Trisomy 21 is the immediate cause of Down's syndrome, but primary etiologic mechanisms have not yet been conclusively demonstrated. Among the factors mentioned as possibly predisposing to trisomy 21 are parental irradiation,1-3 maternal virus infection,-l genes enhancing the likelihood of faulty chromosomal distribution, and a factor related to parental a~t o i m m u n i t y .~ As one approach to testing the latter possibility, we have performed immunoclinical investigations on several largc groups of families in which there were subjects with Down's syndrome."-S The details of these investigations will be presented elsewhere;in this communication, the data are summarized and possible interpretations are discussed.
STUDY GROUPSFour hundred and eighty-three families of subjects with Down's syndrome, ascertained in three different ways, have been investigated. These consist of 295 families who reside in Winnipeg and other areas of Manitoba (Manitoba Study); 82 families of patients living at home who were ascertained through a small private school for mentally retarded children in the Seattle area (10 families) and through the Genetics Clinics at the University of Washington Hospital and the Children's Orthopedic Hospital and Medical Center (Seattle-Home Study); and 106 families of subjects in the two state institutions for the mentally retarded in the Seattle area (Seattle-Institution Study). The parents in the Manitoba Study were matched for age and sex with Manitoba blood bank donors. Serological results in younger sibs and probands were compared with those expected for age and sex based on results obtained in 252 children without thyroid, hepatic, or chromosomal diseases who were seen at the Children's Orthopedic Hospital and Medical Center. Probands and sibs over the age of 19 years were compared with Manitoba blood bank donors. The Seattle-Clinic families were matched for maternal age with families of well babies or children with genetic diseases. Only parents were systematically studied for thyroid antibodies. The index cases in the 106 control families for the Seattle-Institution group had mental retardation not known to be associated with a chromosomal aberration. They reside in the same institutions as d o the probands with Down's syndrome, and they were matched with them for probands' age and for maternal age. Other factors, such as probands' sex, paternal age, maternal reproductive