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Dimopoulos K, Constantine A, Clift P, Condliffe R, Moledina S, Jansen K, Inuzuka R, Veldtman GR, Cua CL, Tay ELW, Opotowsky AR, Giannakoulas G, Alonso-Gonzalez R, Cordina R, Capone G, Namuyonga J, Scott CH, D’Alto M, Gamero FJ, Chicoine B, Gu H, Limsuwan A, Majekodunmi T, Budts W, Coghlan G, Broberg CS, Constantine A, Clift P, Condliffe R, Moledina S, Jansen K. Cardiovascular Complications of Down Syndrome: Scoping Review and Expert Consensus. Circulation 2023; 147:425-441. [PMID: 36716257 PMCID: PMC9977420 DOI: 10.1161/circulationaha.122.059706] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in individuals with Down syndrome. Congenital heart disease is the most common cardiovascular condition in this group, present in up to 50% of people with Down syndrome and contributing to poor outcomes. Additional factors contributing to cardiovascular outcomes include pulmonary hypertension; coexistent pulmonary, endocrine, and metabolic diseases; and risk factors for atherosclerotic disease. Moreover, disparities in the cardiovascular care of people with Down syndrome compared with the general population, which vary across different geographies and health care systems, further contribute to cardiovascular mortality; this issue is often overlooked by the wider medical community. This review focuses on the diagnosis, prevalence, and management of cardiovascular disease encountered in people with Down syndrome and summarizes available evidence in 10 key areas relating to Down syndrome and cardiac disease, from prenatal diagnosis to disparities in care in areas of differing resource availability. All specialists and nonspecialist clinicians providing care for people with Down syndrome should be aware of best clinical practice in all aspects of care of this distinct population.
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Affiliation(s)
- Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.D., A.C.).,National Heart and Lung Institute, Imperial College London, United Kingdom (K.D., A.C.)
| | - Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (K.D., A.C.).,National Heart and Lung Institute, Imperial College London, United Kingdom (K.D., A.C.)
| | - Paul Clift
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, United Kingdom (P.C.)
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom (R.C.)
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom (S.M.).,Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (K.J.).,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (K.J.)
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital, Japan (R.I.)
| | - Gruschen R. Veldtman
- Scottish Adult Congenital Cardiac Service, Golden Jubilee Hospital, Glasgow, Scotland, United Kingdom (G.R.V.)
| | - Clifford L. Cua
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH (C.L.C.)
| | - Edgar Lik Wui Tay
- Department of Cardiology, National University Hospital Singapore (E.T.L.W.)
| | - Alexander R. Opotowsky
- The Heart Institute, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, OH (A.R.O.)
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital School of Medicine, Aristotle University of Thessaloniki, Greece (G.G.)
| | - Rafael Alonso-Gonzalez
- Division of Cardiology, Toronto General Hospital, University Health Network, Peter Munk Cardiovascular Center, University of Toronto, Canada (R.A.-G.).,Toronto Adult Congenital Heart Disease Program, Canada (R.A.-G.)
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, New South Wales, Australia (R.C.)
| | - George Capone
- Down Syndrome Clinical and Research Center, Kennedy Krieger Institute, Baltimore, MD (G. Capone).,Johns Hopkins School of Medicine, Baltimore, MD (G. Capone)
| | - Judith Namuyonga
- Department of Paediatric Cardiology, Uganda Heart Institute, Kampala (J.N.).,Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda (J.N.)
| | | | - Michele D’Alto
- Department of Cardiology, University “L. Vanvitelli”–Monaldi Hospital, Naples, Italy (M.D.)
| | - Francisco J. Gamero
- Department of Cardiovascular Surgery, Benjamin Bloom Children’s Hospital, El Salvador (F.J.G.)
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL (B.C.)
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China (H.G.)
| | - Alisa Limsuwan
- Division of Pediatric Cardiology, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (A.L.)
| | - Tosin Majekodunmi
- Department of Cardiology, Euracare Multi-specialist Hospital, Nigeria (T.M.)
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Science, Catholic University Leuven, Belgium (W.B.)
| | - Gerry Coghlan
- Department of Cardiology, Royal Free Hospital, London, United Kingdom (G. Coghlan)
| | - Craig S. Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (C.S.B.)
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Chaipongpun N, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, Traisrisilp K, Jatavan P, Sirilert S, Tongsong T. Performance of Serum Quad Test in Screening for Fetal Down Syndrome in a Large-Scale Unselected Population in a Developing Country. Int J Public Health 2023; 68:1605441. [PMID: 37089793 PMCID: PMC10114521 DOI: 10.3389/ijph.2023.1605441] [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: 09/29/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Objective: To assess the effectiveness of Quad test in the detection of Down syndrome (DS) in routine practice among a large-scale population and to compare the effectiveness of Quad test based on the Western reference model (WM) and that based on Thai reference model (TM). Methods: Quad test was performed on 42,769 pregnancies at 14-21 weeks. The fetal risk of DS derived from Quad test was automatically computed based on WM and used in evaluating the effectiveness. Also, the fetal risk was calculated based on the TM. Results: Of 39,740 women with complete follow-ups including 74 fetuses with DS, with WM, the detection and false positive rates were 81.1% and 7.2%, respectively, whereas the detection and false positive rates with TM were 87.8%, and 6.8%, respectively. According to ROC curves, the performance of Quad test based on TM was slightly but significantly better than that based on WM (AUC of 0.959 vs. 0.940, p = 0.001). Conclusion: Quad test is highly effective in service settings and suitable for developing countries and the effectiveness is even higher when based on ethnicity-specific reference model.
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3
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Alassaf A. Natal Teeth in an Infant With Down Syndrome: A Rare Presentation With a Genetic Evaluation and Review of the Literature. Cureus 2022; 14:e30101. [DOI: 10.7759/cureus.30101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
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4
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Baksh RA, Strydom A, Pape SE, Chan LF, Gulliford MC. Susceptibility to COVID-19 Diagnosis in People with Down Syndrome Compared to the General Population: Matched-Cohort Study Using Primary Care Electronic Records in the UK. J Gen Intern Med 2022; 37:2009-2015. [PMID: 35386043 PMCID: PMC8985744 DOI: 10.1007/s11606-022-07420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, people with Down syndrome (DS) have experienced a more severe disease course and higher mortality rates than the general population. It is not yet known whether people with DS are more susceptible to being diagnosed with COVID-19. OBJECTIVE To explore whether DS is associated with increased susceptibility to COVID-19. DESIGN Matched-cohort study design using anonymised primary care electronic health records from the May 2021 release of Clinical Practice Research Datalink (CPRD) Aurum. SETTING Electronic health records from approximately 1400 general practices (GPs) in England. PARTICIPANTS 8854 people with DS and 34,724 controls matched for age, gender and GP who were registered on or after the 29th January 2020. MEASUREMENTS The primary outcome was COVID-19 diagnosis between January 2020 and May 2021. Conditional logistic regression models were fitted to estimate associations between DS and COVID-19 diagnosis, adjusting for comorbidities. RESULTS Compared to controls, people with DS were more likely to be diagnosed with COVID-19 (7.4% vs 5.6%, p ≤ 0.001, odds ratio (OR) = 1.35; 95% CI = 1.23-1.48). There was a significant interaction between people with DS and a chronic respiratory disease diagnosis excluding asthma and increased odds of a COVID-19 diagnosis (OR = 1.71; 95% CI = 1.20-2.43), whilst adjusting for a number of comorbidities. CONCLUSION Individuals with DS are at increased risk for contracting COVID-19. Those with underlying lung conditions are particularly vulnerable during viral pandemics and should be prioritised for vaccinations.
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Affiliation(s)
- R Asaad Baksh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. .,The LonDowns Consortium, London, UK.
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Sarah E Pape
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,The LonDowns Consortium, London, UK
| | - Li F Chan
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, London, UK
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, London, UK
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CILHOROZ B, RECENO C, HEFFERNAN K, DERUISSEAU L. Cardiovascular Physiology and Pathophysiology in Down Syndrome. Physiol Res 2022; 71:1-16. [DOI: 10.33549/physiolres.934791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Down Syndrome (Ds) is the most common chromosomal cause of intellectual disability that results from triplication of chromosome 21 genes. Individuals with Ds demonstrate cognitive deficits in addition to comorbidities including cardiac defects, pulmonary arterial hypertension (PAH), low blood pressure (BP), and differences in autonomic regulation. Many individuals with Ds are born with heart malformations and some can be surgically corrected. Lower BP at rest and in response to exercise and other stressors are a prevalent feature in Ds. These reduced cardiovascular responses may be due to underlying autonomic dysfunction and have been implicated in lower exercise/work capacity in Ds, which is an important correlate of morbidity, mortality and quality of life. Exercise therapy can be beneficial to normalize autonomic function and may help prevent the development of co-morbidities in Ds. We will review cardiovascular physiology and pathophysiology in individuals with Ds, along with exercise therapy and special considerations for these individuals.
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Affiliation(s)
- B CILHOROZ
- Department of Exercise Sciences, Syracuse University, Syracuse, New York, USA
| | - C RECENO
- Department of Exercise Science and Athletic Training, Ithaca, New York, USA
| | - K HEFFERNAN
- Department of Exercise Sciences, Syracuse University, Syracuse, New York, USA
| | - L DERUISSEAU
- Department of Exercise Sciences, Syracuse University, Syracuse, New York, USA
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6
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Islam NN, Sumit AF, Chowdhury MM, Ullah MA, Araf Y, Sarkar B, Gozal D. Age and gender-related differences in quality of life of Bangladeshi patients with Down Syndrome: A cross-sectional study. Heliyon 2022; 8:e08777. [PMID: 35097229 PMCID: PMC8783120 DOI: 10.1016/j.heliyon.2022.e08777] [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: 05/28/2021] [Revised: 08/28/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
Currently available screening instruments for evaluation of individuals with intellectual disabilities do not capture all the complications associated with Down Syndrome (DS). Here, we examined age and gender-specific variability revolving around major challenges related to ophthalmologic and auditory health, social integration, daily life, and behavioral problems in 468 (age: 2–84 years) individuals with DS living in all eight divisions of Bangladesh. More than half of the children presented with significant difficulty in walking or other targeted movements compared with 37.9% of adolescents (p = 0.03). Nearly 70% of children exhibited communication difficulties, particularly revolving around the understanding of speech, comprehending or learning tasks or new materials, and in expressing thoughts in words or behaviors (p = 0.003–0.006). Uncontrolled urination was frequent and predominantly found among children (p = 0.04). No significant differences were present in females vs. males except for concern about physical appearance (females: 58.5% vs. males: 47.5%; p = 0.02). The severity of DS was associated with intellectual performance, communication difficulties, and self-sufficiency (i.e., uncontrolled micturition or bowel movements) but not with psychotic, ophthalmologic, auditory, or motor skills-related problems. Increased awareness of DS phenotypic profiles among professionals and caregivers can foster earlier detection and counselling and help formulate appropriate interventions to reduce long-term sequelae and enhance cognitive and behavioral developmental outcomes.
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Affiliation(s)
- Nafisa Nawal Islam
- Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Dhaka 1342, Bangladesh
| | - Ahmed Faisal Sumit
- Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Md Mottakin Chowdhury
- Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Dhaka 1342, Bangladesh
| | - Md Asad Ullah
- Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Dhaka 1342, Bangladesh
| | - Yusha Araf
- Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Bishajit Sarkar
- Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Dhaka 1342, Bangladesh
| | - David Gozal
- Department of Child Health, MU Women's and Children's Hospital, University of Missouri School of Medicine, Columbia, MO, United States
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7
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Zhang Y, Tian Z, Ye S, Mu Q, Wang X, Ren S, Hou X, Yu W, Guo J. Changes in bone mineral density in Down syndrome individuals: a systematic review and meta-analysis. Osteoporos Int 2022; 33:27-37. [PMID: 34383099 DOI: 10.1007/s00198-021-06070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Data evaluating changes in bone mineral density (BMD) in Down syndrome (DS) individuals remains controversial. Therefore, we conducted a systematic review and meta-analysis to better understand associations between BMD and DS. A systematic literature search of PubMed, EMBASE, Web of Science, and the Cochrane Library up until 1st January 2021 was conducted. We used the keywords "bone mineral density" and "Down Syndrome." Fifteen studies were included. Overall, our results showed a significant decrease in BMD of total body (TB BMD) [MD = - 0.18; 95% CI (- 0.23 and - 0.12), P < 0.00001, I2 = 89%], total hip (TH BMD) [MD = - 0.12; 95% CI (- 0.15 and - 0.10), P < 0.00001, I2 = 0%], lumbar spine (LS BMD) [MD = - 0.12; 95% CI (- 0.14 and - 0.09), P < 0.00001, I2 = 18%], and femoral neck (FN BMD) [MD = - 0.08; 95% CI (- 0.10 and - 0.06), P < 0.00001, I2 = 0%] in DS individuals when compared with controls. Moreover, the volumetric BMD of lumbar spine (LS vBMD) [MD = - 0.01; 95% CI (- 0.02 and - 0.01), P = 0.0004, I2 = 19%] also showed a decreasing tendency while the volumetric BMD of the femoral neck (FN vBMD) [MD = 0.01; 95% CI (0.00 and 0.02), P = 0.02, I2 = 0%] was elevated in DS individuals versus controls. These findings demonstrated that individuals with DS had a decreased total and regional (TH, LS, and FN) BMD when compared with the general population. Additionally, when BMD was adjusted for skeletal volume, LS vBMD was also lower, while FN vBMD was elevated in DS individuals versus controls.
