Interferon lambda 4 (gene symbol: IFNL4) is one of the most recently discovered human genes and the newest addition to the interferon lambda protein family. This gene encodes the IFNL4 protein, which is involved in immune response to viral infection.
IFNL4 is similar to three neighboring genes (IFNL1, IFNL2 and IFNL3) in that proteins encoded by these genes bind to a shared co-receptor complex. Formation of this complex leads to activation of the JAK-STAT signalling pathway and upregulation of numerous interferon-stimulated genes. Genetics variants within or near this gene have been linked to clearance of hepatitis C virus (HCV) infection and other phenotypes.
Discovery The first three interferon lambda genes were discovered in 2003 by two independent research groups that used different nomenclatures in their reports. In 2013, Prokunina-Olsson et al. reported the presence of a fourth gene in this region, which they discovered after treating human hepatocytes with polyinosinic:polycytidylic acid (poly I:C) to simulate HCV infection and induce expression of interferon lambda genes. RNA sequencing revealed the presence of IFNL4, which had been overlooked previously, in the interferon lambda region.
In 2003, the Human Genome Organization Gene Nomenclature Committee (HUGO NC) had designated the first three genes found in this region as interleukins, but HUGO NC reconsidered that decision upon discovery of the fourth gene ten years later. Today, these four genes are recognized as interferon lambda genes, with official symbols of IFNL1 (formerly IL29), IFNL2 (formerly IL28A), IFNL3 (formerly IL28B) and IFNL4.
Structure The interferon lambda genes lie in the 19q13.13 chromosomal region. IFNL4 is located between IFNL3 and IFNL2. The IFNL4 gene contains five exons and the full IFNL4 protein consists of 179 amino acids.
The proteins encoded by the IFNL1, IFNL2, and IFNL3 genes have high amino-acid sequence similarity. IFNL2 and IFNL3 share ~96% amino-acid identity, and IFNL1 shares ~81% identity with IFNL2 and IFNL3. IFNL4 differs considerably from other members of this family. IFNL4 is most closely related to IFNL3, however, these proteins share only ~30% amino-acid identity. Similarity between IFNL3 and IFNL4 is greatest for the A and F helices, where lambda interferons interact with the IFNLR1 receptor, and least in the D helix, where they interact with IL10R2, the second component of the interferon lambda receptor complex.
Genetic variants In 2009 (i.e., before the discovery of IFNL4), results from genome wide association studies (GWAS) indicated that single nucleotide polymorphisms (SNPs) near IFNL3 (rs12979860, rs8099917, and others) strongly associated with response to pegylated interferon-α and ribavirin treatment and spontaneous clearance of hepatitis C virus (HCV) infection.
As the gene then known as IL28B was the closest known gene at the time, these genetic variants were called 'IL28B variants' and it was assumed that the observed associations reflected differences in the structure or regulation of that gene. However, discovery of IFNL4 revealed many of these variants to be within or nearest to IFNL4. The rs12979860 SNP is located within intron 1 of IFNL4, while rs8099917 lies in an intergenic region, but nearest to IFNL4.
IFNL4 contains a polymorphism that controls the generation of the IFNL4 protein. The IFNL4-ΔG/TT (rs368234815, previously ss469415590) dinucleotide variant is composed of the rs11322783 (Δ/T) and rs74597329 (G/T) SNPs. Because those SNPs are in full linkage disequilibrium, rs368234815, rs11322783 and rs74597329 all provide the same information. In the NCBI dbSNP database, rs368234815 been merged into rs11322783. In the Genome Aggregation Database, however, IFNL4-ΔG/TT is represented by rs74597329. IFNL4-ΔG generates the complete IFNL4 protein while IFNL4-TT results in a frameshift that prematurely terminates the protein, producing truncated polypeptides without known biological function.
Another functional polymorphism within IFNL4 alters the protein's biological function. A non-synonymous variant located in exon 2 (rs117648444) substitutes a serine for a proline at amino acid position 70 (P70S) when present on a haplotype that includes the IFNL4-ΔG allele. In vitro studies have demonstrated the IFNL4 S70 protein has weaker biological function than IFNL4 P70. Specifically, IFNL4 S70 produced lower levels of interferon-stimulated gene expression and less antiviral activity compared to IFNL4 P70.
Population genetics Although the IFNL4 gene is present in all primates (and most non-primate mammals except mice or rats), humans are the only species in which the allele that abrogates IFNL4 has been found.
The chromosomal region containing IFNL4 has undergone the strongest selection of any region that harbors an interferon gene. Specifically, there has been very strong evolutionary selection for the IFNL4-TT variant, which 'knocks out' production of the IFNL4 protein. This allele likely arose just before the out-of-Africa migration and underwent immediate selection in the African population. That selection strengthened in European and Asian populations. As a result, whereas ~95% of individuals of African ancestry carry at least one copy of the IFNL4-ΔG allele and are able to produce IFNL4, that percentage drops to ~50% in Europeans and <15% in Asians. Comparison of African and East Asian populations revealed the IFNL4-TT allele to be among the most differentiated variants genome-wide.
