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Evidence of premature immune aging in patients thymectomized during early childhood
Open accessAbstract
While the thymus is known to be essential for the initial production of T cells during early life, its contribution to immune development remains a matter of debate. In fact, during cardiac surgery in newborns, the thymus is completely resected to enable better access to the heart to correct congenital heart defects, suggesting that it may be dispensable during childhood and adulthood. Here, we show that young adults thymectomized during early childhood exhibit an altered T cell compartment. Specifically, absolute CD4+ and CD8+ T cell counts were decreased, and these T cell populations showed substantial loss of naive cells and accumulation of oligoclonal memory cells. A subgroup of these young patients (22 years old) exhibited a particularly altered T cell profile that is usually seen in elderly individuals (more than 75 years old). This condition was directly related to CMV infection and the induction of strong CMV-specific T cell responses, which may exhaust the naive T cell pool in the absence of adequate T cell renewal from the thymus. Together, these marked immunological alterations are reminiscent of the immune risk phenotype, which is defined by a cluster of immune markers predictive of increased mortality in the elderly. Overall, our data highlight the importance of the thymus in maintaining the integrity of T cell immunity during adult life.
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“These studies showed that, independently from age, reduced thymic function and lower production of naïve T cells, together with the consumption of these cells (e.g., upon activation and differentiation during a viral infection), lead to reduced numbers of naïve T cells [75,76].”
From Aging of the immune system: Focus on inflammation and vaccination (2016) · cites this paper as [75]
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“Recent studies demonstrate that removal of thymus in children undergoing cardiac surgery leads to immunosenescence and premature onset of age-related decline in immune function (Sauce et al., 2009).”
Λιούλιος, Γ., Fylaktou, A., Papagianni, A. A., & Stangou, M. J. (2021) · Clinical Immunology · doi:10.1016/j.clim.2021.108685 · Cited by 36
The role of TEMRA cell-mediated immune senescence in the development and treatment of HIV disease
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“Chronic infection with CMV contributes to the accumulation of TEMRA cells (44).”
BackgroundSystems Biology of Vaccination in the Elderly
Duraisingham, S., Rouphael, N., Cavanagh, M., Nakaya, H. I., Goronzy, J. J., & Pulendran, B. (2012) · Current topics in microbiology and immunology · doi:10.1007/82_2012_250 · Cited by 34
“specific for cytomegalovirus (CMV) (Sauce et al. 2009).”
Sepsis-Induced Hypercytokinemia and Lymphocyte Apoptosis in Aging-Accelerated Klotho Knockout Mice
Inoue, S., Sato, T., Suzuki-Utsunomiya, K., Komori, Y., Hozumi, K., Chiba, T., Yahata, T., Nakai, K., & Inokuchi, S. (2013) · Shock · doi:10.1097/shk.0b013e3182845445 · Cited by 32
“Age-related thymopoietic insufficiency results in a reduced peripheral T-cell pool and the clonal expansion of preexisting memory T cells to maintain the overall T-cell pool (31).”
BackgroundT cell aging and Alzheimer’s disease
Guo, L., Li, X., Gould, T. M., Wang, Z., & Cao, W. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1154699 · Cited by 35
“Another piece of evidence comes from the study of congenital heart disease (CHD); the thymus is removed during cardiac surgery in newborns with CHD, leading to T cell aging (47).”
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Premature ageing of the immune system underlies immunodeficiency in ataxia telangiectasia
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Immune aging and infectious diseases
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“[ 146 ] These individuals exhibit signs of premature immunosenescence, displaying immune profiles typically seen in older adults, such as reduced naive T-cell numbers and an accumulation of memory T cells.”
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“A potential risk of early thymectomy was seen for the development of premature immunosenescence and of an immune-risk-phenotype [1, 17, 23] which is defined as a cluster of immune features (e.”
BackgroundResultInfluentialImmunosenescence promotes cancer development: from mechanisms to treatment strategies
Wang, L., & Tang, D. (2025) · Cell Communication and Signaling · doi:10.1186/s12964-025-02082-6 · Cited by 32
“…corroborated these findings, showing a marked decrease in postoperative naïve T-cell production and a severe imbalance in the naïve-to-memory T cell ratio in patients who have undergone thymectomy [30, 31], providing clinical evidence that thymic degeneration is a key driver of immune system aging.”