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Affiliation(s)
- Y Zhang
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - Z Tian
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China
| | - S Ye
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - Q Mu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China
| | - X Wang
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China
| | - S Ren
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - X Hou
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China
| | - W Yu
- Department of Central Laboratory & Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, 100044, China.
| | - J Guo
- Department of Pediatric, Peking University People's Hospital, Beijing, 100044, China.
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8
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Watanabe M, Kibe C, Sugawara M, Miyake H. Courtesy stigma of parents of children with Down syndrome: Adaptation process and transcendent stage. J Genet Couns 2021; 31:746-757. [PMID: 34951509 PMCID: PMC9415099 DOI: 10.1002/jgc4.1541] [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: 04/29/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022]
Abstract
Courtesy stigma, which arises from close connections to people with stigmatized characteristics, negatively affects interpersonal relations. This study aimed to evaluate courtesy stigma and the adaptation process of parents of children with Down syndrome based on semi-structured interviews with 23 Japanese parents. The interview themes were (a) negatively perceived interpersonal experiences and coping strategies; (b) information disclosure and others' responses; and (c) positively perceived interpersonal experiences. The interview data were transcribed and analyzed based on a grounded theory approach. The results suggested that parents perceived and experienced multidimensional courtesy stigma, and they used various coping strategies categorized in combinations of passive-active and internal-external. All parents disclosed information about their child's diagnosis to others, and reverse disclosure (i.e., revealing own relations with people with disabilities) was characteristically observed thereafter. Through active interaction and reflection, the parents cultivated social relationships, compassion, world views, and community involvement, which led to the transcendent stage. However, internal conflict as a mediator between people with and without Down syndrome re-emerged even after achieving the transcendent stage. These findings could help to develop interventions in genetic counseling for parents to deal with interpersonal relationship difficulties.
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Affiliation(s)
- Motoko Watanabe
- Department of Clinical Genetics, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Institute for Human Life Innovation, Ochanomizu University, Tokyo, Japan
| | - Chieko Kibe
- Center for Institutional Research, Educational Development, and Learning Support, Ochanomizu University, Tokyo, Japan
| | - Masumi Sugawara
- Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, Tokyo, Japan
| | - Hidehiko Miyake
- Institute for Human Life Innovation, Ochanomizu University, Tokyo, Japan.,Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
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9
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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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10
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Laignier MR, Lopes-Júnior LC, Santana RE, Leite FMC, Brancato CL. Down Syndrome in Brazil: Occurrence and Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211954. [PMID: 34831710 PMCID: PMC8620277 DOI: 10.3390/ijerph182211954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022]
Abstract
Background: Down syndrome is the most frequent genetic cause of intellectual disability, with an estimated birth prevalence of 14 per 10,000 live births. In Brazil, statistical data on the occurrence of babies born with Down syndrome remain unclear. We aimed to estimate the occurrence of Down syndrome between 2012 and 2018, and to observe its association with maternal, gestational, paternal characteristics, and newborn vitality. Methods: A retrospective study was carried out using secondary data included in the Certificate of Live Birth in a state located in the southeastern region of Brazil. Data analysis was performed in the software Stata 14.1. Pearson’s chi-square test for bivariate analysis, and logistic regression for multivariate analysis were performed, with a 95% confidence interval (CI) and a significance of 5%. Results: We observed that 157 cases of Down syndrome were reported among 386,571 live births, representing an incidence of 4 in 10,000 live births. Down syndrome was associated with maternal age ≥ 35 years, paternal age ≥ 30 years, the performance of six or more prenatal consultations, prematurity, and low birth weight (p < 0.05). Conclusions: Women aged 35 and over were more likely to have children born with Down syndrome. In addition, there is an association of Down syndrome with premature birth, low birth weight, and the number of prenatal consultations (≥6).
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Affiliation(s)
- Mariana Rabello Laignier
- Nursing Department at the Health Sciences Center, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (L.C.L.-J.); (F.M.C.L.)
- Correspondence:
| | - Luís Carlos Lopes-Júnior
- Nursing Department at the Health Sciences Center, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (L.C.L.-J.); (F.M.C.L.)
| | - Raquel Esperidon Santana
- Associação de Pais, Amigos e Pessoas com Síndrome de Down do Espírito Santo, Vitória 29075-910, Brazil; (R.E.S.); (C.L.B.)
| | - Franciéle Marabotti Costa Leite
- Nursing Department at the Health Sciences Center, Universidade Federal do Espírito Santo, Vitória 29075-910, Brazil; (L.C.L.-J.); (F.M.C.L.)
| | - Carolina Laura Brancato
- Associação de Pais, Amigos e Pessoas com Síndrome de Down do Espírito Santo, Vitória 29075-910, Brazil; (R.E.S.); (C.L.B.)
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11
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Thomas JR, Sloan K, Cave K, Wallace JM, Roper RJ. Skeletal Deficits in Male and Female down Syndrome Model Mice Arise Independent of Normalized Dyrk1a Expression in Osteoblasts. Genes (Basel) 2021; 12:1729. [PMID: 34828335 PMCID: PMC8624983 DOI: 10.3390/genes12111729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 01/11/2023] Open
Abstract
Trisomy 21 (Ts21) causes alterations in skeletal development resulting in decreased bone mass, shortened stature and weaker bones in individuals with Down syndrome (DS). There is a sexual dimorphism in bone mineral density (BMD) deficits associated with DS with males displaying earlier deficits than females. The relationships between causative trisomic genes, cellular mechanisms, and influence of sex in DS skeletal abnormalities remain unknown. One hypothesis is that the low bone turnover phenotype observed in DS results from attenuated osteoblast function, contributing to impaired trabecular architecture, altered cortical geometry, and decreased mineralization. DYRK1A, found in three copies in humans with DS, Ts65Dn, and Dp1Tyb DS model mice, has been implicated in the development of postnatal skeletal phenotypes associated with DS. Reduced copy number of Dyrk1a to euploid levels from conception in an otherwise trisomic Ts65Dn mice resulted in a rescue of appendicular bone deficits, suggesting DYRK1A contributes to skeletal development and homeostasis. We hypothesized that reduction of Dyrk1a copy number in trisomic osteoblasts would improve cellular function and resultant skeletal structural anomalies in trisomic mice. Female mice with a floxed Dyrk1a gene (Ts65Dn,Dyrk1afl/wt) were mated with male Osx-Cre+ (expressed in osteoblasts beginning around E13.5) mice, resulting in reduced Dyrk1a copy number in mature osteoblasts in Ts65Dn,Dyrk1a+/+/Osx-Cre P42 male and female trisomic and euploid mice, compared with littermate controls. Male and female Ts65Dn,Dyrk1a+/+/+ (3 copies of DYRK1A in osteoblasts) and Ts65Dn,Dyrk1a+/+/Osx-Cre (2 copies of Dyrk1a in osteoblasts) displayed similar defects in both trabecular architecture and cortical geometry, with no improvements with reduced Dyrk1a in osteoblasts. This suggests that trisomic DYRK1A does not affect osteoblast function in a cell-autonomous manner at or before P42. Although male Dp1Tyb and Ts65Dn mice exhibit similar skeletal deficits at P42 in both trabecular and cortical bone compartments between euploid and trisomic mice, female Ts65Dn mice exhibit significant cortical and trabecular deficits at P42, in contrast to an absence of genotype effect in female Dp1Tyb mice in trabecular bone. Taken together, these data suggest skeletal deficits in DS mouse models and are sex and age dependent, and influenced by strain effects, but are not solely caused by the overexpression of Dyrk1a in osteoblasts. Identifying molecular and cellular mechanisms, disrupted by gene dosage imbalance, that are involved in the development of skeletal phenotypes associated with DS could help to design therapies to rescue skeletal deficiencies seen in DS.
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Affiliation(s)
- Jared R. Thomas
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
| | - Kourtney Sloan
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
| | - Kelsey Cave
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
| | - Joseph M. Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Randall J. Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (J.R.T.); (K.S.); (K.C.)
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12
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Trisomy of Human Chromosome 21 Orthologs Mapping to Mouse Chromosome 10 Cause Age and Sex-Specific Learning Differences: Relevance to Down Syndrome. Genes (Basel) 2021; 12:genes12111697. [PMID: 34828303 PMCID: PMC8618694 DOI: 10.3390/genes12111697] [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: 10/04/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 02/08/2023] Open
Abstract
Down syndrome (DS), trisomy of human chromosome 21 (Hsa21), is the most common genetic cause of intellectual disability. The Dp10(1)Yey (Dp10) is a mouse model of DS that is trisomic for orthologs of 25% of the Hsa21 protein-coding genes, the entirety of the Hsa21 syntenic region on mouse chromosome 10. Trisomic genes include several involved in brain development and function, two that modify and regulate the activities of sex hormones, and two that produce sex-specific phenotypes as null mutants. These last four are the only Hsa21 genes with known sexually dimorphic properties. Relatively little is known about the potential contributions to the DS phenotype of segmental trisomy of Mmu10 orthologs. Here, we have tested separate cohorts of female and male Dp10 mice, at 3 and 9 months of age, in an open field elevated zero maze, rotarod, and balance beam, plus the learning and memory tasks, spontaneous alternation, puzzle box, double-H maze, context fear conditioning, and acoustic startle/prepulse inhibition, that depend upon the function of the prefrontal cortex, striatum, hippocampus, and cerebellum. We show that there are age and sex-specific differences in strengths and weaknesses, suggesting that genes within the telomere proximal region of Hsa21 influence the DS phenotype.
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13
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Ahmed MM, Block A, Busquet N, Gardiner KJ. Context Fear Conditioning in Down Syndrome Mouse Models: Effects of Trisomic Gene Content, Age, Sex and Genetic Background. Genes (Basel) 2021; 12:genes12101528. [PMID: 34680922 PMCID: PMC8535510 DOI: 10.3390/genes12101528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 01/20/2023] Open
Abstract
Down syndrome (DS), trisomy of the long arm of human chromosome 21 (Hsa21), is the most common genetic cause of intellectual disability (ID). Currently, there are no effective pharmacotherapies. The success of clinical trials to improve cognition depends in part on the design of preclinical evaluations in mouse models. To broaden understanding of the common limitations of experiments in learning and memory, we report performance in context fear conditioning (CFC) in three mouse models of DS, the Dp(16)1Yey, Dp(17)1Yey and Dp(10)1Yey (abbreviated Dp16, Dp17 and Dp10), separately trisomic for the human Hsa21 orthologs mapping to mouse chromosomes 16, 17 and 10, respectively. We examined female and male mice of the three lines on the standard C57BL/6J background at 3 months of age and Dp17 and Dp10 at 18 months of age. We also examined female and male mice of Dp17 and Dp10 at 3 months of age as F1 hybrids obtained from a cross with the DBA/2J background. Results indicate that genotype, sex, age and genetic background affect CFC performance. These data support the need to use both female and male mice, trisomy of sets of all Hsa21 orthologs, and additional ages and genetic backgrounds to improve the reliability of preclinical evaluations of drugs for ID in DS.
