Haploinsufficiency of A20 caused by a novel pathogenic missense variant of TNFAIP3 and successfully treated with anti-TNF and immunosuppressive therapies

Loss-of-function of protein A20, encoded by TNFAIP3, leads to an early-onset haploinsufficiency of A20 (HA20). This study reports one Chinese child with HA20 and explores the genetic etiology of TNFAIP3 variant. The patient exhibited transient recurrent episodes of fever, intermittent signs of arthritis, gastrointestinal symptoms and multiple colonic ulcers. Laboratory tests revealed elevated inflammatory indicators and mild to moderate anemia. Genetic analysis identified a heterozygous de novo variant in his TNFAIP3 gene (c.740C＞T, p. P247L), which had never been reported before. The novel missense variation was validated to be pathogenic through causing insufficient expression of A20, over-activation of NF-κB signaling pathway and elevated levels of proinflammatory cytokines in response to stimulation by lipopolysaccharide. A combination of oral corticosteroids, TNF-α inhibitors and thalidomide freed him from symptoms and abnormal inflammatory indicators. Furthermore, continual improvement of the patient's condition was observed during a follow-up period of five months. We demonstrate a case with a de novo missense variant resulting in a loss-of-function of TNFAIP3, which expands the clinical spectrum of HA20. Cytokine antagonists and immunosuppressants may be effective drugs.

Solubility of trace elements and heavy metals from stabilized sewage sludge by fly ash

Stabilized sewage sludge (SS) by fly ash (FA) and alkaline mine tailing as artificial soil, to be applied on the ecological rehabilitation at mining junkyard, offers a potential viable utilization of the industrial by-product, as well as solves the shortage of soil resource in mine area. In this study, trace element and heavy metal soil solution concentrations arising from fly ash, sewage sludge, mine tailing, and artificial soil mixtures were investigated in a laboratory incubation. It was found that total Cd, Pb, and Zn contents in artificial soils were significantly lower than the control standards for pollutants in sludges from agricultural use (GB 4284-84). Soil solution Cd and Pb concentrations were obviously reduced by mixing sewage sludge with alkaline fly ash. Initial soil solution Cd, Pb, and Zn concentrations in artificial soils were 1.773-14.672, 4.05-24.95, and 133-608 microg L(-1), respectively, and after 35-days incubation, soil solution Cd, Pb, and Zn concentrations gradually decreased and were approaching control levels by the end of the experiment, and finial soil solution were decreased to 0.037-0.365, 2.12-7.34, and 29-509 microg L(-1), respectively.