Thymus Functionality Needs More Than a Few TECs
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Reduced thymus activity and infection prematurely age the immune system
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“In accordance, early thymectomy in infants has demonstrated a subsequent premature aging of the immune system [6, 7] and increased incidence of infections, cancer and autoimmunity at follow-up after 18 years [8].”
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“Thymic involution implies a decreased output of naı̈ve T cells, which is evident in peripheral blood and the lymph nodes (Sauce et al., 2009; Appay et al., 2010).”
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Santos, R. P., Torres, C. F., Martín‐Arranz, M. D., de Parga, J. M. S., & Martínez, M. A. (2016) · Cited by 26
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The Immune System and the Developing Brain
Schwarz, J. M., & Bilbo, S. D. (2011) · Colloquium Series on The Developing Brain · doi:10.4199/c00045ed1v01y201110dbr004 · Cited by 25
“The thymus rapidly develops within 3–4 weeks after birth in rodents, and thymectomy during this time (or during the first postnatal week in humans) profoundly suppresses immunity throughout life (Appay, Sauce, & Prelog, 2010; Sauce et al., 2009).”
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Glennie, S. J., Nyirenda, M., Williams, N., & Heyderman, R. S. (2011) · Immunology · doi:10.1111/j.1365-2567.2011.03523.x · Cited by 25
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“Thymectomy Mirrors Age-related Immune Impairment Thymectomy early in life may lead to premature immunosenescence [15,28,36,37].”
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“Reduction in the T cell pool is a common aspect of pathological conditions such as human immunodeficiency virus (HIV) infection [30], cytotoxic chemotherapy [31], strong T cell depletion [32], and thymectomy in early age [33].”
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How to Define Biomarkers of Human T Cell Aging and Immunocompetence?
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“Further evidence that supports the key role of the thymus to maintain naïve T cell number and function derives from a study demonstrating premature T cell aging in patients thymectomized during early childhood (Sauce et al., 2009).”
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Silva, S. L., Albuquerque, A. S., Amaral, A. J., Li, Q., Mota, C., Cheynier, R., Victorino, R. M. M., Santos, M. C. P., & Sousa, A. E. (2017) · PLoS ONE · doi:10.1371/journal.pone.0180385 · Cited by 21
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“…(Lipsitch et al., 2020), SARS-CoV-2-reactive MP (cross-reactive) T cells have been detected in unexposed individuals (Bacher et al., 2020; Braun et al., 2020; Grifoni et al., 2020; Le Bert et al., 2020; Mateus et al., 2020; Sekine et al., 2020; Thieme et al., 2020; Weiskopf et al., 2020).”
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“04* Black 6 (11) 24 (32) Hispanic 2 (4) 3 (4) Other 1 (2) 1 (1) Diagnosis (%) Congenital heart disease 36 (67) 37 (49) 0.”
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“A reduction in total and naïve CD4 + T helper and CD8 + cytotoxic T cell compartments reportedly persisted for 2 decades after thymectomy (135, 136).”
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“This has also been noted in young adults thymectomized during childhood [67] and in HIV-infected adults [47].”
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Le vieillissement du système immunitaire : du fondamental à la clinique
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“Second, young adults who underwent thymectomy in early childhood exhibit a decrease in CD4 + and CD8 + T cells, reduced proportions of naïve T cells, and an accumulation of oligoclonal memory T cells ( 63 ).”
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“Under physiologic conditions, thymus releases immature lymphocytes termed “recent thymic emigrants” (RTEs) which maintain a stable pool of na€ıve T-cells.30 Whether thymus activity is maintained in adulthood is debated but it is accepted that most (approximately 90% of CD4C T cells) of T cells in older adults are gene…”
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“Moreover, it resembles the profile of immunosenescence documented in individuals thymectomized early in life during corrective cardiac surgery (26, 30, 31).”