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Affiliation(s)
- Md. Mahiuddin Ahmed
- Department of Neurology, Linda Crnic Institute for Down Syndrome, University of Colorado Alzheimer’s and Cognition Center, Aurora, CO 80045, USA;
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Aaron Block
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Nicolas Busquet
- Department of Neurology, Animal Behavior and In Vivo Neurophysiology Core, NeuroTechnology Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Katheleen J. Gardiner
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- Correspondence:
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14
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Ponroy Bally B, Murai KK. Astrocytes in Down Syndrome Across the Lifespan. Front Cell Neurosci 2021; 15:702685. [PMID: 34483840 PMCID: PMC8416355 DOI: 10.3389/fncel.2021.702685] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Down Syndrome (DS) is the most common genetic cause of intellectual disability in which delays and impairments in brain development and function lead to neurological and cognitive phenotypes. Traditionally, a neurocentric approach, focusing on neurons and their connectivity, has been applied to understanding the mechanisms involved in DS brain pathophysiology with an emphasis on how triplication of chromosome 21 leads to alterations in neuronal survival and homeostasis, synaptogenesis, brain circuit development, and neurodegeneration. However, recent studies have drawn attention to the role of non-neuronal cells, especially astrocytes, in DS. Astrocytes comprise a large proportion of cells in the central nervous system (CNS) and are critical for brain development, homeostasis, and function. As triplication of chromosome 21 occurs in all cells in DS (with the exception of mosaic DS), a deeper understanding of the impact of trisomy 21 on astrocytes in DS pathophysiology is warranted and will likely be necessary for determining how specific brain alterations and neurological phenotypes emerge and progress in DS. Here, we review the current understanding of the role of astrocytes in DS, and discuss how specific perturbations in this cell type can impact the brain across the lifespan from early brain development to adult stages. Finally, we highlight how targeting, modifying, and/or correcting specific molecular pathways and properties of astrocytes in DS may provide an effective therapeutic direction given the important role of astrocytes in regulating brain development and function.
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Affiliation(s)
- Blandine Ponroy Bally
- Centre for Research in Neuroscience, Department of Neurology and Neurosurgery, Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - Keith K Murai
- Centre for Research in Neuroscience, Department of Neurology and Neurosurgery, Brain Repair and Integrative Neuroscience Program, Research Institute of the McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
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15
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Michie M. Is preparation a good reason for prenatal genetic testing? Ethical and critical questions. Birth Defects Res 2021; 112:332-338. [PMID: 32115901 DOI: 10.1002/bdr2.1651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/09/2022]
Abstract
As prenatal genetic testing technologies have become both easier and more accessible, women are increasingly choosing prenatal genetic testing for a reason that is largely unexamined in the clinical literature: preparation. This reasoning, offered not only from pregnant women but frequently from testing laboratories and health care providers, reflects long-held assumptions that prenatal genetic results-properly delivered and followed with information, clinical surveillance, and/or social supports-prepare families for a child with a genetic condition, and even improve health and social outcomes for children and families. But these assumptions remain unexamined, since there are no clear definitions or recommendations for prenatal preparation. Preparation may refer to several overlapping ways in which prenatal information may change parents' approach to the rest of the pregnancy, including: (a) clinical activities, including surveillance, interventions, and delivery planning; (b) social and informational support, such as interacting with patient support groups and gathering information about quality of life; and (c) psychological "coping" or adjustments to the reality of raising a child with a genetic condition. These meanings and activities intersect and influence one another and form a foundation for postnatal family adaptation, but they are rarely parsed out in studies examining the impact of prenatal diagnosis. Based on previous work delineating conceptual models as middle terms between theory and reality, we are building a conceptual model that incorporates an empirical understanding of meanings and actions encompassed by prenatal preparation. Comparing diverse families' expectations with the resources they are offered can identify (mis)matches between priorities and approaches.
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Affiliation(s)
- Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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16
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Rafferty K, Archer KJ, Turner K, Brown R, Jackson-Cook C. Trisomy 21-associated increases in chromosomal instability are unmasked by comparing isogenic trisomic/disomic leukocytes from people with mosaic Down syndrome. PLoS One 2021; 16:e0254806. [PMID: 34283872 PMCID: PMC8291705 DOI: 10.1371/journal.pone.0254806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/05/2021] [Indexed: 12/17/2022] Open
Abstract
Down syndrome, which results from a trisomic imbalance for chromosome 21, has been associated with 80+ phenotypic traits. However, the cellular changes that arise in somatic cells due to this aneuploid condition are not fully understood. The primary aim of this study was to determine if germline trisomy 21 is associated with an increase in spontaneous somatic cell chromosomal instability frequencies (SCINF). To achieve this aim, we quantified SCINF in people with mosaic Down syndrome using a cytokinesis-blocked micronucleus assay. By comparing values in their isogenic trisomic/disomic cells, we obtained a measure of differences in SCINF that are directly attributable to a trisomy 21 imbalance, since differential effects attributable to "background" genetic factors and environmental exposures could be eliminated. A cross-sectional assessment of 69 people with mosaic Down syndrome (ages 1 to 44; mean age of 12.84 years) showed a significantly higher frequency of micronuclei in their trisomic (0.37 ± 0.35 [mean ± standard deviation]) compared to disomic cells (0.18 ± 0.11)(P <0.0001). The daughter binucleates also showed significantly higher levels of abnormal patterns in the trisomic (1.68 ± 1.21) compared to disomic (0.35 ± 0.45) cells (P <0.0001). Moreover, a significant Age x Cell Type interaction was noted (P = 0.0113), indicating the relationship between age and SCINF differed between the trisomic and disomic cells. Similarly, a longitudinal assessment (mean time interval of 3.9 years; range of 2 to 6 years) of 18 participants showed a mean 1.63-fold increase in SCINF within individuals over time for their trisomic cells (P = 0.0186), compared to a 1.13-fold change in their disomic cells (P = 0.0464). In summary, these results showed a trisomy 21-associated, age-related increase in SCINF. They also underscore the strength of the isogenic mosaic Down syndrome model system for "unmasking" cellular changes arising from a trisomy 21 imbalance.
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Affiliation(s)
- Kelly Rafferty
- Department of Human & Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Kellie J. Archer
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Kristi Turner
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Ruth Brown
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Colleen Jackson-Cook
- Department of Human & Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, United States of America
- * E-mail:
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17
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Sleep Disorders in Adults with Down Syndrome. J Clin Med 2021; 10:jcm10143012. [PMID: 34300177 PMCID: PMC8306783 DOI: 10.3390/jcm10143012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Sleep disorders, despite being very frequent in adults with Down syndrome (DS), are often overlooked due to a lack of awareness by families and physicians and the absence of specific clinical sleep guidelines. Untreated sleep disorders have a negative impact on physical and mental health, behavior, and cognitive performance. Growing evidence suggests that sleep disruption may also accelerate the progression to symptomatic Alzheimer’s disease (AD) in this population. It is therefore imperative to have a better understanding of the sleep disorders associated with DS in order to treat them, and in doing so, improve cognition and quality of life, and prevent related comorbidities. This paper reviews the current knowledge of the main sleep disorders in adults with DS, including evaluation and management. It highlights the existing gaps in knowledge and discusses future directions to achieve earlier diagnosis and better treatment of sleep disorders most frequently found in this population.
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18
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The Association between Sex and Risk of Alzheimer's Disease in Adults with Down Syndrome. J Clin Med 2021; 10:jcm10132966. [PMID: 34279450 PMCID: PMC8268850 DOI: 10.3390/jcm10132966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Sex differences in the risk of Alzheimer’s Disease (AD) in adults with Down Syndrome (DS) have not been extensively investigated, and existing studies have found conflicting results. This study examined the effect of sex on the risk of AD in adults with DS, adjusted for covariates. Methods: Adults with DS were assessed longitudinally for the development of AD. Competing risk survival analyses were used to determine the effect of sex alone and after adjustment for APOE-ε4 status, ethnicity, and level of intellectual disability (ID). Results: Sex differences were significant only in adults over 60 years of age, where men with DS were 6.32 (95% CI: 2.11–18.96, p < 0.001) times more likely to develop AD compared with age-matched women with DS. Conclusions: There is an age-associated effect of sex on the risk of AD, with men over 60 years old having six times the risk of AD compared with age-matched women, independent of APOE-ε4 status, ethnicity, and level of ID.
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19
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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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20
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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: 20] [Impact Index Per Article: 6.7] [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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21
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Abstract
PURPOSE Down syndrome (DS) is caused by trisomy 21 (Ts21) and results in skeletal deficits including shortened stature, low bone mineral density, and a predisposition to early onset osteoporosis. Ts21 causes significant alterations in skeletal development, morphology of the appendicular skeleton, bone homeostasis, age-related bone loss, and bone strength. However, the genetic or cellular origins of DS skeletal phenotypes remain unclear. RECENT FINDINGS New studies reveal a sexual dimorphism in characteristics and onset of skeletal deficits that differ between DS and typically developing individuals. Age-related bone loss occurs earlier in the DS as compared to general population. Perturbations of DS skeletal quality arise from alterations in cellular and molecular pathways affected by the overexpression of trisomic genes. Sex-specific alterations occur in critical developmental pathways that disrupt bone accrual, remodeling, and homeostasis and are compounded by aging, resulting in increased risks for osteopenia, osteoporosis, and fracture in individuals with DS.
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Affiliation(s)
- Jared R Thomas
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 West Michigan Street, SL 306, Indianapolis, IN, 46202-3275, USA
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, 723 West Michigan Street, SL 306, Indianapolis, IN, 46202-3275, USA.
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22
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Inhibitory Dimensions and Delay of Gratification: A Comparative Study on Individuals with Down Syndrome and Typically Developing Children. Brain Sci 2021; 11:brainsci11050636. [PMID: 34069218 PMCID: PMC8156003 DOI: 10.3390/brainsci11050636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
While previous research on inhibition in people with Down syndrome (DS) reported contradictory results, with no explicit theoretical model, on the other hand, a more homogeneous impaired profile on the delay of gratification skills emerged. The main goal of the present study was to investigate response inhibition, interference suppression, and delay of gratification in 51 individuals with DS matched for a measure of mental age (MA) with 71 typically developing (TD) children. Moreover, we cross-sectionally explored the strengths and weaknesses of these components in children and adolescents vs. adults with DS with the same MA. A battery of laboratory tasks tapping on inhibitory sub-components and delay of gratification was administrated. Results indicated that individuals with DS showed an overall worse performance compared to TD children on response inhibition and delay of gratification, while no differences emerged between the two samples on the interference suppression. Additionally, our results suggested that older individuals with DS outperformed the younger ones both in response inhibition and in the delay of gratification, whereas the interference suppression still remains impaired in adulthood. This study highlights the importance of evaluating inhibitory sub-components considering both MA and chronological age in order to promote more effective and evidence-based training for this population.
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Chicoine B, Rivelli A, Fitzpatrick V, Chicoine L, Jia G, Rzhetsky A. Prevalence of Common Disease Conditions in a Large Cohort of Individuals With Down Syndrome in the United States. J Patient Cent Res Rev 2021; 8:86-97. [PMID: 33898640 DOI: 10.17294/2330-0698.1824] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Given the current life expectancy and number of individuals living with Down syndrome (DS), it is important to learn common occurrences of disease conditions across the developmental lifespan. This study analyzed data from a large cohort of individuals with DS in an effort to better understand these disease conditions, inform future screening practices, tailor medical care guidelines, and improve utilization of health care resources. Methods This retrospective, descriptive study incorporated up to 28 years of data, compiled from 6078 individuals with DS and 30,326 controls matched on age and sex. Data were abstracted from electronic medical records within a large Midwestern health system. Results In general, individuals with DS experienced higher prevalence of testicular cancer, leukemias, moyamoya disease, mental health conditions, bronchitis and pneumonia, gastrointestinal conditions, thyroid disorder, neurological conditions, atlantoaxial subluxation, osteoporosis, dysphagia, diseases of the eyes/adnexa and of the ears/mastoid process, and sleep apnea, relative to matched controls. Individuals with DS experienced lower prevalence of solid tumors, heart disease conditions, sexually transmitted diseases, HIV, influenza, sinusitis, urinary tract infections, and diabetes. Similar rates of prevalence were seen for lymphomas, skin melanomas, stroke, acute myocardial infarction, hepatitis, cellulitis, and osteoarthritis. Conclusions While it is challenging to draw a widespread conclusion about comorbidities in individuals with Down syndrome, it is safe to conclude that care for individuals with DS should not automatically mirror screening, prevention, or treatment guidelines for the general U.S. population. Rather, care for those with DS should reflect the unique needs and common comorbidities of this population.
