Abstract
Background
Patients with Down syndrome (DS) are at increased risk for infections and autoimmune disorders. Although several immunological abnormalities were previously found, differences in T cell receptor repertoire have never been shown. Thus we compared the T cell receptor gamma (TRG) repertoire in DS and non-syndromic pediatric patients by next-generation sequencing, in addition to other immunological markers.
Methods
Genomic DNA was extracted from thymuses of pediatric patients who underwent heart surgery, where six were with DS and six were non-syndromic patients. Peripheral blood counts, T cell subpopulations, thymus TCR excision circles (TRECs), spectratyping, and next-generation sequencing for TRG were analyzed.
Results
The mean age of the patients was 7 months and the mean lymphocyte count was slightly lower in patients with DS, whereas thymus TREC results were similar to non-syndromic patients (p = 0.197). The TRG repertoire analysis showed that patients with DS had a significantly larger number of unique TRG sequences, together with decreased clonal expansion. Lastly, the V and J gene usages in the thymus were similar in DS and non-syndromic patients.
Conclusions
Patients with DS showed increased TRG repertoire diversity with decreased clonal expansion compared to non-syndromic patients.
Impact
-
Alterations in T cell receptor gamma repertoire were found in patients with Down syndrome using next-generation sequencing (NGS) technique. Patients showed increased repertoire diversity and decreased clonal expansion compared to controls.
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These findings add to previous reports on abnormalities of other immune system components in patients with Down syndrome. NGS technique may point out differences not seen by previous methods.
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Repertoire abnormalities may contribute to those patients’ predisposition to infections and autoimmune diseases.
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References
Hobson-Rohrer, W. L. & Samson-Fang, L. Down syndrome. Pediatr. Rev. 34, 573–574 (2013).
Bishara, N. & Clericuzio, C. L. Common dysmorphic syndromes in the NICU. Neoreviews 9 e29–e38 (2007).
Murphy, M., Lempert, M. J. & Epstein, L. B. Decreased level of T cell receptor expression by Down syndrome (trisomy 21) thymocytes. Am. J. Med. Genet. 37, 234–237 (1990).
Nespoli, L., Burgio, G. R., Ugazio, A. G. & Maccario, R. Immunological features of Down’s syndrome: a review. J. Intellect. Disabil. Res. 37(Pt 6), 543–551 (1993).
Ugazio, A. G., Maccario, R., Notarangelo, L. D. & Burgio, G. R. Immunology of Down syndrome: a review. Am. J. Med. Genet. Suppl. 7, 204–212 (1990).
Cossarizza, A. et al. Precocious aging of the immune system in Down syndrome: alteration of B lymphocytes, T-lymphocyte subsets, and cells with natural killer markers. Am. J. Med. Genet. 37, 213–218 (2005).
Philip, R. et al. Abnormalities of the in vitro cellular and humoral responses to tetanus and influenza antigens with concomitant numerical alterations in lymphocyte subsets in Down syndrome (trisomy 21). J. Immunol. 136, 1661–1667 (1986).
de Hingh, Y. C. M. et al. Intrinsic abnormalities of lymphocyte counts in children with Down syndrome. J. Pediatr. 147, 744–747 (2005).
Li Volti, S. et al. Safety and effectiveness of an acellular pertussis vaccine in subjects with Down’s syndrome. Childs Nerv. Syst. 12, 100–102 (1996).
Levin, S. et al. Thymic deficiency in Down’s syndrome. Pediatrics 63, 80–87 (1979).
Larocca, L. M. et al. Morphological and immunohistochemical study of Down syndrome thymus. Am. J. Med. Genet. Suppl. 7, 225–230 (1990).
Marcovecchio, G. E. et al. Thymic epithelium abnormalities in DiGeorge and Down syndrome patients contribute to dysregulation in T cell development. Front. Immunol. 10, 447 (2019).
Lima, F. A. et al. Decreased AIRE expression and global thymic hypofunction in Down syndrome. J. Immunol. 187, 3422–3430 (2011).
Kusters, M. A. A., Verstegen, R. H. J., Gemen, E. F. A. & De Vries, E. Intrinsic defect of the immune system in children with Down syndrome: a review. Clin. Exp. Immunol. 156, 189–193 (2009).
