in down syndrome patients: a pilot study

Background

Vojta Therapy (VT) is a neurorehabilitation approach that targets ontogenetic postural function and automatic body posture control. Research has shown its potential to enhance gait ability. However, limited evidence exists regarding its immediate effects on individuals with Down syndrome (DS).

Objectives

This study aimed to assess the immediate effects of one session VT on spatiotemporal gait parameters in individuals with DS.

Design

A non-randomized pilot study was conducted.

Methods

Sixteen individuals with DS (mean age: 17.88 ± 4.57 years, 8 males) participated in this study. Each received a single VT session administered by an experienced physiotherapist. Spatiotemporal gait parameters before and after VT were analyzed using the Vicon motion capture system.

Results

Significant improvements were observed in walking speed (m/s), cadence (steps/min), right step time (s), step length (cm), stride length (cm), and double support time (%GC) following the VT session (P < 0.05). These findings suggest that VT may offer immediate benefits in improving gait parameters for individuals with DS.

Conclusions

Future large-scale studies with more robust designs are necessary to explore the long-term effects of extended VT programs.

The prevalence of solid tumors and hematologic malignancies among patients with Down syndrome: A systematic review and meta-analysis

BACKGROUND

Patients with Down syndrome (DS) have a unique genetic and clinical profile that may increase the risk of cancer.

METHODS

A literature search on PubMed, Scopus, Web of Science, and the Cochrane databases was conducted, focusing on studies to investigate the prevalence of solid and hematologic tumors in DS.

RESULTS

Fifteen studies were included, encompassing 62,121 individuals with Down syndrome (DS). The overall prevalence of cancer in DS was 2.02 % (95 % CI: 1.63-2.50 %). The analysis of hematological tumors revealed a prevalence of 1.18 % (95 % CI: 0.86 % - 1.62 %) for leukemia, 0.86 % (95 % CI: 0.73 % - 1.01 %) for acute lymphoblastic leukemia, and 0.51 % (95 % CI: 0.29 % - 0.90 %) for acute myeloid leukemia. Among solid tumors, testicular cancer had the highest prevalence, at 0.22 % (95 % CI: 0.12 % - 0.43 %).

CONCLUSIONS

Our results highlight the need for targeted screening strategies, prevention strategies and treatment protocols among those with Down syndrome.

Hematologic Neoplasms Associated with Down Syndrome: Cellular and Molecular Heterogeneity of the Diseases

The molecular basis of Down syndrome (DS) predisposition to leukemia is not fully understood but involves various factors such as chromosomal abnormalities, oncogenic mutations, epigenetic alterations, and changes in selection dynamics. Myeloid leukemia associated with DS (ML-DS) is preceded by a preleukemic phase called transient abnormal myelopoiesis driven by GATA1 gene mutations and progresses to ML-DS via additional mutations in cohesin genes, CTCF, RAS, or JAK/STAT pathway genes. DS-related ALL (ALL-DS) differs from non-DS ALL in terms of cytogenetic subgroups and genetic driver events, and the aberrant expression of CRLF2, JAK2 mutations, and RAS pathway-activating mutations are frequent in ALL-DS. Recent advancements in single-cell multi-omics technologies have provided unprecedented insights into the cellular and molecular heterogeneity of DS-associated hematologic neoplasms. Single-cell RNA sequencing and digital spatial profiling enable the identification of rare cell subpopulations, characterization of clonal evolution dynamics, and exploration of the tumor microenvironment's role. These approaches may help identify new druggable targets and tailor therapeutic interventions based on distinct molecular profiles, ultimately improving patient outcomes with the potential to guide personalized medicine approaches and the development of targeted therapies.

Leukemogenesis in infants and young children with trisomy 21

Children with Down syndrome (DS) have a greater than 100-fold increased risk of developing acute myeloid leukemia (ML) and an approximately 30-fold increased risk of acute lymphoblastic leukemia (ALL) before their fifth birthday. ML-DS originates in utero and typically presents with a self-limiting, neonatal leukemic syndrome known as transient abnormal myelopoiesis (TAM) that is caused by cooperation between trisomy 21-associated abnormalities of fetal hematopoiesis and somatic N-terminal mutations in the transcription factor GATA1. Around 10% of neonates with DS have clinical signs of TAM, although the frequency of hematologically silent GATA1 mutations in DS neonates is much higher (~25%). While most cases of TAM/silent TAM resolve without treatment within 3 to 4 months, in 10% to 20% of cases transformation to full-blown leukemia occurs within the first 4 years of life when cells harboring GATA1 mutations persist and acquire secondary mutations, most often in cohesin genes. By contrast, DS-ALL, which is almost always B-lineage, presents after the first few months of life and is characterized by a high frequency of rearrangement of the CRLF2 gene (60%), often co-occurring with activating mutations in JAK2 or RAS genes. While treatment of ML-DS achieves long-term survival in approximately 90% of children, the outcome of DS-ALL is inferior to ALL in children without DS. Ongoing studies in primary cells and model systems indicate that the role of trisomy 21 in DS leukemogenesis is complex and cell context dependent but show promise in improving management and the treatment of relapse, in which the outcome of both ML-DS and DS-ALL remains poor.

Parental occupational exposure to combustion products, metals, silica and asbestos and risk of childhood leukaemia: Findings from the Childhood Cancer and Leukaemia International Consortium (CLIC)

Parental occupational exposures around conception (father) or during pregnancy (mother) have been hypothesized as potential predisposing factors for childhood leukaemia. We investigated parental exposure to several known occupational carcinogens and childhood leukaemia risk. We conducted a pooled analysis using case-control data from four European countries (3362 childhood leukemia cases and 6268 controls). Parental occupational exposures to polycyclic aromatic hydrocarbons (PAH), diesel engine exhaust (DEE), chromium, nickel, crystalline silica, and asbestos were assessed by a general population job-exposure matrix. We estimated odd ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models for all childhood leukaemia combined, by leukaemia type (ALL and AML) and by ALL subtype (B-lineage and T-lineage). We found an association between high paternal occupational exposure to crystalline silica and childhood ALL (OR 2.20, CI 1.60-3.01) with increasing trend from no exposure to high exposure (P = <0.001), and also for AML (OR 2.03, CI 1.04-3.97; P for trend = 0.008). ORs were similar for B- and T-lineage ALL. For ALL, ORs were also slightly elevated with wide confidence intervals for high paternal occupational exposure to chromium (OR 1.23, CI 0.77-1.96), and DEE (OR 1.21, CI 0.82-1.77). No associations were observed for paternal exposures to nickel, PAH and asbestos. For maternal occupational exposure we found several slightly elevated odds ratios but mostly with very wide confidence intervals due to low numbers of exposed mothers. This is a first study suggesting an association between fathers' occupational exposure to crystalline silica and an increased risk of childhood leukaemia in their offspring. As this association was driven by certain occupations (field crop farmers and miners) where other potentially relevant exposures like pesticides and radon may also occur, more research is needed to confirm our findings of an association with crystalline silica, and if so, mechanistic studies to understand the pathways.