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Affiliation(s)
- Brian Chicoine
- Advocate Aurora Health, Downers Grove, IL.,Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
| | - Anne Rivelli
- Advocate Aurora Health, Downers Grove, IL.,Advocate Aurora Research Institute, Downers Grove, IL
| | - Veronica Fitzpatrick
- Advocate Aurora Health, Downers Grove, IL.,Advocate Aurora Research Institute, Downers Grove, IL
| | - Laura Chicoine
- Advocate Aurora Health, Downers Grove, IL.,Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
| | - Gengjie Jia
- Department of Medicine, University of Chicago, Chicago, IL.,Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL
| | - Andrey Rzhetsky
- Department of Medicine, University of Chicago, Chicago, IL.,Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL
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Perrot A, Maillot P, Le Foulon A, Rebillat AS. Effect of Exergaming on Physical Fitness, Functional Mobility, and Cognitive Functioning in Adults With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:34-44. [PMID: 33370786 DOI: 10.1352/1944-7558-126.1.34] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/25/2020] [Indexed: 06/12/2023]
Abstract
This study examined whether exergames could improve physical, functional, and cognitive functions in people with Down syndrome. Twelve adults with DS, aged over 35 (M = 50.35, SD = 7.45), were randomly assigned to a Wii-based program (n = 6) or a control group (n = 6), and completed physical (Chair Stand Test, 6-Minute Walk Test), functional (TUG, TUDS), and cognitive tests (Corsi, Barrage tests). The experimental group completed a 12-week Wii-based program. There was high intervention adherence and, compared with the control group, greater improvements were observed in the Wii-based exercise intervention group in physical fitness and functional outcomes (p < .05), with no changes in cognitive outcomes.
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Affiliation(s)
- Alexandra Perrot
- Alexandra Perrot, Université Paris-Saclay CIAMS, 91405, Orsay, France - Université d'Orléans, CIAMS, 45067, Orléans, France
| | - Pauline Maillot
- Pauline Maillot and Agnès Lefoulon, Université de Paris, Paris, France
| | - Agnès Le Foulon
- Pauline Maillot and Agnès Lefoulon, Université de Paris, Paris, France
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25
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The association between obesity and sedentary behavior or daily physical activity among children with Down's syndrome aged 7-12 years in Japan: A cross-sectional study. Heliyon 2020; 6:e04861. [PMID: 32964158 PMCID: PMC7490823 DOI: 10.1016/j.heliyon.2020.e04861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/03/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background An assessment of the adverse health effects of obesity in children with Down's syndrome (DS) is required to develop programs that facilitate the acquisition of healthy behaviors. Individuals with DS are often obese. These individuals must develop health related behaviors in childhood. For this reason, it is necessary to clarify the factors associated with obesity in children with DS. Aims This study had two purposes. The first was to assess the obesity and to evaluate the sedentary behavior (SB) and physical activity of Japanese elementary school children with Down's syndrome. The second was to investigate the association between obesity and SB or moderate to vigorous physical activity (MVPA). Methods and procedures Ninety-three children (male/female: 51/42) with DS in elementary school grades 1 to 6 (aged 7–12 years) participated in this study in Japan. Physical characteristics were obtained from the questionnaire completed by their parents. The questionnaire provided information on regular school checkups. SB and MVPA were evaluated using a triaxial accelerometer. Results Approximately 20% of the children with DS were obese. Nearly half of the children with DS achieved 60 min of MVPA. SB time was significantly longer in the upper grades (aged 11–12 years) than in the lower grades (aged 7–8 years). Comparing weekdays and weekend days, the middle (aged 9–10 years) and upper grades had significantly shorter MVPA times on weekend days. The frequency of obesity was significantly associated with shorter MVPA times in the lower grades and longer SB time in the middle grades. Conclusions and implications Children with DS may increase their SB time as their age group (grade category) increases. Increasing opportunities for MVPA during weekends may increase physical activity. The observed relationship between obesity and SB time or MVPA time may apply only to younger and middle grade children with DS. Further investigation is necessary to confirm these relationships.
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Coentro VS, Geddes DT, Perrella SL. Altered sucking dynamics in a breastfed infant with Down syndrome: a case report. Int Breastfeed J 2020; 15:71. [PMID: 32799897 PMCID: PMC7429689 DOI: 10.1186/s13006-020-00318-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The health and developmental advantages of human milk and breastfeeding are particularly important for infants with Down syndrome. However, they typically have shorter breastfeeding duration due to sucking issues that are not well understood. This case report describes serial measures of milk transfer volumes, sucking dynamics and tongue movement in a breastfeeding infant with Down syndrome. Management of maternal milk production enabled feeding of only breast milk until maturation of breastfeeding skills and the achievement of full breastfeeding by 6 months. CASE PRESENTATION The mother of a term infant with Down syndrome and no associated health complications presented with concerns regarding adequacy of milk removal at the breast and low milk supply. We monitored sucking dynamics during breastfeeding by measuring intraoral vacuum strength, nutritive and non-nutritive suck rates and burst durations, and tongue movement using submental ultrasound. Breastfeeds were monitored at 4, 10, 14, 19 and 24 weeks, and maternal 24 h milk production was measured at 4, 10 and 24 weeks postpartum. We observed a weaker suck strength and shorter nutritive suck duration, and atypical tongue movement up to 19 weeks, with low milk transfer volumes. Regular breast expression was effective in increasing maternal milk production, providing expressed milk for all complementary feeds. Full breastfeeding was achieved by 6 months when reference sucking values were observed. CONCLUSIONS This case report illustrates that infants with Down syndrome may have low intraoral vacuum and limited nutritive sucking that persists for several months, likely due to delayed oro-motor development. In the absence of effective sucking human milk feeding can continue when milk production is stimulated with frequent and adequate breast expression. It is possible for infants with Down syndrome and no associated health complications to eventually establish full breastfeeding. Mothers that wish to breastfeed their infant with Down syndrome require anticipatory guidance and continuing lactation and family support.
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Affiliation(s)
- Viviane Silva Coentro
- School of Molecular Sciences, The University of Western Australia, M310, 35 Stirling Highway, Crawley, 6008, Western Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, M310, 35 Stirling Highway, Crawley, 6008, Western Australia
| | - Sharon L Perrella
- School of Molecular Sciences, The University of Western Australia, M310, 35 Stirling Highway, Crawley, 6008, Western Australia.
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de Gonzalo-Calvo D, Barroeta I, Nan MN, Rives J, Garzón D, Carmona-Iragui M, Benejam B, Videla L, Fernández S, Altuna M, Valldeneu S, Blesa R, Lleó A, Blanco-Vaca F, Fortea J, Tondo M. Evaluation of biochemical and hematological parameters in adults with Down syndrome. Sci Rep 2020; 10:13755. [PMID: 32792619 PMCID: PMC7426851 DOI: 10.1038/s41598-020-70719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022] Open
Abstract
Down syndrome (DS) is the most common worldwide cause of intellectual disability of genetic origin and the most common chromosomal disorder affecting live-born infants. In addition to intellectual disability, individuals with DS have other comorbidities and complex medical conditions. The increase in the life expectancy of patients with DS requires expanding the knowledge about their clinical characteristics and related laboratory parameters. Several studies exploring laboratory tests in DS patients exist, but their focus is limited to specific areas of metabolism. Therefore, our main goal was to describe the biochemical and hematological findings in a DS cohort and to compare the values to those of a control population. A total of 248 DS individuals and 84 control subjects were enrolled. DS individuals had a higher frequency of several clinical conditions compared to control individuals and presented with significant differences with respect to the controls in both biochemical and hematological parameters. We found age- and sex-related differences in several of the parameters. A good understanding of the differences in our cohort might be of aid in the clinical follow-up of adults with DS, especially considering that the lifespan of DS individuals may reach 60 years of age in developed countries.
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Affiliation(s)
- David de Gonzalo-Calvo
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Institute of Biomedical Research of Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona, Spain.,Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Madalina Nicoleta Nan
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - José Rives
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Diana Garzón
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - María Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Bessy Benejam
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Sílvia Valldeneu
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Francisco Blanco-Vaca
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain.,Center of Biomedical Investigation Network for Diabetes and Metabolic Diseases (CIBERDEM), Madrid, Spain.,Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Mireia Tondo
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain.
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Down syndrome, accelerated aging and immunosenescence. Semin Immunopathol 2020; 42:635-645. [PMID: 32705346 PMCID: PMC7666319 DOI: 10.1007/s00281-020-00804-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/29/2020] [Indexed: 12/11/2022]
Abstract
Down syndrome is the most common chromosomal disorder, associated with moderate to severe intellectual disability. While life expectancy of Down syndrome population has greatly increased over the last decades, mortality rates are still high and subjects are facing prematurely a phenomenon of atypical and accelerated aging. The presence of an immune impairment in Down syndrome subjects is suggested for a long time by the existence of an increased incidence of infections, the incomplete efficacy of vaccinations, and a high prevalence of autoimmunity. Immunologic abnormalities have been described since many years in this population, both from a numerical and a functional points of view, and these abnormalities can mirror the ones observed during normal aging. In this review, we summarize our knowledge on immunologic disturbances commonly observed in subjects with Down syndrome, and in innate and adaptive immunity, as well as regarding chronic inflammation. We then discuss the role of accelerated aging in these observed abnormalities and finally review the potential age-associated molecular and cellular mechanisms involved.
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Shields N, Willis C, Imms C, Prendergast LA, Watts JJ, van Dorsselaer B, McKenzie G, Bruder AM, Taylor NF. FitSkills: protocol for a stepped wedge cluster randomised trial of a community-based exercise programme to increase participation among young people with disability. BMJ Open 2020; 10:e037153. [PMID: 32641337 PMCID: PMC7348474 DOI: 10.1136/bmjopen-2020-037153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION There is a need to develop relevant, acceptable initiatives that facilitate physical activity participation in young people with disability. FitSkills was developed to support young people with disability to exercise. The primary aims are to investigate if FitSkills can be scaled up from a small, university-led programme to run as a larger community-university partnership programme, and to determine its effectiveness in improving physical activity participation and health-related quality of life for young people with disability. The secondary aims are to evaluate cost-effectiveness, changes in attitudes towards disability and other health-related outcomes for young people with disability. METHODS AND ANALYSIS A stepped wedge cluster randomised trial using a cohort design and embedded health economic evaluation will compare the effect of FitSkills with a control phase. FitSkills matches a young person with disability with a student mentor and the pair exercise together at their local gymnasium for 1 hour, two times per week for 12 weeks (24 sessions in total). One hundred and sixty young people with disability aged 13 to 30 years will be recruited. Eight community gymnasia will be recruited and randomised into four cluster units to have FitSkills introduced at 3-month intervals. Primary (feasibility, participation and health-related quality of life) and secondary outcomes will be collected longitudinally every 3 months from trial commencement, with eight data collection time points in total. The Practical Robust Implementation and Sustainability Model will be used to support knowledge translation and implementation of project findings into policy and practice. ETHICS AND DISSEMINATION Ethical approval was obtained from the La Trobe University Human Ethics Committee (HEC17-012), Australian Catholic University (2017-63R), Deakin University (2017-206) and the Victorian Department of Education and Training (2018_003616). Results will be disseminated through published manuscripts, conference presentations, public seminars and practical resources for stakeholder groups. TRIAL REGISTRATION NUMBER ACTRN12617000766314. TRIAL SPONSOR La Trobe University.
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Affiliation(s)
- Nora Shields
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Claire Willis
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer J Watts
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Ben van Dorsselaer
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Georgia McKenzie
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Andrea M Bruder
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, VIC, Australia
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
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30
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Thomas JR, LaCombe J, Long R, Lana-Elola E, Watson-Scales S, Wallace JM, Fisher EMC, Tybulewicz VLJ, Roper RJ. Interaction of sexual dimorphism and gene dosage imbalance in skeletal deficits associated with Down syndrome. Bone 2020; 136:115367. [PMID: 32305495 PMCID: PMC7262595 DOI: 10.1016/j.bone.2020.115367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/01/2020] [Accepted: 04/14/2020] [Indexed: 12/17/2022]
Abstract
All individuals with Down syndrome (DS), which results from trisomy of human chromosome 21 (Ts21), present with skeletal abnormalities typified by craniofacial features, short stature and low bone mineral density (BMD). Differences in skeletal deficits between males and females with DS suggest a sexual dimorphism in how trisomy affects bone. Dp1Tyb mice contain three copies of all of the genes on mouse chromosome 16 that are homologous to human chromosome 21, males and females are fertile, and therefore are an excellent model to test the hypothesis that gene dosage influences the sexual dimorphism of bone abnormalities in DS. Dp1Tyb as compared to control littermate mice at time points associated with bone accrual (6 weeks) and skeletal maturity (16 weeks) showed deficits in BMD and trabecular architecture that occur largely through interactions between sex and genotype and resulted in lower percent bone volume in all female and Dp1Tyb male mice. Cortical bone in Dp1Tyb as compared to control mice exhibited different changes over time influenced by sex × genotype interactions including reduced cortical area in both male and female Dp1Tyb mice. Mechanical testing analyses suggested deficits in whole bone properties such as bone mass and geometry, but improved material properties in female and Dp1Tyb mice. Sexual dimorphisms and the influence of trisomic gene dosage differentially altered cellular properties of male and female Dp1Tyb bone. These data establish sex, gene dosage, skeletal site and age as important factors in skeletal development of DS model mice, paving the way for identification of the causal dosage-sensitive genes. Skeletal differences in developing male and female Dp1Tyb DS model mice replicated differences in less-studied adolescents with DS and established a foundation to understand the etiology of trisomic bone deficits.
