Aleksandra Szczawińska-Popłonyk, Natalia Popłonyk, Karina Awdi
{"title":"Down Syndrome in Children: A Primary Immunodeficiency with Immune Dysregulation.","authors":"Aleksandra Szczawińska-Popłonyk, Natalia Popłonyk, Karina Awdi","doi":"10.3390/children11101251","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> The multisystemic features of Down syndrome (DS) in children are accompanied by immunodeficiency, making them susceptible to infections and immune dysregulation with autoimmune, allergic, inflammatory, and hematological complications. This study was aimed at a better understanding of the abnormalities within the B and T cell compartments and their correlations with clinical immunophenotypes. <b>Methods:</b> Medical records of 35 DS children were retrospectively reviewed, referring to clinical symptomatology including history of infections, immune dysregulation disorders, and humoral and cellular immune response. <b>Results:</b> While the etiology of respiratory tract infections included typical viral and bacterial pathogens, SARS-CoV2-induced inflammatory disease and syndromic immunodeficiency contributed significantly to the deterioration of the clinical course. Allergic diseases in the form of asthma, allergic rhinitis, and alimentary allergy were the most frequent manifestations of immune dysregulation and were followed by autoimmune disorders, such as Crohn's disease, celiac disease, autoimmune thyroiditis, and alopecia, as well as inflammatory disorders, balanitis xerotica obliterans and lymphadenopathy, and a hematological disorder of myelopoiesis. Deficiency of serum immunoglobulin levels, reduced numbers of naïve B cells, and non-switched memory B cells along with low naïve T helper cells and significantly reduced regulatory T helper cells were the most prominent immune abnormalities. <b>Conclusions:</b> The loss of naïveté in B and T lymphocyte compartments with a deficiency of regulatory T cells may be underpinning pathomechanisms for the skewed immune response. The clinical immunophenotype in DS is complex and represents syndromic primary immunodeficiency with immune dysregulation.</p>","PeriodicalId":48588,"journal":{"name":"Children-Basel","volume":"11 10","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11506678/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Children-Basel","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/children11101251","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The multisystemic features of Down syndrome (DS) in children are accompanied by immunodeficiency, making them susceptible to infections and immune dysregulation with autoimmune, allergic, inflammatory, and hematological complications. This study was aimed at a better understanding of the abnormalities within the B and T cell compartments and their correlations with clinical immunophenotypes. Methods: Medical records of 35 DS children were retrospectively reviewed, referring to clinical symptomatology including history of infections, immune dysregulation disorders, and humoral and cellular immune response. Results: While the etiology of respiratory tract infections included typical viral and bacterial pathogens, SARS-CoV2-induced inflammatory disease and syndromic immunodeficiency contributed significantly to the deterioration of the clinical course. Allergic diseases in the form of asthma, allergic rhinitis, and alimentary allergy were the most frequent manifestations of immune dysregulation and were followed by autoimmune disorders, such as Crohn's disease, celiac disease, autoimmune thyroiditis, and alopecia, as well as inflammatory disorders, balanitis xerotica obliterans and lymphadenopathy, and a hematological disorder of myelopoiesis. Deficiency of serum immunoglobulin levels, reduced numbers of naïve B cells, and non-switched memory B cells along with low naïve T helper cells and significantly reduced regulatory T helper cells were the most prominent immune abnormalities. Conclusions: The loss of naïveté in B and T lymphocyte compartments with a deficiency of regulatory T cells may be underpinning pathomechanisms for the skewed immune response. The clinical immunophenotype in DS is complex and represents syndromic primary immunodeficiency with immune dysregulation.
背景:唐氏综合征(DS)患儿的多系统特征伴随着免疫缺陷,使他们容易受到感染和免疫失调,出现自身免疫、过敏、炎症和血液病并发症。本研究旨在更好地了解 B 细胞和 T 细胞的异常及其与临床免疫表型的相关性。研究方法回顾性分析 35 名 DS 儿童的病历,参考临床症状,包括感染史、免疫调节紊乱、体液和细胞免疫反应。结果显示虽然呼吸道感染的病因包括典型的病毒和细菌病原体,但 SARS-CoV2- 引发的炎症性疾病和综合免疫缺陷症在很大程度上导致了临床病程的恶化。哮喘、过敏性鼻炎和消化道过敏等形式的过敏性疾病是免疫失调最常见的表现,其次是克罗恩病、乳糜泻、自身免疫性甲状腺炎和脱发等自身免疫性疾病,以及炎症性疾病、斑秃和淋巴结病,还有骨髓造血功能紊乱。血清免疫球蛋白水平不足、天真 B 细胞和非转换记忆 B 细胞数量减少、天真 T 辅助细胞数量低和调节性 T 辅助细胞数量显著减少是最突出的免疫异常现象。结论是B淋巴细胞和T淋巴细胞天真性的丧失以及调节性T细胞的缺乏可能是导致免疫反应失衡的基本病理机制。DS 的临床免疫表型非常复杂,是一种免疫失调的综合征性原发性免疫缺陷。
期刊介绍:
Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries.
The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.