SUMMARY
Down syndrome (DS) is often accompanied by autoimmune diseases. Among those, autoimmune thyroid disease,
type 1 diabetes and celiac disease are the most common. The major cause of enhanced vulnerability of DS patients to
a variety of autoimmune diseases is impaired immune response, with multiple abnormalities in all components of the immune system,
especially in cell-mediated immunity. This could explain a significantly higher frequency of autoimmune disorders in DS compared
to the general population. The diagnosis of autoimmune diseases accompanying DS could be complicated by masking effects
of the underlying features of the syndrome such as failure to thrive, short stature and delayed puberty. However, screening
for immunological signs of coexistent autoimmunity such as tissue-specific antibodies and monitoring insulin secretion, glucose levels,
thyroid function and other metabolic parameters should help in early diagnosis of coexistent autoimmunity in DS patiens.
KEY WORDS
autoimmune thyroid disease; celiac disease; coexistence; Down syndrome; type 1 diabetes
REFERENCES
Anwar AJ, Walker JD, Frier BM: Type 1 diabetes
mellitus and Down's syndrome: prevalence,
management and diabetic complications.
Diabet Med 15:160-163, 1998.
Barankin B, Guenther L: Dermatological
manifestations of Down's syndrome. J Cutan
Med Surg 5:289-293, 2001.
Bertera S, Alexander A, Giannoukakis N, Robbins
PD, Trucco M: Immunology of type 1
diabetes. Endocrinol Metab Clin North Am
28:841-846, 1999.
Book L, Hart A, Black J: Prevalence and clinical
characteristics of celiac disease in Down's
syndrome in a US study. Am J Med Genet
98:70-74, 2001.
Burch PRJ, Milunsky A: Early onset diabetes
mellitus in the general and Down's syndrome
populations. Lancet 1:554-558, 1969.
Carlstedt K, Krekmanova L, Dahllof, G, Ericsson,
B, Braathen G, Modeer T: Oral carriage of
Candida species in children and adolescents
with Down's syndrome. Int J Paediatr Dent
6:95-100, 1996.
Carnicer J, Farre C, Varea V, Vilar P, Moreno J,
Artigas J: Prevalence of coeliac disease in
Down's syndrome. Eur J Gastroenterol
Hepatol 13:263-267, 2001.
Chan KN, Phillips AD, Mirakian R, Walker-Smith
JA: Endomysial antibody screening in
children. J Pediatr Gastroenterol Nutr
18:316-320, 1994.
Corrao G, Corazzo GR, Andreani ML, Torchio P,
Valentini RA, Galatola G, Quaglino D,
Gasbarrini G, Diorio F: Serological screening
of celiac disease: Choosing the optimal
procedure according to various prevalence
values. Gut 35:771-775, 1994.
Cuckle H: Biochemical screening for Down
syndrome. Eur J Obstet Gynecol Reprod
Biol 92:97-101, 2000.
DCCT Research Group: The effect of intensive
treatment of diabetes on the development and
progression of long-term complications in
insulin-dependent diabetes mellitus. N Engl J
Med 329:977-986, 1993.
DCCT Research Group: Effect of intensive
diabetes treatment on the development and
progression of long-term complications in
adolescents with insulin-dependent diabetes
mellitus: Diabetes Control and Complications
Trial J Pediatr. 125:177-188, 1994.
Dietrich W, Ehnis, Bauer M, Donner P, Volta U,
Riecken EO, Schuppan D: Identification of
tissue transglutaminase as the autoantigen of
celiac disease. Nat Med 3:797-801, 1997.
Feingold E, Lamb NE, Sherman SL: Methods for
genetic linkage analysis using trisomies. Am
J Hum Genet 56:475-483, 1990.
Fulcher T, Griffin M, Crowley S, Firth R, Acheson
R, O'Meara N: Diabetic retinopathy in Down's
syndrome. Br J Ophthalmol 82:407-409,
1998.
Goldacre MJ, Wotton CJ, Seagroatt V, Yeates D:
Cancers and immune related diseases
associated with Down's syndrome: a record
linkage study. Arch Dis Child 89:1014-1017, 2004.
Griffin ME, Fulcher T, Nikookam K, Crowley J,
Firth RG, OMeara NM. Down's syndrome,
IDDM, and hypothyroidism. Diabetes Care 20:1202-1203, 1997.
Ivarsson SA, Ericsson VB, Gustafsson J, Forslund
M, Forslund M, Vegfors P, Anneren G: The
impact of thyroid autoimmunity in children
and adolescents with Down syndrome. Acta
Pediatr 86:1065-1067, 1997.
Jansson U, Johansson C: Down syndrome and
celiac disease. J Pediatr Gastroenterol
Nutrition 21:443-445, 1995.
Karlsson B, Gustafsson J, Hedov G, Ivarsson SA:
Thyroid dysfunction in Down’s syndrome:
relation to age and thyroid autoimmunity.
Arch Dis Child 79:242-245, 1998.
Kennedy RL, Darne J: The role of hCG in
regulation of the thyroid gland in normal and
abnormal pregnancy. Obstet Gynecol 78:298-307, 1991.
Kinik ST, Ozcay F, Varan B: Type I diabetes
mellitus, Hashimoto's thyroiditis and celiac
disease in an adolescent with Down syndrome.
Pediatr Int 48:433-435, 2006.
Knip M: Prediction and prevention of type 1
diabetes. Acta Paediatr Suppl 425:54-62, 1998.
Kraiem Z: The measurement of antithyroid
autoantibodies in the diagnosis and
management of thyroid autoimmune disease.