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“…studies reported that reduced thymic activity leads to changes in the immune cell composition in patients with CHD, including lower total numbers ofTcells 14 – 16 ,lowerfrequenciesofnaïveCD4 + andCD8 + αβ Tcells 17 ,and less diversity in the T cell receptor (TCR) repertoire of αβ T cells 18 .”
McCullough, K. M., Katrinli, Ş., Hartmann, J., Lori, A., Klengel, C., Missig, G., Klengel, T., Langford, N. A., Newman, E. L., Anderson, K. J., et al. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02159-7 · Cited by 14
“Furthermore, our findings are consistent with literature demonstrating thymectomy in children alters cell composition, immune activity, and causes premature immune aging [11, 85].”
ResultThymectomy in Juvenile Myasthenia Gravis Is Safe Regarding Long Term Immunological Effects
Popperud, T. H., Gul, K. A., Brunborg, C., Olaussen, R. W., Abrahamsen, T. G., Osnes, L., & Kerty, E. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.596859 · Cited by 14
Uremia-Associated Immunological Aging and Severity of COVID-19 Infection
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“resulting in premature aging of T cells (4).”
BackgroundAging, nutrition and immunity – their relationship and interaction
Alam, I., & Pawelec, G. (2012) · Nutrition and Aging · doi:10.3233/nua-130013 · Cited by 13
“showed that infection with Cytomegalovirus (CMV) exhibited more severe alterations in the T cell repertoire compared to those who were free of CMV infection [84].”
BackgroundBirth cohort patterns suggest that infant survival predicts adult mortality rates
Meza, R., Pourbohloul, B., & Brunham, R. C. (2010) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174410000218 · Cited by 12
“Chronic infection acquired early in life such as that due to cytomegalovirus has been associated with premature immunosenescence and age-related chronic disease.(33) Of current interest are observations summarized by Gluckman et al.”
BackgroundStosio, M., Ruszkowski, J., Mikosik, A., Haponiuk, I., & Witkowski, J. M. (2017) · Polish Journal of Cardio-Thoracic Surgery · doi:10.5114/kitp.2017.72231 · Cited by 13
“Some researchers have demonstrated reductions in the total number of CD4+ and CD8+cells [3, 14, 23] and accumulations of oligoclonal memory cells as late as 22 years after thymectomy [14].”
BackgroundInfluentialRestoring resident tissue macrophages to combat aging and cancer
Park, M. D., Yatim, N., Zhang, J., Cho, B. A., Yoo, S., Schaefer, M. M., Chowell, D., Puleston, D. J., & Mérad, M. (2025) · Nature Aging · doi:10.1038/s43587-025-00898-y · Cited by 14
“Studies since then have yielded insights into thymic involution 15,16 , T cell exhaustion 17 and an aging-related bias of hematopoietic differentiation toward the myeloid lineage 18 .”
Baliu‐Piqué, M., Tesselaar, K., & Borghans, J. A. M. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.1059481 · Cited by 13
An Evolutionary Approach to Clonally Complex Hematologic Disorders
Schwenger, E., & Steidl, U. G. (2021) · Blood Cancer Discovery · doi:10.1158/2643-3230.bcd-20-0219 · Cited by 10
Thymic Atrophy and Immune Dysregulation in Infants with Complex Congenital Heart Disease
Bremer, S. J., Boxnick, A., Glau, L., Biermann, D., Joosse, S. A., Thiele, F., Billeb, E., May, J., Kolster, M., Hackbusch, R., et al. (2024) · Journal of Clinical Immunology · doi:10.1007/s10875-024-01662-4 · Cited by 14
“Previous research has mainly linked the compromised T-cell compartment observed in these patients with early-life thymectomy [50–52].”
BackgroundFastenackels, S., Bayard, C., Larsen, M., Magnier, P., Bonnafous, P., Seddiki, N., Appay, V., Gautheret-Dejean, A., & Sauce, D. (2019) · Journal of Virology · doi:10.1128/jvi.02321-18 · Cited by 10
“It has already been shown that HCMV responses inflate over time (12, 13).”