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Affiliation(s)
- Jared R Thomas
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Jonathan LaCombe
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Rachel Long
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA
| | | | | | - Joseph M Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, IN, USA
| | | | - Victor L J Tybulewicz
- The Francis Crick Institute, London, UK; Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University, Indianapolis, IN, USA.
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Hassan NM, Buldt AK, Shields N, Landorf KB, Menz HB, Munteanu SE. Reproducibility of foot dimensions measured from 3-dimensional foot scans in children and adolescents with Down syndrome. J Foot Ankle Res 2020; 13:31. [PMID: 32498702 PMCID: PMC7271427 DOI: 10.1186/s13047-020-00403-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Children and adolescents with Down syndrome have a distinctive foot shape (such as wide and flat feet) that often leads to difficulty with footwear fitting. 3-dimensional (3D) scanning can accurately measure the foot dimensions of individuals with Down syndrome, which may assist shoe fit. However, the reproducibility of measuring foot dimensions using 3D scans in children and adolescents with Down syndrome is unknown. The aim of this study was to determine the intra- and inter-rater reproducibility of measuring foot dimensions of children and adolescents with Down syndrome using 3D scanning. METHODS 3D foot scans of 30 participants with Down syndrome aged 5 to 17 years were obtained using the FotoScan 3D scanner. Foot dimensions assessed were foot length, ball of foot length, outside ball of foot length, diagonal foot width, horizontal foot width, heel width, ball girth, instep girth, first and fifth toe height, and instep height. Additionally, the Wesjflog Index and forefoot shape were determined. Measurements were completed by two raters independently on two separate occasions, 2 weeks apart. Intra- and inter-rater reliability were assessed using intra-class correlation coefficients (ICCs) and Gwet's AC1 statistics with 95% confidence intervals. Agreement was determined by calculating limits of agreement (LOA) and percentage agreement. RESULTS Eighteen participants were female and 12 were male (mean age 10.6 [3.9] years). Intra-rater reproducibility (ICCs ranged from 0.74 to 0.99, 95% LOA from - 13.7 mm to 16.3 mm) and inter-rater reproducibility (ICCs ranging from 0.73 to 0.99, 95% LOA from - 18.8 mm to 12.7 mm) was good to excellent, although some measurements (ball of foot length, outside ball of foot length, heel width and girth measurements) displayed wider LOAs indicating relatively poorer agreement. Forefoot shape displayed substantial to almost perfect reliability (Gwet's AC1 0.68 to 0.85) and percentage agreement ranged from 73 to 87%, indicating acceptable agreement. CONCLUSIONS The measurement of specific foot dimensions of children and adolescents with Down syndrome using 3D scans is reproducible. Findings of this study may be used to support future research measuring specific foot dimensions of children and adolescents with Down syndrome using 3D foot scans.
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Affiliation(s)
- Nirmeen M Hassan
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia. .,Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.
| | - Andrew K Buldt
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
| | - Nora Shields
- Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia.,Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, Victoria, 3086, Australia
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LaCombe JM, Roper RJ. Skeletal dynamics of Down syndrome: A developing perspective. Bone 2020; 133:115215. [PMID: 31887437 PMCID: PMC7044033 DOI: 10.1016/j.bone.2019.115215] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 01/14/2023]
Abstract
Individuals with Down syndrome (DS) display distinctive skeletal morphology compared to the general population, but disparate descriptions, methodologies, analyses, and populations sampled have led to diverging conclusions about this unique skeletal phenotype. As individuals with DS are living longer, they may be at a higher risk of aging disorders such as osteoporosis and increased fracture risk. Sexual dimorphism has been suggested between males and females with DS in which males, not females, experience an earlier decline in bone mineral density (BMD). Unfortunately, studies focusing on skeletal health related to Trisomy 21 (Ts21) are few in number and often too underpowered to answer questions about skeletal development, resultant osteoporosis, and sexual dimorphism, especially in stages of bone accrual. Further confounding the field are the varied methods of bone imaging, analysis, and data interpretation. This review takes a critical look at the current knowledge of DS skeletal phenotypes, both from human and mouse studies, and presents knowledge gaps that need to be addressed, differences in research methodologies and analyses that affect the interpretation of results, and proposes guidelines for overcoming obstacles to understand skeletal traits associated with DS. By examining our current knowledge of bone in individuals with Ts21, a trajectory for future studies may be established to provide meaningful solutions for understanding the development of and improving skeletal structures in individuals with and without DS.
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Affiliation(s)
- Jonathan M LaCombe
- Department of Biology, Indiana University-Purdue University Indianapolis, United States of America
| | - Randall J Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, United States of America.
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33
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Weber GE, Koenig KA, Khrestian M, Shao Y, Tuason ED, Gramm M, Lal D, Leverenz JB, Bekris LM. An Altered Relationship between Soluble TREM2 and Inflammatory Markers in Young Adults with Down Syndrome: A Preliminary Report. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2020; 204:1111-1118. [PMID: 31959733 PMCID: PMC7033027 DOI: 10.4049/jimmunol.1901166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/13/2019] [Indexed: 01/13/2023]
Abstract
Individuals with Down syndrome (DS) develop Alzheimer's disease (AD)-related neuropathology, characterized by amyloid plaques with amyloid β (Aβ) and neurofibrillary tangles with tau accumulation. Peripheral inflammation and the innate immune response are elevated in DS. Triggering receptor expressed in myeloid cells 2 (TREM2) genetic variants are risk factors for AD and other neurodegenerative diseases. Soluble TREM2 (sTREM2), a soluble cleavage product of TREM2, is elevated in AD cerebrospinal fluid and positively correlates with cognitive decline. There is relatively little information about TREM2 in DS. Our objective was to examine the relationship between sTREM2 and inflammatory markers in young adults with DS, prior to the development of dementia symptoms. Because TREM2 plays a role in the innate immune response and has been associated with dementia, the hypothesis of this exploratory study was that young adults with DS predementia (n = 15, mean age = 29.5 y) would exhibit a different relationship between sTREM2 and inflammatory markers in plasma, compared with neurotypical, age-matched controls (n = 16, mean age = 29.6 y). Indeed, young adults with DS had significantly elevated plasma sTREM2 and inflammatory markers. Additionally, in young adults with DS, sTREM2 correlated positively with 24 of the measured cytokines, whereas there were no significant correlations in the control group. Hierarchical clustering of sTREM2 and cytokine concentrations also differed between the groups, supporting the hypothesis that its function is altered in people with DS predementia. This preliminary report of human plasma provides a basis for future studies investigating the relationship between TREM2 and the broader immune response predementia.
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Affiliation(s)
- Grace E Weber
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | | | - Maria Khrestian
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | - Yvonne Shao
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | | | - Marie Gramm
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
- Cologne Center for Genomics, University of Cologne, 50931 Cologne, Germany; and
| | - Dennis Lal
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195
| | - James B Leverenz
- Cleveland Clinic Lou Ruvo Center for Brain Health, Neurological Institute, Clevland Clinic, Cleveland, OH 44195
| | - Lynn M Bekris
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH 44195;
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Antonarakis SE, Skotko BG, Rafii MS, Strydom A, Pape SE, Bianchi DW, Sherman SL, Reeves RH. Down syndrome. Nat Rev Dis Primers 2020; 6:9. [PMID: 32029743 PMCID: PMC8428796 DOI: 10.1038/s41572-019-0143-7] [Citation(s) in RCA: 325] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 12/11/2022]
Abstract
Trisomy 21, the presence of a supernumerary chromosome 21, results in a collection of clinical features commonly known as Down syndrome (DS). DS is among the most genetically complex of the conditions that are compatible with human survival post-term, and the most frequent survivable autosomal aneuploidy. Mouse models of DS, involving trisomy of all or part of human chromosome 21 or orthologous mouse genomic regions, are providing valuable insights into the contribution of triplicated genes or groups of genes to the many clinical manifestations in DS. This endeavour is challenging, as there are >200 protein-coding genes on chromosome 21 and they can have direct and indirect effects on homeostasis in cells, tissues, organs and systems. Although this complexity poses formidable challenges to understanding the underlying molecular basis for each of the many clinical features of DS, it also provides opportunities for improving understanding of genetic mechanisms underlying the development and function of many cell types, tissues, organs and systems. Since the first description of trisomy 21, we have learned much about intellectual disability and genetic risk factors for congenital heart disease. The lower occurrence of solid tumours in individuals with DS supports the identification of chromosome 21 genes that protect against cancer when overexpressed. The universal occurrence of the histopathology of Alzheimer disease and the high prevalence of dementia in DS are providing insights into the pathology and treatment of Alzheimer disease. Clinical trials to ameliorate intellectual disability in DS signal a new era in which therapeutic interventions based on knowledge of the molecular pathophysiology of DS can now be explored; these efforts provide reasonable hope for the future.
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Affiliation(s)
- Stylianos E Antonarakis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland.
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael S Rafii
- Keck School of Medicine of University of Southern California, California, CA, USA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah E Pape
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie L Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Roger H Reeves
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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35
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Moriyama CH, Massetti T, Crocetta TB, Silva TDD, Mustacchi Z, Guarnieri R, De Abreu LC, Araújo AVLD, Menezes LDCD, Monteiro CBDM, Leone C. Systematic Review of the Main Motor Scales for Clinical Assessment of Individuals with down Syndrome. Dev Neurorehabil 2020; 23:39-49. [PMID: 31726906 DOI: 10.1080/17518423.2019.1687598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of the present review was to identify the motor scales currently used to assess individuals with Down Syndrome (DS).Method: PubMed, WOS and BVS databases were systematically searched to identify the most relevant published studies that used motor scales in the evaluation of individuals with DS.Results: Of the 99 studies that met the eligibility criteria in this process, 20 experimental and observational studies were found to fully meet the eligibility criteria.Conclusion: We identified several motor scales including the Alberta Infant Motor Scale (AIMS), Test of Infant Motor Performance (TIMP), BAYLEY, Peabody Gross Motor Scale (PGMS-PDMS-GM), Gross Motor Function Measure (GMFM), Movement Assessment Battery for Children (MABC) and Pediatric Evaluation of Disability Inventory (PEDI).
