Association of a functional variant downstream of TNFAIP3 with systemic lupus erythematosus

Systemic lupus erythematosus (SLE, MIM152700) is an autoimmune disease characterized by self-reactive antibodies resulting in systemic inflammation and organ failure. TNFAIP3, encoding the ubiquitin-modifying enzyme A20, is an established susceptibility locus for SLE. By fine mapping and genomic re-sequencing in ethnically diverse populations, we fully characterized the TNFAIP3 risk haplotype and identified a TT>A polymorphic dinucleotide (deletion T followed by a T to A transversion) associated with SLE in subjects of European (P = 1.58 × 10(-8), odds ratio = 1.70) and Korean (P = 8.33 × 10(-10), odds ratio = 2.54) ancestry. This variant, located in a region of high conservation and regulatory potential, bound a nuclear protein complex composed of NF-κB subunits with reduced avidity. Further, compared with the non-risk haplotype, the haplotype carrying this variant resulted in reduced TNFAIP3 mRNA and A20 protein expression. These results establish this TT>A variant as the most likely functional polymorphism responsible for the association between TNFAIP3 and SLE.

Meta-analysis and imputation identifies a 109 kb risk haplotype spanning TNFAIP3 associated with lupus nephritis and hematologic manifestations

TNFAIP3 encodes the ubiquitin-modifying enzyme, A20, a key regulator of inflammatory signaling pathways. We previously reported association between TNFAIP3 variants and systemic lupus erythematosus (SLE). To further localize the risk variant(s), we performed a meta-analysis using genetic data available from two Caucasian case-control datasets (1453 total cases, 3381 total control subjects) and 713 SLE trio families. The best result was found at rs5029939 (P=1.67 x 10(-14), odds ratio=2.09, 95% confidence interval 1.68-2.60). We then imputed single nucleotide polymorphisms (SNPs) from the CEU Phase II HapMap using genotypes from 431 SLE cases and 2155 control subjects. Imputation identified 11 SNPs in addition to three observed SNPs, which together, defined a 109 kb SLE risk segment surrounding TNFAIP3. When evaluating whether the rs5029939 risk allele was associated with SLE clinical manifestations, we observed that heterozygous carriers of the TNFAIP3 risk allele at rs5029939 have a twofold increased risk of developing renal or hematologic manifestations compared to homozygous non-risk subjects. In summary, our study strengthens the genetic evidence that variants in the region of TNFAIP3 influence risk for SLE, particularly in patients with renal and hematologic manifestations, and narrows the risk effect to a 109 kb DNA segment that spans the TNFAIP3 gene.

Differential expression in lung and bronchial lymph node of pigs with high and low responses to infection with porcine reproductive and respiratory syndrome virus

One hundred Hampshire x Duroc cross-bred pigs and 100 Nebraska Index line pigs were infected with porcine reproductive and respiratory syndrome virus (PRRSV) and evaluated for resistance and susceptibility. Controls (100/line) were uninfected littermates to infected pigs. Viremia (V), BW change (WTDelta), and rectal temperature at 0, 4, 7, and 14 d postinfection were recorded. Lung, bronchial lymph node (BLN), and blood tissue were collected at necropsy (14 d postinfection). Infected pigs were classified as low or high responders to PRRSV based on the first principal component from principal component analyses of all variables. Low responders to PRRSV (low PRRSV burden) and their uninfected littermates were assigned to the low (L) class. High responders to PRRSV (high PRRSV burden) and their uninfected littermates were assigned to the high (H) class. Infected pigs in the L class had large WTDelta, low V, and few lung lesions; H-class pigs had small WTDelta, high V, and many lung lesions. Ribonucleic acid was extracted from lung and BLN tissue of the 7 highest and 7 lowest responders per line and from each of their control littermates. A control reference design was used, and cDNA from each reference sample tissue was prepared from pooled RNA extracted from 2 control pigs from each line whose infected littermates had a principal component value of 0. Design variables in data analyses were line (Index vs. Hampshire x Duroc), class (H vs. L), treatment (infected vs. uninfected controls), and slide/pig as error. Oligo differential expression was based on P < 0.01 occurring in both lung and BLN. Line and treatment effects were significant for 38 and 541 oligos, respectively, in both lung and BLN. Line x class interaction existed for expression of thymosin beta-4, DEAD box RNA helicase 3, acetyl-cholinesterase, and Homo sapiens X (inactive)-specific transcript in both tissues. Treatment x class existed for expression of CCAAT/enhancer-binding delta protein, nuclear factor of kappa light polypeptide gene enhancer in B cells inhibitor alpha, thioredoxin-interacting protein, major facilitator superfamily domain containing 1, and unknown sequences SS00012040 and SS00012343. Line x treatment and line x treatment x class interactions were not significant. Possible important genetic associations for fine-mapping candidate genes related to response to PRRSV and determining causative alleles were revealed.