BackgroundSelf-citationHip Fracture Leads to Transitory Immune Imprint in Older Patients
Vallet, H., Bayard, C., Petitcorps, H. L., Ohana, J., Fastenackels, S., Fali, T., Cohen‐Bittan, J., Khiami, F., Boddaert, J., & Sauce, D. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.571759 · Cited by 10
“The pool of naïve T cells decreases due to the thymic involution (8) and there is a shrinking of TCR repertoire (9).”
BackgroundSelf-citationImmunosenescence and Inflamm-Aging: Clinical Interventions and the Potential for Reversal of Aging
Kumar, S. J., Shukla, S., Kumar, S., & Mishra, P. (2024) · Cureus · doi:10.7759/cureus.53297 · Cited by 12
“Recent research, such as that conducted by Sauce et al. [20], concluded the prevalence of premature immunosenescence in young adults who underwent thymectomy very early on due to the presence of congenital heart diseases.”
MethodLeposavić, G., Pilipović, I., & Nanut, M. P. (2011) · NeuroImmunoModulation · doi:10.1159/000329499 · Cited by 11
Wong, I. O. L., Cowling, B. J., Leung, G. M., & Schooling, C. M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0038988 · Cited by 10
“Whether better adaptive immunity would also be expected to protect against aging [40], and thereby also relate to the greater gains in life expectancy among women than men with economic development remains to be determined.”
BackgroundHwang, J. H., Kim, D. W., Kim, K. S., & Lee, S. Y. (2019) · Medicine · doi:10.1097/md.0000000000017042 · Cited by 10
“Such conditions of chronic inflammation induce proliferation of lymphoid tissue, leading to the development ofMALT lymphoma.([1,3,9]) In our case report, the patient had a history of an autoimmune disease (i.”
Neutrophil and T Cell Functions in Patients with Congenital Heart Diseases: A Review
Yuki, K., & Koutsogiannaki, S. (2021) · Pediatric Cardiology · doi:10.1007/s00246-021-02681-3 · Cited by 10
Immunology of the Fetus and Newborn
Williams, C. B., Eisenstein, E. M., & Cole, F. S. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-0134-0.10036-8 · Cited by 10
Early life thymectomy induces arterial dysfunction in mice
Buckley, D. J., Sharma, S., Joseph, B., Fayyaz, A. H., Canizales, A., Terrebonne, K. J., & Trott, D. W. (2023) · GeroScience · doi:10.1007/s11357-023-00853-y · Cited by 9
“Additionally, decreased proportions of naïve T cells have been observed in the blood of humans thymectomized during early childhood [37].”
Burning Down the House: Thymic Repair and Regeneration After Acute Damage
Dudakov, J. A., & van den Brink, M. R. M. (2025) · Immunological Reviews · doi:10.1111/imr.70050 · Cited by 9
Bosch, J. A., Rector, J. L., Turner, J. E., Riddell, N. E., O’Hartaigh, B. W. J., & Burns, V. E. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4776-4_6 · Cited by 9
Heterogeneity of thymic output in the elderly and its association with sex and smoking
Sandhar, B. S., Vyas, V. S., Harding, D., Ragazzini, R., Bonfanti, P., Marelli‐Berg, F. M., Bell, C. G., Chain, B., & Longhi, M. P. (2025) · JCI Insight · doi:10.1172/jci.insight.189008 · Cited by 10
“Early thymectomy has been associated with marked immunological changes reminiscent of an aged immune phenotype characterized by immunose-nescence and an inflammatory state (17, 35–39).”
InfluentialImpacto de la función tímica en el deterioro inmunológico asociado a la edad
Ferrando‐Martínez, S., la Fuente, M. D., Guerrero, J. M., Leal, M., & Muñoz‐Fernández, M. Á. (2013) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2012.11.009 · Cited by 8
Autoimmune Neurologic Diseases in Children
Sweeney, M. L. (2018) · Seminars in Neurology · doi:10.1055/s-0038-1660520 · Cited by 8
Aging and immunity: the age-old tangoPreprint
Fernández-Maestre, I., Harris, A. S., & Amor, C. (2025) · Genes & Development · doi:10.1101/gad.352644.125 · Cited by 8
“…BLIMP-1 Senescent T cells CD3 + , PD-1 + , TIM-3 + , CD57 + , KLRG1 + , CD45RA + , CD8 + , CD27 − , CD28 − CD3 + , PD-1 + , TIM-3 + , CD57 + , KLRG1 + , CD45RA CD11b + , GR1/Ly6G + , F4/80 − or decreased CD4 + and CD8 + naive T cells, accompanied by a contracted TCR repertoire (Sauce et al. 2009).”
