“…Increases in RBC levels of pyruvate and lactate as well as acyl-conjugated fatty acids may relate to diabetes and obesity, which are recurring comorbidities in the T21 population, 13 complementing previous lipidomics reports on n-6 fatty acid dysregulation in RBCs from children with T21. 18 RBC metabolic markers of T21 included purine catabolites like hypoxanthine as well as immunomodulatory/inflammationrelated metabolites like (1) conjugated bile acids (markers of alteration to the microbiome), 25 (2) the carboxylic acids fumarate and succinate, 7,26 and (3) the tryptophan oxidation product kynurenine, 27 linking the present observations with the autoimmune and inflammatory comorbidities of DS. 13,14 Increases in plasma purines, specifically adenosine and its deaminated byproducts, have been previously reported in individuals with DS, where increased adenosine deaminase activity and hyperuricemia result from excessive purine synthesis secondary to the overexpression of genes in the purine de novo synthesis pathway GARS-AIRS-GART located on chromosome 21.…”