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Affiliation(s)
| | - Thais Massetti
- Postgraduate Program in Rehabilitation Sciences, Medicine School, University of São Paulo, São Paulo, Brazil
| | | | - Talita Dias Da Silva
- School of Arts, Sciences and Humanities (EACH), University of São Paulo, São Paulo, Brazil
| | - Zan Mustacchi
- Genetic Outpatient Clinic of the Darcy Vargas Children's Hospital (HIDV), São Paulo, SP, Brazil
| | - Regiani Guarnieri
- Studies Design and Scientific Writing Laboratory, ABC Medical School, São Paulo, Brazil
| | - Luiz Carlos De Abreu
- Studies Design and Scientific Writing Laboratory, ABC Medical School, São Paulo, Brazil
| | | | | | - Carlos Bandeira De Mello Monteiro
- Postgraduate Program in Rehabilitation Sciences, Medicine School, University of São Paulo, São Paulo, Brazil.,School of Arts, Sciences and Humanities (EACH), University of São Paulo, São Paulo, Brazil
| | - Claudio Leone
- School of Public Health, University of São Paulo, São Paulo, Brazil
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36
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Magge SN, Zemel BS, Pipan ME, Gidding SS, Kelly A. Cardiometabolic Risk and Body Composition in Youth With Down Syndrome. Pediatrics 2019; 144:peds.2019-0137. [PMID: 31315916 PMCID: PMC6855833 DOI: 10.1542/peds.2019-0137] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Whether BMI captures adiposity and cardiometabolic risk in Down syndrome (DS), a condition associated with obesity, short stature, and altered body proportions, is not known. We compared cardiometabolic risk measures in youth with DS and typically developing matched controls. METHODS Youth with (n = 150) and without (n = 103) DS of comparable age (10-20 years), sex, race, ethnicity, and BMI percentile underwent whole-body dual-energy X-ray absorptiometry, fasting glucose, insulin, lipids, lipoprotein particles, inflammatory factors, and when BMI percentile ≥85, an oral glucose tolerance test. RESULTS Sixty-four percent of youth with DS had BMI percentile ≥85. Among these, no difference in glucose, insulin, or insulin resistance was detected, but prediabetes was more prevalent with DS (26.4% vs 10.3%; P = .025) after adjustment for demographics, pubertal status, and BMI z score (odds ratio = 3.2; P = .026). Among all participants, those with DS had higher low-density lipoprotein cholesterol (median 107 [interquartile range 89-128] vs 88.5 [79-103] mg/dL; P < .00005), triglycerides (89.5 [73-133] vs 71.5 [56-104] mg/dL; P < .00005), non-high-density lipoprotein cholesterol (non-HDL-C; 128 [104-153] vs 107 [92-123] mg/dL; P < .00005), and triglycerides/HDL-C (2.2 [1.6-3.4] vs 1.7 [1.1-2.5] mg/dL; P = .0003) and lower levels of HDL-C (41 [36.5-47] vs 45 [37-53] mg/dL; P = .012). DS youth had higher high-sensitivity C-reactive protein, interleukin-6, small low-density lipoprotein particles (LDL-P), and total LDL-P, but similar LDL-P size. Youth with DS had less visceral fat (VFAT), fat mass, and lean mass for BMI z score, but greater VFAT at higher fat mass. However, VFAT did not fully explain the increased prevalence of dyslipidemia or prediabetes in youth with DS. CONCLUSIONS Despite similar insulin resistance, youth with DS had greater prevalence of dyslipidemia and prediabetes than typically developing youth, which was not fully explained by VFAT.
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Affiliation(s)
- Sheela N. Magge
- Division of Endocrinology and Diabetes, School of Medicine and Health Sciences, The George Washington University and Clinical and Translational Science Institute at Children’s National, Children’s Research Institute, Children’s National Health System, Washington, District of Columbia; Divisions of
| | - Babette S. Zemel
- Gastroenterology, Hepatology, and Nutrition,,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; and
| | - Mary E. Pipan
- Developmental Behavioral Pediatrics, and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; and
| | | | - Andrea Kelly
- Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; and
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37
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Franceschi C, Garagnani P, Gensous N, Bacalini MG, Conte M, Salvioli S. Accelerated bio-cognitive aging in Down syndrome: State of the art and possible deceleration strategies. Aging Cell 2019; 18:e12903. [PMID: 30768754 PMCID: PMC6516152 DOI: 10.1111/acel.12903] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/08/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022] Open
Abstract
Down syndrome (DS) has been proposed by George Martin as a segmental progeroid syndrome since 1978. In fact, DS persons suffer from several age‐associated disorders much earlier than euploid persons. Furthermore, a series of recent studies have found that DS persons display elevated levels of age biomarkers, thus supporting the notion that DS is a progeroid trait. Nowadays, due to the progressive advancements in social inclusion processes and medical assistance, DS persons live much longer than in the past; therefore, the early‐onset health problems of these persons are becoming an urgent and largely unmet social and medical burden. In particular, the most important ailment of DS persons is the accelerated cognitive decline that starts when they reach about 40 years of age. This decline can be at least in part counteracted by multi‐systemic approaches including early‐onset cognitive training, physical activity, and psychosocial assistance. However, no pharmacological treatment is approved to counteract this decline. According to the most advanced conceptualization of Geroscience, tackling the molecular mechanisms underpinning the aging process should be a smart/feasible strategy to combat and/or delay the great majority of age‐related diseases, including cognitive decline. We think that a debate is needed urgently on if (and how) this strategy could be integrated in protocols to face DS‐associated dementia and overall unhealthy aging. In particular we propose that, on the basis of data obtained in different clinical settings, metformin is a promising candidate that could be exploited to counteract cognitive decline in DS.
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Affiliation(s)
- Claudio Franceschi
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
- Lobachevsky State University of Nizhny Novgorod Nizhny Novgorod Russia
| | - Paolo Garagnani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy
- Clinical Chemistry, Department of Laboratory Medicine Karolinska Institutet at Huddinge University Hospital Stockholm Sweden
- Applied Biomedical Research Center (CRBA) S. Orsola‐Malpighi Polyclinic Bologna Italy
- CNR Institute of Molecular Genetics Unit of Bologna Bologna Italy
| | - Noémie Gensous
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy
| | | | - Maria Conte
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy
- Interdepartmental Center “L. Galvani” (CIG) University of Bologna Bologna Italy
| | - Stefano Salvioli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy
- Interdepartmental Center “L. Galvani” (CIG) University of Bologna Bologna Italy
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38
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Granno S, Nixon-Abell J, Berwick DC, Tosh J, Heaton G, Almudimeegh S, Nagda Z, Rain JC, Zanda M, Plagnol V, Tybulewicz VLJ, Cleverley K, Wiseman FK, Fisher EMC, Harvey K. Downregulated Wnt/β-catenin signalling in the Down syndrome hippocampus. Sci Rep 2019; 9:7322. [PMID: 31086297 PMCID: PMC6513850 DOI: 10.1038/s41598-019-43820-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
Abstract
Pathological mechanisms underlying Down syndrome (DS)/Trisomy 21, including dysregulation of essential signalling processes remain poorly understood. Combining bioinformatics with RNA and protein analysis, we identified downregulation of the Wnt/β-catenin pathway in the hippocampus of adult DS individuals with Alzheimer's disease and the 'Tc1' DS mouse model. Providing a potential underlying molecular pathway, we demonstrate that the chromosome 21 kinase DYRK1A regulates Wnt signalling via a novel bimodal mechanism. Under basal conditions, DYRK1A is a negative regulator of Wnt/β-catenin. Following pathway activation, however, DYRK1A exerts the opposite effect, increasing signalling activity. In summary, we identified downregulation of hippocampal Wnt/β-catenin signalling in DS, possibly mediated by a dose dependent effect of the chromosome 21-encoded kinase DYRK1A. Overall, we propose that dosage imbalance of the Hsa21 gene DYRK1A affects downstream Wnt target genes. Therefore, modulation of Wnt signalling may open unexplored avenues for DS and Alzheimer's disease treatment.
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Affiliation(s)
- Simone Granno
- Department of Pharmacology, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathon Nixon-Abell
- Department of Pharmacology, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
- Cell Biology Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Daniel C Berwick
- Department of Pharmacology, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
- School of Health, Life and Chemical Sciences, The Open University, Walton Hall, Milton Keynes, MK6 7AA, UK
| | - Justin Tosh
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - George Heaton
- Department of Pharmacology, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Sultan Almudimeegh
- Department of Pharmacology, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Zenisha Nagda
- Department of Pharmacology, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Jean-Christophe Rain
- Hybrigenics Services - Fondation Jérôme Lejeune, 3-5 Impasse Reille, 75014, Paris, France
| | - Manuela Zanda
- UCL Genetics Institute, Darwin Building, Gower Street, London, WC1E 6BT, UK
| | - Vincent Plagnol
- UCL Genetics Institute, Darwin Building, Gower Street, London, WC1E 6BT, UK
| | - Victor L J Tybulewicz
- The Francis Crick Institute, 1 Midland Rd, Kings Cross, London, NW1 1AT, UK
- Department of Medicine, Imperial College, London, W12 0NN, UK
- London Down Syndrome Consortium (LonDownS), London, UK
| | - Karen Cleverley
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Frances K Wiseman
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- London Down Syndrome Consortium (LonDownS), London, UK
| | - Elizabeth M C Fisher
- Department of Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- London Down Syndrome Consortium (LonDownS), London, UK
| | - Kirsten Harvey
- Department of Pharmacology, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
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Sinai A, Mokrysz C, Bernal J, Bohnen I, Bonell S, Courtenay K, Dodd K, Gazizova D, Hassiotis A, Hillier R, McBrien J, McCarthy J, Mukherji K, Naeem A, Perez-Achiaga N, Rantell K, Sharma V, Thomas D, Walker Z, Whitham S, Strydom A. Predictors of Age of Diagnosis and Survival of Alzheimer's Disease in Down Syndrome. J Alzheimers Dis 2019; 61:717-728. [PMID: 29226868 PMCID: PMC6004911 DOI: 10.3233/jad-170624] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: People with Down syndrome (DS) are an ultra-high risk population for Alzheimer’s disease (AD). Understanding the factors associated with age of onset and survival in this population could highlight factors associated with modulation of the amyloid cascade. Objective: This study aimed to establish the typical age at diagnosis and survival associated with AD in DS and the risk factors associated with these. Methods: Data was obtained from the Aging with Down Syndrome and Intellectual Disabilities (ADSID) research database, consisting of data extracted from clinical records of patients seen by Community Intellectual Disability Services (CIDS) in England. Survival times when considering different risk factors were calculated. Results: The mean age of diagnosis was 55.80 years, SD 6.29. Median survival time after diagnosis was 3.78 years, and median age at death was approximately 60 years. Survival time was associated with age of diagnosis, severity of intellectual disability, living status, anti-dementia medication status, and history of epilepsy. Age at diagnosis and treatment status remained predictive of survival time following adjustment. Conclusion: This study provides the best estimate of survival in dementia within the DS population to date, and is in keeping with previous estimates from smaller studies in the DS population. This study provides important estimates and insights into possible predictors of survival and age of diagnosis of AD in adults with DS, which will inform selection of participants for treatment trials in the future.
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Affiliation(s)
- Amanda Sinai
- Division of Psychiatry, University College London, London, UK.,Sheba Medical Center, Tel Hashomer, Israel
| | - Claire Mokrysz
- Division of Psychiatry, University College London, London, UK
| | - Jane Bernal
- Cornwall Partnership Foundation NHS Trust, UK
| | - Ingrid Bohnen
- Westminster Learning Disability Partnership, Central and North West London NHS Foundation Trust, London, UK
| | - Simon Bonell
- Livewell SouthWest (CIC), Plymouth, UK (data from South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK).,Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - Ken Courtenay
- Division of Psychiatry, University College London, London, UK.,Barnet Enfield and Haringey Mental Health NHS Trust, UK
| | - Karen Dodd
- Surrey and Borders Partnership NHS Foundation Trust, Epsom, UK
| | - Dina Gazizova
- Enfield Integrated Learning Disabilities Service, Enfield, UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | - Judith McBrien
- Plymouth Teaching Primary Care Trust (now known as Livewell Southwest CIC), UK
| | - Jane McCarthy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Asim Naeem
- Sutton MHLD Team, SW London and St George's Mental Health NHS Trust, Surrey, UK.,St George's University of London, UK
| | | | - Khadija Rantell
- Institute of Neurology, Queen Square, Education Unit, London, UK
| | - Vijaya Sharma
- Hertfordshire Partnership University NHS Foundation Trust, UK
| | - David Thomas
- Department of Community Mental Health, RAF Marham, Norfolk, UK (data from East London NHS Foundation Trust, UK)
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK.,Essex Partnership University NHS Foundation Trust, UK
| | | | - Andre Strydom
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The LonDownS Consortium
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40
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Parungao JM, Reyes C, Jackson N, Roizen N, Piper M. Factors Influencing the Adequacy of Bowel Preparation in Patients With Developmental Disabilities. Gastroenterology Res 2019; 11:416-421. [PMID: 30627265 PMCID: PMC6306108 DOI: 10.14740/gr1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022] Open
Abstract
Background The rate of inadequate bowel preparation in the general population is approximately 23%. As more individuals with developmental disabilities enter late adulthood, a concomitant rise in endoscopic procedures for this population, including screening colonoscopies, is anticipated. However, there are sparse data on the adequacy of bowel preparation in patients with developmental disabilities. Methods A retrospective analysis of 91 patients with developmental disabilities who underwent colonoscopy from 2006 to 2014 was performed. Bowel preparation adequacy from these procedures was evaluated, together with other data, including age, developmental disability diagnoses, procedure type, indication and setting. Results Mean age at the time of endoscopy was 52.6 ± 13.4 years, with an age range of 18 - 74 years. Inadequate bowel preparation was found in approximately 51% of documented cases. Outpatients were more likely to have adequate bowel preparation compared to inpatients, with an odds ratio of 2.75 (95% confidence interval: 1.14 - 6.62, P = 0.022). No other major factors identified had any statistically significant influence on the adequacy of bowel preparation. Conclusion Over half of patients with developmental disabilities undergoing colonoscopy had inadequate bowel preparations in our study, which is more than twice the rate for the general population. Furthermore, outpatients were 2.75 times more likely to have adequate bowel preparation compared to inpatients. Further studies are recommended to improve endoscopic practices for this patient population.
