“…We and others have shed light on the additional mutational events that are required for progression to overt ML-DS (Labuhn et al, 2019; Yoshida et al, 2013), however, far less is known about the role of trisomy 21 in creating the TAM/ML-DS disease phenotype. A critical region has been identified on Hsa21 that mediates the expansion of early hematopoietic progenitors observed in DS patients (Banno et al, 2016; Gurbuxani et al, 2004; Roy et al, 2012) and several Hsa21 genes – such as ERG (Birger et al, 2013; Ng et al, 2010), DYRK1A (Malinge et al, 2012), CHAF1B (Volk et al, 2018) and miR-125b (Alejo-Valle et al, 2021; Wagenblast et al, 2021) – have been postulated to play a role in leukemogenesis. On the other hand, Ts65dn mice that are trisomic for 104 orthologs of Hsa21 genes do not fully recapitulate the human phenotype in association with GATA1s (Klusmann et al, 2010), and the postulated factors are either located outside of the critical region, not overexpressed in trisomic fetal progenitor cells (Roy et al ., 2012), or lack full leukemic potential in humans when combined with mutated GATA1s (Chou et al, 2012; Grimm et al, 2021; Malinge et al ., 2012).…”