Association of Thymectomy With Infection Following Congenital Heart Surgery
Hermes, H. M., Cohen, G. A., Mehrotra, A., McMullan, D. M., Permut, L. C., Goodwin, S., & Stevens, A. M. (2011) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135111403328 · Cited by 7
“Moreover, the control groups were usually age-matched healthy controls without heart disease or surgery, conditions that alone can lead to stress-induced immunosuppression.(6,12,16,17) Clinical outcomes depended on parental questionnaires or unreported methods, inherently incomplete and unreliable.”
BackgroundMaladie rénale chronique et immunosénescence prématurée : données et perspectives
Crépin, T., Legendre, M., Courivaud, C., Vauchy, C., Laheurte, C., Rebibou, J.-M., Saas, P., Ducloux, D., & Bamoulid, J. (2019) · Néphrologie & Thérapeutique · doi:10.1016/j.nephro.2019.04.005 · Cited by 9
Long‐term immunological changes after corrective cardiac surgery
Eltan, S. B., Amirov, R., Babayeva, R., Altunbaş, M. Y., Karakurt, L. T., Can, S., Gungoren, E. Y., Bozkurt, S., Ozturk, N. K., Çatak, M. C., et al. (2024) · Scandinavian Journal of Immunology · doi:10.1111/sji.13418 · Cited by 6
Ravens, S., & Tolosa, E. (2024) · European Journal of Immunology · doi:10.1002/eji.202451073 · Cited by 6
“These patients show a prematurely aged immune sys-tem, with a reduced naïve T-cell pool and restricted αβ T-cell repertoire [48], and they are at higher risk of developing autoimmunity, cancer, and other comorbidities [49].”
Barreira‐Silva, P., Melo-Miranda, R., Nóbrega, C., Roque, S., Serre-Miranda, C., Borges, M. C., Armada, G., Calçada, D. D. S., Behar, S. M., Appelberg, R., et al. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.696415 · Cited by 6
“However, further investigation showed that thymectomy early in life leads to premature immune aging (4).”
BackgroundIncreased risk of infections in pediatric Fontan patients after heart transplantation
Ahmed, H., Lee, J., Bernstein, D., Rosenthal, D. N., Dykes, J. C., Lee, D., Barkoff, L., Weinberg, K. I., Hollander, S. A., & Chen, S. (2022) · Pediatric Transplantation · doi:10.1111/petr.14421 · Cited by 6
“T- cell subsets were obtained for 21/25 (81%) Fontan and 27/33 (82%) DCM patients within 24 h of completion of the third dose of ATG, revealing a significantly lower CD3 count in Fontan patients [Fontan median: 8/μl (5, 14) vs DCM median: 16/μl (10, 39); p = .”
BackgroundEvaluation of renal function and immune system cells in elderly individuals from São Paulo City
Teixeira, D., Longo‐Maugéri, I. M., Duarte, Y. A. O., Lebrão, M. L., & Bueno, V. (2013) · Clinics · doi:10.6061/clinics/2013(01)oa06 · Cited by 6
“In healthy elderly individuals, the decreased cellularity in the peripheral blood has been attributed to thymus involution (6) rather than bone marrow insufficiency (7).”
BackgroundThymolipoma and its Association with Myasthenia Gravis: a Multi-center Experience
Hamouri, S., Syaj, S., Al-Kraimeen, L. M., Smady, M. M. A., Alhadidi, H., & Barakat, F. (2021) · Medical Archives · doi:10.5455/medarh.2021.75.375-381 · Cited by 6
“Thus, the immunological milieu should be monitored, especially in young patients (29, 30).”
