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Neonatal thymectomy in children—accelerating the immunologic clock?

Lookup NU author(s): Dr Aisling Flinn, Professor Andrew Gennery

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Mosby Inc., 2020.

For re-use rights please refer to the publisher's terms and conditions.


Abstract

© 2020 American Academy of Allergy, Asthma & Immunology. The thymus is critical for central tolerance and diverse T-lymphocyte repertoire development, to provide lifelong defense against pathogens while maintaining self-tolerance. Peak thymic output occurs in utero, during infancy, and in early childhood, diminishing throughout life. Infants with congenital heart disease requiring sternotomy often undergo thymectomy to clear the surgical field. The long-term effects of early thymectomy are just being appreciated. Many patients remain asymptomatic despite immunologic findings mirroring those of immunosenescence. Few develop increased infection or lymphoreticular malignancy risk. When considering the effects of infant thymectomy, patients with partial DiGeorge syndrome or hypomorphic recombination-activating gene (RAG) mutations may be instructive. These patients are lymphocytopenic, with increased early-onset infection and autoimmunity risk that is not seen in most patients who underwent thymectomy during infancy. The thymic structure of patients with partial DiGeorge syndrome or hypomorphic RAG is abnormal, with disrupted architecture inclining to perturbation of central tolerance. Similar findings may be seen in patients with myasthenia gravis, although disrupted peripheral tolerance may play a greater role in autoimmunity development. In conclusion, thymectomy during infancy may increase future risk of infection or autoimmunity, with premature immunosenescence mediated through disruption of central and peripheral tolerance mechanisms initiated by early cessation or diminution of thymic output. Ideally, some thymic tissue should be preserved at the time of surgery.


Publication metadata

Author(s): Deya-Martinez A, Flinn AM, Gennery AR

Publication type: Article

Publication status: Published

Journal: Journal of Allergy and Clinical Immunology

Year: 2020

Volume: 146

Issue: 2

Pages: 236-243

Print publication date: 01/08/2020

Online publication date: 10/03/2020

Acceptance date: 26/02/2020

Date deposited: 19/02/2021

ISSN (print): 0091-6749

ISSN (electronic): 1097-6825

Publisher: Mosby Inc.

URL: https://doi.org/10.1016/j.jaci.2020.02.028

DOI: 10.1016/j.jaci.2020.02.028

PubMed id: 32169378


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