A rare human TNFAIP3 variant reveals how A20 abundance is regulated by TAX1BP1

Variants in TNFAIP3 (encoding A20) are among the most consistent non-MHC genetic associations with human autoimmune disease. Moreover, TNFAIP3 haploinsufficiency confers an autosomal dominant autoinflammatory and autoimmune disease. Whilst these findings strongly suggest that quantitative changes in A20 predispose to pathology, there is currently no evidence that post-transcriptional modifications regulate A20 abundance. We used human reverse genetics approach to investigate this question. From a cohort of patients with complex immune diseases, we identified an ultrarare hypomorphic TNFAIP3 variant (A20S254R) that is both hypomorphic and prone to phosphorylation. One of five carriers of this variant was distinguished by autoimmunity and an NF-kB gain-of-function transcriptional signature. A search for modifiers identified a variant in TAX1BP1 (p.Leu207Ile). We discovered that TAX1BP1 normally retrains A20 phosphorylation. Furthermore, TAX1BP1 preferentially binds phospho-A20, which explains the enhanced interaction between TAX1BP1L207I and A20S254R. A20 phosphorylation regulates its abundance, not by MALT1-mediated degradation, but probably via autophagy. Thus, while A20 phosphorylation has been implicated in A20 protease activity, an epistatic interaction between rare human genetic variants reveals how phosphorylation also regulates A20 abundance.