Musiani, P. et al. Intrathymic deficient expansion of T cell precursors in Down syndrome. Am. J. Med. Genet. 37, 219–224 (1990).
Nikolich-Žugich, J., Slifka, M. K. & Messaoudi, I. The many important facets of T-cell repertoire diversity. Nat. Rev. Immunol. 4, 123–132 (2004).
Prada, N. et al. Direct analysis of thymic function in children with Down’s syndrome. Immun. Ageing 2, 4 (2005).
Verstegen, R. H. J. et al. Impact of Down syndrome on the performance of neonatal screening assays for severe primary immunodeficiency diseases. J. Allergy Clin. Immunol. 133, 1208–1211 (2014).
Yu, X. et al. Human syndromes of immunodeficiency and dysregulation are characterized by distinct defects in T-cell receptor repertoire development. J. Allergy Clin. Immunol. 133, 1109–1115 (2014).
O’Connell, A. E. et al. Next generation sequencing reveals skewing of the T and B cell receptor repertoires in patients with Wiskott-Aldrich syndrome. Front. Immunol. 5, 340 (2014).
Ramesh, M., Simchoni, N., Hamm, D. & Cunningham-Rundles, C. High-throughput sequencing reveals an altered T cell repertoire in X-linked agammaglobulinemia. Clin. Immunol. 161, 190–196 (2015).
Henderson, L. A. et al. Next-generation sequencing reveals restriction and clonotypic expansion of Treg cells in juvenile idiopathic arthritis. Arthritis Rheumatol. 68, 1758–1768 (2016).
Thapa, D. R. et al. Longitudinal analysis of peripheral blood T cell receptor diversity in patients with systemic lupus erythematosus by next-generation sequencing. Arthritis Res. Ther. 17, 132 (2015).
Chapman, C. G. et al. Characterization of T-cell receptor repertoire in inflamed tissues of patients with Crohnʼs disease through deep sequencing. Inflamm. Bowel Dis. 22, 1275–1285 (2016).
Lev, A. et al. The kinetics of early T and B cell immune recovery after bone marrow transplantation in RAG-2-deficient SCID patients. PLoS ONE 7, e30494 (2012).
Amariglio, N. et al. Molecular assessment of thymus capabilities in the evaluation of T-cell immunodeficiency. Pediatr. Res. 67, 211–216 (2010).
Lockitch, G. et al. Age-related changes in humoral and cell- mediated immunity in Down syndrome children living at home. Pediatr. Res. 22, 536–540 (1987).
Noble, R. L. & Warren, R. P. Altered T-cell subsets and defective T-cell function in young children with Down syndrome (trisomy-21). Immunol. Invest. 16, 371–382 (1987).
Cuadrado, E. & Barrena, M. J. Immune dysfunction in Down’s syndrome: primary immune deficiency or early senescence of the immune system? Clin. Immunol. Immunopathol. 78, 209–214 (1996).
Kwan, A. et al. Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States. JAMA 312, 729–738 (2014).
Machnes-Maayan, D. et al. Insight into normal thymic activity by assessment of peripheral blood samples. Immunol. Res. 61, 198–205 (2015).
Shearer, W. T. et al. Lymphocyte subsets in healthy children from birth through 18 years of age: the Pediatric AIDS Clinical Trials Group P1009 study. J. Allergy Clin. Immunol. 112, 973–980 (2003).
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S.R.—laboratory work, acquisition of data, analysis and interpretation of data, and drafting the manuscript. A.L.—laboratory work, acquisition of data, and analysis and interpretation of data. Y.-N.L.—laboratory work, acquisition of data, analysis and interpretation of data, and revising the manuscript. D.M.-M.—conception and design, acquisition of data, analysis and interpretation of data. U.K., A.V., and D.M.—clinical input and revising the manuscript. R.S.—conception and design, analysis of data, and revising the manuscript.
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Rabinowicz, S., Lev, A., Lee, Y.N. et al. Immune and TRG repertoire signature of the thymus in Down syndrome patients. Pediatr Res 89, 102–109 (2021). https://doi.org/10.1038/s41390-020-0857-y
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DOI: https://doi.org/10.1038/s41390-020-0857-y