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Affiliation(s)
- Jose Mari Parungao
- United Medical Center, Washington, DC 20032, USA.,These authors contributed equally to this work
| | - Charina Reyes
- Division of Developmental-Behavioral Pediatrics, University of Maryland Medical Center, Baltimore, MD 21201, USA.,These authors contributed equally to this work
| | - Nancy Jackson
- Department of Research, Providence-Providence Park Hospital, Southfield, MI 48075, USA
| | - Nancy Roizen
- Division of Developmental-Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA
| | - Michael Piper
- Department of Gastroenterology, Providence-Providence Park Hospital, Southfield, MI 48075, USA
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41
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Lao PJ, Handen BL, Betthauser TJ, Cody KA, Cohen AD, Tudorascu DL, Stone CK, Price JC, Johnson SC, Klunk WE, Christian BT. Imaging neurodegeneration in Down syndrome: brain templates for amyloid burden and tissue segmentation. Brain Imaging Behav 2019; 13:345-353. [PMID: 29752653 PMCID: PMC6230506 DOI: 10.1007/s11682-018-9888-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus of Alzheimer's disease (AD) neuroimaging research has shifted towards an investigation of the earliest stages of AD pathogenesis, which manifests in every young adult with Down syndrome (DS; trisomy 21) resulting from a deterministic genetic predisposition to amyloid precursor protein overproduction. Due to morphological differences in brain structure in the DS population, special consideration must be given to processing pipelines and the use of normative atlases developed for the non-DS population. Further, the use of typical MRI to MRI template spatial normalization is less desirable in this cohort due to a greater presence of motion artefacts in MRI images. The diffuse nature of PiB uptake and comparatively lower spatial resolution of the PET image permits the purposing of this modality as a template for spatial normalization, which can substantially improve the robustness of this procedure in the cases of MRI images with motion. The aim of this work was to establish standardized methods for spatial normalization and tissue type segmentation using DS specific templates in order to perform voxel-wise analyses. A total of 72 adults with DS underwent [11C]PiB PET to assess brain amyloid burden and volumetric MRI imaging. A DS specific PiB template for spatial normalization and a set of DS specific prior probability templates were created with two-pass methods. With implementation of this DS specific PiB template, no participants were excluded due to poor spatial normalization, thus maximizing the sample size for PiB analyses in standardized space. In addition, difference images between prior probability templates created from the general population and the DS population reflected known morphological differences, particularly in the frontal cortex. In conclusion, DS specific templates that account for unique challenges improve spatial normalization and tissue type segmentation, and provide a framework for reliable voxel-wise analysis of AD biomarkers in this atypical population.
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Affiliation(s)
- Patrick J. Lao
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705 USA ,Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705 USA
| | - Ben L. Handen
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213 USA ,Department of Pediatrics, University of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224 USA ,Department of Psychology, University of Pittsburgh, 201 South Bouquet Street, Pittsburgh, PA 15260 USA ,Department of Instruction and Learning, University of Pittsburgh, 230 South Bouquet Street, Pittsburgh, PA 15260 USA
| | - Tobey J. Betthauser
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705 USA ,Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705 USA
| | - Karly A. Cody
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705 USA
| | - Annie D. Cohen
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213 USA
| | - Dana L. Tudorascu
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213 USA ,Department of Internal Medicine, University of Pittsburgh, 3459 Fifth Avenue, Pittsburgh, PA 15213 USA ,Department of Biostatistics, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
| | - Charles K. Stone
- Department of Cardiovascular Medicine, University of Wisconsin-Madison, 1 South Park Street, Madison, WI 53715 USA
| | - Julie C. Price
- Department of Radiology, University of Pittsburgh, 3600 Forbes @ Meyran Avenues, Pittsburgh, PA 15213 USA ,Department of Radiology, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129 USA
| | - Sterling C. Johnson
- Department of Medicine-Geriatrics, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI 53705 USA
| | - William E. Klunk
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213 USA ,Department of Neurology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213 USA
| | - Bradley T. Christian
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705 USA ,Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705 USA ,Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719 USA
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On the Design of Broad-Based Neuropsychological Test Batteries to Assess the Cognitive Abilities of Individuals with Down Syndrome in the Context of Clinical Trials. Brain Sci 2018; 8:brainsci8120205. [PMID: 30486228 PMCID: PMC6315396 DOI: 10.3390/brainsci8120205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Down syndrome (DS) is the most common genetically-defined cause of intellectual disability. Neurodevelopmental deficits displayed by individuals with DS are generally global, however, disproportionate deficits in cognitive processes that depend heavily on the hippocampus and prefrontal cortex are also well documented. Additionally, DS is associated with relative strengths in visual processing and visuospatial short-term memory, and weaknesses in the verbal domain. Although reports of pharmacological rescuing of learning and memory deficits in mouse models of DS abound in the literature, proving the principle that cognitive ability of persons with DS can be boosted through pharmacological means is still an elusive goal. The design of customized batteries of neuropsychological efficacy outcome measures is essential for the successful implementation of clinical trials of potential cognitive enhancing strategies. Here, we review the neurocognitive phenotype of individuals with DS and major broad-based test batteries designed to quantify specific cognitive domains in these individuals, including the one used in a pilot trial of the drug memantine. The main goal is to illustrate the essential considerations in planning trials to enhance cognitive functions in individuals with DS, which should also have implications for the design of similar studies in individuals with other forms of intellectual disability.
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Giménez S, Videla L, Romero S, Benejam B, Clos S, Fernández S, Martínez M, Carmona-Iragui M, Antonijoan RM, Mayos M, Fortuna A, Peñacoba P, Plaza V, Osorio RS, Sharma RA, Bardés I, Rebillat AS, Lleó A, Blesa R, Videla S, Fortea J. Prevalence of Sleep Disorders in Adults With Down Syndrome: A Comparative Study of Self-Reported, Actigraphic, and Polysomnographic Findings. J Clin Sleep Med 2018; 14:1725-1733. [PMID: 30353801 DOI: 10.5664/jcsm.7382] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/29/2018] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES Sleep problems are often undetected in adults with Down syndrome (DS). Our objective was to determine the prevalence of sleep disorders in adults with DS through self-reported and objective sleep measures. METHODS We performed a community-based cross-sectional study of 54 adults with DS not referred for sleep disorders. Two polysomnography (PSG) sleep studies were performed. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) and the risk for the sleep apnea syndrome (OSA) was identified using the Berlin Questionnaire (BQ). Participants' sleep/wake pattern was assessed from sleep diaries and by wrist actigraphy. PSQI, ESS, and PSG measures were compared with 35 sex-, age-, and body mass index-matched patients in the control groups. RESULTS In PSG measures, adults with DS showed lower sleep efficiency (69 ± 17.7 versus 81.6 ± 11; P < .001), less rapid eye movement sleep (9.4 ± 5.8 versus 19.4 ± 5.1; P < .001), a higher prevalence of OSA (78% versus 14%; P < .001), and a higher apnea-hypopnea index (23.5 ± 24.5 versus 3.8 ± 10.5; P < .001) than patients in the control group. In the DS group, the questionnaires (mean PSQI 3.7 ± 2.9; mean ESS 6.3 ± 4.5 and mean BQ 1 ± 0) did not reflect the sleep disturbances detected on the PSG. Actigraphy data recorded daytime sleep that was not self-reported (118.2 ± 104.2 minutes). CONCLUSIONS Adults with DS show severe sleep disruption and a high prevalence of OSA, undetected by self-reported sleep measures. Actigraphy, PSG, and validated simplified devices for screening OSA should be routinely recommended for this population because treatment of sleep disorders can contribute to healthy aging.
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Affiliation(s)
- Sandra Giménez
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Drug Research Center, Institute for Biomedical Research Sant Pau (IIB Sant Pau), Department of Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades en Salud Mental CIBERSAM Spain.,Department of Clinical Psychobiology, University of Barcelona, Spain
| | - Laura Videla
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain
| | - Sergio Romero
- Biomedical Engineering Research Centre, Department of Automatic Control, Universitat Politècnica de Catalunya, Barcelona, Spain.,CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain
| | - Bessy Benejam
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain
| | - Susana Clos
- Drug Research Center, Institute for Biomedical Research Sant Pau (IIB Sant Pau), Department of Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades en Salud Mental CIBERSAM Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain
| | - Maribel Martínez
- Drug Research Center, Institute for Biomedical Research Sant Pau (IIB Sant Pau), Department of Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Carmona-Iragui
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain.,Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas
| | - Rosa M Antonijoan
- Drug Research Center, Institute for Biomedical Research Sant Pau (IIB Sant Pau), Department of Pharmacology and Therapeutics, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades en Salud Mental CIBERSAM Spain
| | - Mercedes Mayos
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CibeRes), Spain
| | - Ana Fortuna
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Patricia Peñacoba
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Vicente Plaza
- Multidisciplinary Sleep Unit, Respiratory Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CibeRes), Spain
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, New York
| | - Ram A Sharma
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, New York
| | - Ignasi Bardés
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain
| | | | - Alberto Lleó
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas
| | - Rafael Blesa
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas
| | - Sebastian Videla
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain.,Clinical Research Support Unit. Bellvitge Biomedical Research Institute (IDIBELL) Department of Clinical Pharmacology, University of Barcelona, Barcelona, Spain
| | - Juan Fortea
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down Memory Unit, Barcelona, Spain.,Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas
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Khanna S, Dhaimade PA, Raghunathrao R. Comparative Assessment of Cephalometric and Tympanometric Readings in Down Syndrome. Cureus 2018; 10:e3301. [PMID: 30443471 PMCID: PMC6235630 DOI: 10.7759/cureus.3301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/12/2018] [Indexed: 11/26/2022] Open
Abstract
Aim The purpose of this study was to conduct a comparative assessment of the various cephalometric and auditory parameters between patients with Down syndrome (DS) and healthy controls. Methods The cephalometric and auditory parameters were divided among 50 participants into two equal sets, DS (n = 25) and controls (n=25), and assessed. While a standard cephalometric analysis was conducted to measure the hard tissue parameters, tympanometry was used to assess the audiological parameters. Results The values of the linear and angular cephalometric parameters of the DS group were found to be lower than the controls. All the controls recorded type A tympanogram while the DS group recorded type A, B, and C tympanograms. A significant relationship was observed in the cephalometric readings - eustachian tube (ET) length, posterior upper facial height (PUFH) length, sella (s)-basion (ba)-palatal length (PL), and s-ba-ET angles - among the subjects who presented with type B or C tympanogram in comparison to those with type A. Conclusion Tympanometry, a highly sensitive and relatively simple test to assess audiological parameters, has a significant relationship with a number of cephalometric indicators of growth and development. A deviation from the normal tympanometric readings can be used as an early indicator of the impending craniometric aberrations and handicap. This can be used as an effective tool for early intervention in cases of DS. Patients who have recorded abnormal tympanograms on multiple occasions over a period of six months can be subjected to a further cephalometric analysis.
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Affiliation(s)
- Sunali Khanna
- Municipal Corporation of Greater Mumbai, Nair Hospital Dental College, Mumbai, IND
| | | | - Rangasayee Raghunathrao
- Hearing and Speech Sciences, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, IND
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45
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Henriksen KJ, Chang A, Bayliss GP. Kidney Transplant Outcomes in 2 Adults With Down Syndrome. Kidney Int Rep 2018; 3:979-984. [PMID: 29988986 PMCID: PMC6035128 DOI: 10.1016/j.ekir.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kammi J. Henriksen
- Department of Pathology, The University of Chicago, Chicago, Illinois, USA
| | - Anthony Chang
- Department of Pathology, The University of Chicago, Chicago, Illinois, USA
| | - George P. Bayliss
- Department of Medicine, Division of Kidney Disease and Hypertension, Brown University, Providence, Rhode Island, USA
- Correspondence: George Bayliss, Department of Medicine, Division of Kidney Disease and Hypertension, Alpert Medical School, Brown University, Transplant Clinic, APC 9, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903, USA.
