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At about 40 years of age, practically all patients with Down syndrome exhibit neuropathological changes typical for Alzheimers disease including -amyloid plaques and neurofibrillary tangles (Mann and Esiri 1989)

The UPR, crucial for innate and adaptive immunity, is activated in this situation, suggesting its role in regulating and maintaining the immune response in vitiligo.42 Another recent study analyzed the role of mitochondrial energy metabolism in melanocytes from vitiligo patients, finding reduced ATP production, increased proton leakage, altered expression of glycolytic enzymes, and hyperactivity of the PGC1 axis

Such mechanistic knowledge creates the potential to investigate the evolution of the control systems regulating maternal effects

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