Peripheral blood leukocytes (PBL) from noninstitutionalized individuals with trisomy 21, paired with closely age-matched and/or family members as controls, were analyzed for different aspects of their cellular and humoral immune responses, and were phenotypically characterized by means of various monoclonal antibodies. Both the in vitro PBL proliferative and antibody responses to a bacterial antigen (tetanus toxoid) and to viral antigens (influenza A/Bangkok and B/Singapore) were significantly decreased in trisomy 21. In addition, bacterial and viral antigen-induced in vitro interleukin 2 (IL 2) production was markedly reduced, although mitogen (PHA)-stimulated IL 2 production was not impaired. The functional abnormalities observed in trisomy 21 PBL occur concomitantly with numerical alterations in circulating lymphocyte subsets in these same individuals. Although no difference was observed between the trisomic and control groups in the percentage of total T and B lymphocytes, a decreased level of Leu-3a + 3b-positive cells (T helper/inducer cells) and an increased level of Leu-2a-positive cells (T suppressor/cytotoxic cells) that co-expressed Leu-15 (suppressor alone) were noted.