Clin Rev Allergy Immunol 16:219-225, 1998.
Larocca LM, Lauriola L, Ranelleti FO, Piantelli M,
Maggiano N, Ricci R, Capelli A:
Morphological and immunohistochemical
study of Down syndrome thymus. Am J Med
Genet Suppl 7:225-230, 1990.
Lorini R, Gastaldi R, Traggiai C, Perucchin PP:
Hashimoto's thyroiditis. Pediatr Endocrinol
Rev. 2:205-211, 2003.
Lu CY, Changelian PS, Unanue ER: Alphafetoprotein
inhibits macrophage expression of
Ia antigens. J Immunol 132:1324-1327, 1984.
Maccario R, Ugazio AG, Nespoli L, Alberini C,
Montagna D, Porta F, Bonetti F, Burgio GR:
Lymphocyte subpopulations in Down's
syndrome: high percentage of circulating
HNK-1+, lue2a+ cells. Clin Exp Immunol
57:220-226, 1984.
Mahmoud SA, Lowery-Nordberg M, Chen H,
Thurmon T, Ursin S, Bahna SL: Immune
defects in subjects with dysmorphic disorders.
Allergy Asthma Proc 26:373-381, 2005.
McCulloch AJ, Ince PG, Kendall-Taylor P:
Autoimmune chronic active hepatitis in
Down's syndrome. J Med Genet 19:232-234, 1982.
Mehta DI, Hill ID, Singer-Granick C et al.: Primary
sclerosing cholangitis and multiple
autoimmune disorders in a patient with Down
syndrome. Clin Pediatr (Phila) 34:502-505, 1995.
Milunski A, Neurath PW: Diabetes mellitus in
Down's syndrome. Arch Environ Health
17:372-376, 1968.
Murphy M, Hyun W, Hunte B, Levine A et al.: A
role for tumor necrosis factor-alpha and
interferon-gamma in the regulation of
interleukin-4-induced human thymocyte
proliferation in vitro. Heightened sensitivity in
the Down syndrome (trisomy 21) thymus.
Pediatr Res 32:269-276, 1992.
Murphy M, Insoft RM, Pike-Nobile L et al.:
Overexpression of LFA-1 and ICAM-1 in
Down syndrome thymus. Implications for
abnormal thymocyte maturation. J Immunol
150:5696-5703, 1993.
Nespoli L, Burgio GR, Ugazio AG, Maccario R:
Immunological features of Down syndrome: a review. J Intellect Disabil Res 37:543-551, 1993.
Philip R, Berger AC, McManus NH, Warner NH,
Peacock MA, Epstein LB: Abnormalities in the
in vitro cellular and humoral responses to
tetanus and influenza antigens with
concomitant numerical alterations in
lymphocyte subsets in Down's syndrome
(trisomy 21). J Immunol 136:1661-1667, 1986.
Pueschel SM, Pezzullo JC: Thyroid dysfunction in
Down syndrome. Am J Dis Child 139:636-639, 1985.
Rubello D, Pozzan GB, Casara D, Girelli ME,
Boccato S, Rigon F, Baccichetti C, Piccolo M,
Betterle C, Busnardo B: Natural course of
subclinical hypothyroidism in Downs
syndrome - prospective study results and
therapeutic considerations. J Endocrinol
Invest 18:35-40, 1995.
Sare Z, Ruvalcaba RHA, Kelly VC: Prevalence of
thyroid disorder in Down syndrome. Clin
Genet 14:154-158, 1978.
Sharav T, Collins RM, Baab PJ: Growth studies in
infants and children with Down’s syndrome
and elevated levels of thyrotropin. Am J Dis
Child 142:1302-1306, 1988.
Shield JPH, Wadsworth EJK, Hassold TJ, Judis
LA, Jacobs PA: Is disomic homozygosity at
the APECED locus the cause of increased
autoimmunity in Down's syndrome? Arch Dis
Child 81:147-150, 1999.
Tamiolakis D, Venizelos I, Kotini A, Nikolaidou S,
Papadopoulos N: Prevalence of CD8/CD4 ratio
in the fetal thymic parenchyme in Down's
syndrome. Acta Medica (Hradec Kralove)
46:179-182, 2003.
VanGoor JC, Massa GG, Hirasing R: Increased
incidence and prevalence of diabetes mellitus
in Down's syndrome. Arch Dis Child 77:186, 1997.
Visakorpi J, Maki M: Changing clinical features of
coeliac disease. Acta Paediatr Suppl 395:10-13, 1994.
Weetman AP: Chronic autoimmune thyroiditis. In
Braverman LE, Utiger RD (eds.): The Thyroid,
A Fundamental and Clinical Text, 8th ed.,
Lippincott Williams and Wilkins, Philadelphia
2000, pp. 721-732.
Zori RT, Schatz DA, Ostrer H, Williams CA,
Spillar R, Riley WJ: Relationship of
autoimmunity to thyroid dysfunction in
children and adults with Down syndrome. Am
J Med Genet Suppl 7:238-241, 1990.
Zubillaga P, Vitoria JC, Arrieta A, Echaniz P,
Garciamasdevall MD: Down's syndrome and
celiac disease. J Pediatr Gastroenterol Nutr
16:168-171, 1993.
|
CITED
Nabavi SM, Hamzehloo A, Sabet Z. Down syndrome presenting with multiple sclerosis, thyroid dysfunction, and diabetes mellitus Multiple autoimmune disorders in a genetic disorder. Neurosci. 16: 375-377, 2011.
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