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46
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Head E, Powell DK, Schmitt FA. Metabolic and Vascular Imaging Biomarkers in Down Syndrome Provide Unique Insights Into Brain Aging and Alzheimer Disease Pathogenesis. Front Aging Neurosci 2018; 10:191. [PMID: 29977201 PMCID: PMC6021507 DOI: 10.3389/fnagi.2018.00191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/06/2018] [Indexed: 12/26/2022] Open
Abstract
People with Down syndrome (DS) are at high risk for developing Alzheimer disease (AD). Neuropathology consistent with AD is present by 40 years of age and dementia may develop up to a decade later. In this review, we describe metabolic and vascular neuroimaging studies in DS that suggest these functional changes are a key feature of aging, linked to cognitive decline and AD in this vulnerable cohort. FDG-PET imaging in DS suggests systematic reductions in glucose metabolism in posterior cingulate and parietotemporal cortex. Magentic resonance spectroscopy studies show consistent decreases in neuronal health and increased myoinositol, suggesting inflammation. There are few vascular imaging studies in DS suggesting a gap in our knowledge. Future studies would benefit from longitudinal measures and combining various imaging approaches to identify early signs of dementia in DS that may be amenable to intervention.
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Affiliation(s)
- Elizabeth Head
- Department of Pharmacology & Nutritional Sciences, Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, United States
| | - David K Powell
- Magnetic Resonance Imaging and Spectroscopy Center, Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, United States
| | - Frederick A Schmitt
- Department of Neurology, Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, United States
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Franceschi C, Garagnani P, Morsiani C, Conte M, Santoro A, Grignolio A, Monti D, Capri M, Salvioli S. The Continuum of Aging and Age-Related Diseases: Common Mechanisms but Different Rates. Front Med (Lausanne) 2018; 5:61. [PMID: 29662881 PMCID: PMC5890129 DOI: 10.3389/fmed.2018.00061] [Citation(s) in RCA: 466] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
Geroscience, the new interdisciplinary field that aims to understand the relationship between aging and chronic age-related diseases (ARDs) and geriatric syndromes (GSs), is based on epidemiological evidence and experimental data that aging is the major risk factor for such pathologies and assumes that aging and ARDs/GSs share a common set of basic biological mechanisms. A consequence is that the primary target of medicine is to combat aging instead of any single ARD/GSs one by one, as favored by the fragmentation into hundreds of specialties and sub-specialties. If the same molecular and cellular mechanisms underpin both aging and ARDs/GSs, a major question emerges: which is the difference, if any, between aging and ARDs/GSs? The hypothesis that ARDs and GSs such as frailty can be conceptualized as accelerated aging will be discussed by analyzing in particular frailty, sarcopenia, chronic obstructive pulmonary disease, cancer, neurodegenerative diseases such as Alzheimer and Parkinson as well as Down syndrome as an example of progeroid syndrome. According to this integrated view, aging and ARDs/GSs become part of a continuum where precise boundaries do not exist and the two extremes are represented by centenarians, who largely avoided or postponed most ARDs/GSs and are characterized by decelerated aging, and patients who suffered one or more severe ARDs in their 60s, 70s, and 80s and show signs of accelerated aging, respectively. In between these two extremes, there is a continuum of intermediate trajectories representing a sort of gray area. Thus, clinically different, classical ARDs/GSs are, indeed, the result of peculiar combinations of alterations regarding the same, limited set of basic mechanisms shared with the aging process. Whether an individual will follow a trajectory of accelerated or decelerated aging will depend on his/her genetic background interacting lifelong with environmental and lifestyle factors. If ARDs and GSs are manifestations of accelerated aging, it is urgent to identify markers capable of distinguishing between biological and chronological age to identify subjects at higher risk of developing ARDs and GSs. To this aim, we propose the use of DNA methylation, N-glycans profiling, and gut microbiota composition to complement the available disease-specific markers.
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Affiliation(s)
- Claudio Franceschi
- Institute of Neurological Sciences, University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Paolo Garagnani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.,Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden.,Applied Biomedical Research Center (CRBA), S. Orsola-Malpighi Polyclinic, Bologna, Italy.,CNR Institute of Molecular Genetics, Unit of Bologna, Bologna, Italy
| | - Cristina Morsiani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Maria Conte
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.,Interdepartmental Center "L. Galvani" (CIG), University of Bologna, Bologna, Italy
| | - Andrea Grignolio
- Unit and Museum of History of Medicine, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniela Monti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Miriam Capri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.,Interdepartmental Center "L. Galvani" (CIG), University of Bologna, Bologna, Italy
| | - Stefano Salvioli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.,Interdepartmental Center "L. Galvani" (CIG), University of Bologna, Bologna, Italy
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48
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Lao PJ, Handen BL, Betthauser TJ, Mihaila I, Hartley SL, Cohen AD, Tudorascu DL, Bulova PD, Lopresti BJ, Tumuluru RV, Murali D, Mathis CA, Barnhart TE, Stone CK, Price JC, Devenny DA, Johnson SC, Klunk WE, Christian BT. Alzheimer-Like Pattern of Hypometabolism Emerges with Elevated Amyloid-β Burden in Down Syndrome. J Alzheimers Dis 2018; 61:631-644. [PMID: 29254096 PMCID: PMC5994924 DOI: 10.3233/jad-170720] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Down syndrome (DS) population is genetically predisposed to amyloid-β protein precursor overproduction and Alzheimer's disease (AD). OBJECTIVE The temporal ordering and spatial association between amyloid-β, glucose metabolism, and gray matter (GM) volume in the DS population can provide insight into those associations in the more common sporadic AD. METHODS Twenty-four adults (13 male, 11 female; 39±7 years) with DS underwent [11C]PiB, [18F]FDG, and volumetric MRI scans. Voxel-wise associations between PiB SUVR, FDG SUVR, and GM volume were investigated, with and without individual adjustments for variables of interest. RESULTS Positive associations of PiB and age were widespread throughout the neocortex and striatum. Negative associations of FDG and age (frontal, parietal, and temporal cortex) and of GM volume and age (frontal and insular cortex) were observed. PiB and FDG were negatively associated in parietal cortex, after adjustment for GM volume. CONCLUSIONS In adults with DS, early amyloid-β accumulation in the striatum is divergent from sporadic AD; however, despite the early striatal amyloid-β, glucose hypometabolism was confined to the typical AD-associated regions, which occurs similarly in autosomal dominant AD. Importantly, the glucose hypometabolism was not explained solely by increased partial volume effect due to GM volume reductions.
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Affiliation(s)
- Patrick J. Lao
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin-Madison, Waisman Center, Madison, WI, USA
| | - Ben L. Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Instruction and Learning, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tobey J. Betthauser
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin-Madison, Waisman Center, Madison, WI, USA
| | - Iulia Mihaila
- University of Wisconsin-Madison, Waisman Center, Madison, WI, USA
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Sigan L. Hartley
- University of Wisconsin-Madison, Waisman Center, Madison, WI, USA
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Annie D. Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana L. Tudorascu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter D. Bulova
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian J. Lopresti
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Dhanabalan Murali
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin-Madison, Waisman Center, Madison, WI, USA
| | - Chester A. Mathis
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Todd E. Barnhart
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Charles K. Stone
- Department of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Julie C. Price
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Darlynne A. Devenny
- New York State Institute for Research in Developmental Disabilities, Staten Island, NY, USA
| | - Sterling C. Johnson
- Department of Medicine-Geriatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - William E. Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley T. Christian
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin-Madison, Waisman Center, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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49
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Carfì A, Liperoti R, Fusco D, Giovannini S, Brandi V, Vetrano DL, Meloni E, Mascia D, Villani ER, Manes Gravina E, Bernabei R, Onder G. Bone mineral density in adults with Down syndrome. Osteoporos Int 2017; 28:2929-2934. [PMID: 28685282 DOI: 10.1007/s00198-017-4133-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study analyzed data of bone mineral density (BMD) from a large cohort of adults with Down syndrome (DS). BMD was found to decrease with age more rapidly in these subjects than in the general population, exposing adults with DS to an increased risk of osteoporosis and bone fracture. INTRODUCTION Down syndrome (DS) in adulthood presents with a high prevalence of osteoporosis. However, in DS, bone mineral density (BMD) can be underestimated due to short stature. Furthermore, the rate of age-related decline in BMD and its association with gender in DS has been rarely evaluated or compared with the general population. The present study is aimed at assessing the variation of BMD with age and gender in a sample of adults with DS and to compare these data with those of the general population, after adjusting for anthropometric differences. METHODS Adults with DS, aged 18 or older, were assessed dual-energy-X-ray-absorptiometry (DXA) at the femoral neck and at the lumbar spine. They were compared with the general population enrolled in the National Health and Nutrition Examination Survey (NHANES) 2009-2010 dataset. Bone mineral apparent density (BMAD) was calculated for each individual. RESULTS DXA was evaluated in 234 subjects with DS (mean age 36.93 ± 11.83 years, ranging from 20 to 69 years; 50.4% females). In the lumbar spine both mean BMD (DS 0.880 ± 0.141 vs. NHANES 1.062 ± 0.167, p < 0.001) and BMAD (DS 0.138 ± 0.020 vs. NHANES 0.152 ± 0.020, p < 0.001) were significantly lower in the DS sample than in the NAHNES cohort. The same trend was observed at the femoral neck in both BMD (DS 0.658 ± 0.128 vs. NHANES 0.835 ± 0.137, p < 0.001) and BMAD (DS 0.151 ± 0.030 vs. NHANES 0.159 ± 0.028, p<0.001). Age was associated with lower femoral neck BMAD in both samples; importantly, this association was significantly stronger in the DS sample. In the lumbar spine region, no significant association between BMAD and age could be observed in both samples. CONCLUSIONS Adults with DS have lower bone mineral density compared to the general population and they experience a steeper decline with age. Early screening programs are needed in DS population.
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Affiliation(s)
- A Carfì
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - R Liperoti
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D Fusco
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - S Giovannini
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - V Brandi
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D L Vetrano
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - E Meloni
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D Mascia
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - E R Villani
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - E Manes Gravina
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - R Bernabei
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - G Onder
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Barone E, Head E, Butterfield DA, Perluigi M. HNE-modified proteins in Down syndrome: Involvement in development of Alzheimer disease neuropathology. Free Radic Biol Med 2017; 111:262-269. [PMID: 27838436 PMCID: PMC5639937 DOI: 10.1016/j.freeradbiomed.2016.10.508] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 11/25/2022]
Abstract
Down syndrome (DS), trisomy of chromosome 21, is the most common genetic form of intellectual disability. The neuropathology of DS involves multiple molecular mechanisms, similar to AD, including the deposition of beta-amyloid (Aβ) into senile plaques and tau hyperphosphorylationg in neurofibrillary tangles. Interestingly, many genes encoded by chromosome 21, in addition to being primarily linked to amyloid-beta peptide (Aβ) pathology, are responsible for increased oxidative stress (OS) conditions that also result as a consequence of reduced antioxidant system efficiency. However, redox homeostasis is disturbed by overproduction of Aβ, which accumulates into plaques across the lifespan in DS as well as in AD, thus generating a vicious cycle that amplifies OS-induced intracellular changes. The present review describes the current literature that demonstrates the accumulation of oxidative damage in DS with a focus on the lipid peroxidation by-product, 4-hydroxy-2-nonenal (HNE). HNE reacts with proteins and can irreversibly impair their functions. We suggest that among different post-translational modifications, HNE-adducts on proteins accumulate in DS brain and play a crucial role in causing the impairment of glucose metabolism, neuronal trafficking, protein quality control and antioxidant response. We hypothesize that dysfunction of these specific pathways contribute to accelerated neurodegeneration associated with AD neuropathology.
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Affiliation(s)
- Eugenio Barone
- Department of Biochemical Sciences, Sapienza University of Rome, Italy; Universidad Autónoma de Chile, Instituto de Ciencias Biomédicas, Facultad de Salud, Avenida Pedro de Valdivia 425, Providencia, Santiago, Chile
| | - Elizabeth Head
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA; Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY 40536, USA
| | - D Allan Butterfield
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA; Department of Chemistry, University of Kentucky, Lexington, KY 40506, USA
| | - Marzia Perluigi
- Department of Biochemical Sciences, Sapienza University of Rome, Italy.
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