Endometrial adenocarcinoma histologic subtypes: clinical and pathologic profile

All cases of endometrial adenocarcinoma treated at the Geisinger Medical Center from January 1970 to June 1980 were retrospectively reviewed in an attempt to elucidate the clinical and pathologic profiles of the various histologic subtypes. Complete clinical and pathologic data was available in 418 cases of stage I endometrial adenocarcinoma. The frequency of the histologic subtypes were adenocarcinoma 66%, adenoacanthoma 16%, adenosquamous 5%, papillary 8%, clear cell 3%, and secretory 2%. Absolute 5-year survival was adenocarcinoma 88%, adenoacanthoma 91%, adenosquamous 62%, papillary 63% (P less than 0.01), clear cell 43% (P less than 0.001), and secretory 89%. When comparing the clinical and pathologic profile of the various histologic subtypes, adenosquamous (52%, P less than 0.001) and clear cell (43%, P less than 0.05) were associated with the highest percentage of grade 3 differentiation. Adenosquamous (38%, P less than 0.05) and clear cell (36%) also had the highest percentage of deep myometrial invasion. Papillary subtype (46%, P less than 0.05) was associated with the highest percentage of nulliparity. There was no difference among the subtypes when comparing menopausal status, exogenous estrogen, obesity, hypertension, diabetes, or uterine size. In summary, (1) adenocarcinoma and adenoacanthoma are the most frequent subtypes; (2) adenosquamous, papillary, and clear cell have decreased 5-year survival; (3) the decreased 5-year survival in adenosquamous and clear cell subtypes appears to be associated with increased grade 3 differentiation and deep myometrial invasion while the poor prognosis associated with papillary subtype was not related to grade or myometrial invasion.

Adjuvant radiotherapy for stage I, grade 2 endometrial adenocarcinoma and adenoacanthoma with limited myometrial invasion

All cases of endometrial adenocarcinoma from January 1970 to December 1980 treated at the Geisinger Medical Center were reviewed retrospectively. One hundred eighty-eight cases of stage I grade 2 adenocarcinoma of favorable histologic subtype (adenocarcinoma, adenoacanthoma) and limited myometrial invasion (less than one-third of the myometrium) were identified. Surgery and adjuvant radiotherapy was used in 136 cases, and 52 cases were treated with surgery alone. There was no statistically significant difference between the two groups in menopausal status, parity, exogenous estrogen, obesity, hypertension, diabetes, or uterine size. Five-year survival for the surgery and radiotherapy group was 94% (128 of 136), and the recurrence rate was 2.2% (three of 136). The five-year survival for the surgery-alone group was 98% (51 of 52), and the recurrence rate was 1.9% (one of 52). There was no statistically significant difference in five-year survival or recurrence between the two groups. This study suggests that surgery alone is adequate treatment for stage I grade 2 adenocarcinoma of favorable histologic subtype and limited myometrial invasion. This study also shows a possible benefit in the combined use of histologic subtype, grade, and myometrial invasion as prognostic indicators and as guides for adjuvant radiotherapy.

Evaluation of the fallopian tube section obtained at laparoscopic fulguration

Three hundred tubal specimens obtained at laparoscopic coagulation and resection of the tube for sterilization done in the years 1973 and 1974 were studied. Twenty-three percent of the specimens were not identifiable as of tubal origin, and there was a lack of precision in the diagnosis in 17% of the specimens. Because of the comparable results for sterilization by well-performed coagulation alone and of coagulation with resection of a segment of tube, we feel that resection, with its assocaited hazards, is unnecessary.