BackgroundThe aging immune system: Dysregulation, compensatory mechanisms, and prospects for intervention
Müller, L., & Pawelec, G. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-815962-0.00016-0 · Cited by 5
Immunosenescence : ageing of the immune system : review
Suchard, M. S. (2015) · Pharmacy management · Cited by 5
Giant thymolipoma in a young child initially diagnosed as cardiomegaly
Onoda, T., Meguro, T., Kanno, M., Ohta, H., Nakamura, M., Ohtake, H., & Mitsui, T. (2015) · Pediatrics International · doi:10.1111/ped.12786 · Cited by 5
Immunology of the Fetus and Newborn
Weitkamp, J.-H., Lewis, D. B., & Levy, O. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-40139-5.00036-x · Cited by 4
TB and HIV induced immunosenescence: where do vaccines play a role?
Singh, M., Patel, B., Seo, M., Ahn, P., Wais, N., Shen, H., Nakka, S., Kishore, P., & Venketaraman, V. (2024) · Frontiers in Aging · doi:10.3389/fragi.2024.1385963 · Cited by 5
“This can result in an unstable response to antigens, reduced levels of CD4 + or CD8 + T cells, decreased numbers of naïve cells, and an accumulation of memory T cells, including CD57 + cells, which are associated with senescence (Sauce et al., 2009).”
BackgroundMai, D. H., Sedler, J., Weinberg, K. I., Bernstein, D., Schroeder, A. R., Mathew, R., Chen, S., Lee, D., Dykes, J. C., & Hollander, S. A. (2022) · Pediatric Transplantation · doi:10.1111/petr.14344 · Cited by 4
Childhood myasthenia gravis in Japan : Pathophysiology and treatment options
Hayashi, M. (2023) · Clinical and Experimental Neuroimmunology · doi:10.1111/cen3.12762 · Cited by 5
“85,86 Unlike mice, the human thymus gland reaches its peak growth at birth and remains active until puberty.”
Background
Metadata
- Authors
- Sauce, D., Larsen, M., Fastenackels, S., Duperrier, A., Keller, M., Grubeck-Loebenstein, B., Ferrand, C., Debré, P., Sidi, D., & Appay, V.
- Affiliations
- Inserm (FR)
- US Forest Service (US)
- Hôpital Necker-Enfants Malades (FR)
- Corresponding author
- Appay, Victor
- ORCID
- Venue
- Journal of Clinical Investigation
- Published
- 2009-10-01
- Volume
- 119
- Issue
- 10
- Pages
- 3070-3078
- ISSN
- 0021-9738 (ISSN-L)
- PMC
- PMC2752077
- OpenAlex
- W2153680933
- Cited by
- 278
- References
- 57
- Citations by year
- 2026: 16 · 2025: 11 · 2024: 18 · 2023: 14 · 2022: 15 · 2021: 16 · 2020: 15 · 2019: 11 · 2018: 14 · 2017: 14 · 2016: 17 · 2015: 12 · 2014: 11 · 2013: 22 · 2012: 22
- FWCI
- 10.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Oesterreichisches Musiklexikon online (Institut für kunst- und musikhistorische Forschungen der Österreichischen Akademie der Wissenschaften) (submittedVersion, other-oa)
- Austrian Biographical Dictionary (Austrian Academy of Sciences) (submittedVersion, other-oa)
- HAL (submittedVersion)
- Funders
- Sidaction
- Institut National de la Santé et de la Recherche Médicale
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
- Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
- Life Sciences › Immunology and Microbiology › Immunology › Immune responses and vaccinations
- Keywords
- thymectomy, thymus, T cell compartment, naive T cells, cytomegalovirus infection, CMV-specific T-cell responses, T cell exhaustion, congenital heart surgery, CD4+ T cells, CD8+ T cells
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Aging, Child, Preschool, Cytomegalovirus Infections, Humans, Immune System, Infant, Newborn, Middle Aged, Thymectomy, CD4-Positive T-Lymphocytes, T-Lymphocyte Subsets, Cytokines, CD8-Positive T-Lymphocytes, Young Adult
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