It is unlikely HCV infection exerted the selection pressure that created these striking differences, as HCV did not become common until the twentieth century, and chronic HCV infection has too long of a course to majorly impact reproduction.
There is high linkage disequilibrium between the IFNL4-ΔG/TT variant and the rs12979860 and rs8099917 SNPs. Linkage disequilibrium between IFNL4-ΔG/TT and IFNL4 rs12979860 is complete in Asian populations (r2=1.0) and strong among those of European (r2>0.9), but weaker in African populations (r2~0.7). For rs8099917, linkage disequilibrium with IFNL4-ΔG/TT is strong in Asian populations, moderate in Europeans, and weak in Africans.
The IFNL4-ΔG/TT and rs117648444 variants present in three observed haplotypes that can modify or abrogate the IFNL4 protein. These haplotypes are: IFNL4-ΔG: rs117648444-G, which creates the IFNL4 P70 protein; IFNL4-ΔG: rs117648444-A, which creates the IFNL4 S70 protein; IFNL4-TT: rs117648444-G, which does not generate a full IFNL4 protein.
Associated phenotypes IFNL4 genetic variants are associated with a variety of phenotypes, including immune response to HCV infection, selection for HCV variants, hepatic inflammation and fibrosis, as well as certain opportunistic viral infections, and cancers.
HCV clearance Genotype for the IFNL4-ΔG/TT variant (and SNPs in linkage disequilibrium with that polymorphism) associate with both spontaneous clearance of HCV infection and successful treatment of chronic hepatitis C.
Interferon lambda became a focus of HCV research when studies associated the rs12979860 and rs8099917 SNPs with response to pegylated interferon-α and ribavirin treatment for chronic hepatitis C, and spontaneous HCV clearance. Compared to populations of European or Asian ancestry, African American populations demonstrated a lower frequency of the rs12979860-CC genotype, which is associated with viral clearance. That observation provided an explanation for previously observed racial differences in HCV treatment response and spontaneous clearance. The demonstrated association between genotype for the rs12979860 SNP and treatment led the US Food and Drug Administration to recommend testing for "IL28B" in clinical trials for new HCV treatments. Studies have been predominantly conducted on HCV genotype 1, but the association between IFNL4 genotype and impaired HCV clearance has been observed for other HCV genotypes as well.
IFNL4-ΔG/TT is the likely primary functional variant that accounts for this association. High linkage disequilibrium between marker SNPs (e.g., rs12979860) and candidate explanatory genetic variants (e.g., IFNL4-ΔG/TT) present a challenge in identifying functional polymorphisms. However, weaker linkage disequilibrium between IFNL4-ΔG/TT and IFNL4 rs12979860 in populations of African ancestry facilitate comparison of those polymorphisms, and in African American populations IFNL4-ΔG/TT was shown to be a better predictor than rs12979860 for response to treatment with pegylated interferon-α/ribavirin therapy and spontaneous HCV clearance. These findings were confirmed in a larger study of spontaneous clearance in an African American population and extended to European populations.
Associations between HCV clearance and genotype for the IFNL4-ΔG/TT polymorphism are strong. Among patients enrolled in the Virahep-C Trial, odds ratios for achieving a sustained virological response after treatment pegylated-interferon alpha/ribavirin (IFNL4-TT/TT versus IFNL4- ΔG/ΔG) were 2.90 in African-Americans and 4.42 in European-Americans. In the HALT-C cohort, even larger odds ratios were observed for sustained virological response: 11.0 and 6.94 among African-Americans and European-Americans, respectively.
Haplotypes that include the SNP (rs117648444), which controls the IFNL4 P70S protein variant, also associate with HCV clearance. In population studies, the variant that creates IFNL4 S70 associates with increased rates of spontaneous HCV clearance and better treatment response. In in vitro studies, the derived IFNL4 S70 protein produces reduced intrahepatic interferon stimulating gene expression and antiviral activity relative to IFNL4 P70. These results provide additional evidence that reduced IFNL4 activity improves HCV clearance.
Selection for HCV variants IFNL4 genotype may affect the HCV genome by selecting for certain viral strains, including those that lead to resistance to treatment. A genome-to-genome analysis revealed IFNL4 rs12979860 to be associated with variation for many amino acids in the HCV genome. HCV-infected patients with the rs12979860-CC genotype (i.e., those who do not generate the IFNL4 protein) had a higher frequency of non-synonymous HCV variants than patients with non-CC genotypes.
Certain direct acting antiviral agents (DAAs) used to treat HCV infection target the HCV NS5A protein. HCV variants in which histidine is substituted for tyrosine at amino acid position 93 (NS5A Y93H) may cause resistance to those agents and decrease treatment success. Patients with the NS5A Y93H variant are less likely to respond to NS5A inhibitors such as daclatasvir, ledipasvir and ombitasvir, which are commonly used in popular DAA regimens (e.g., Harvoni). Patients with the IFNL4-TT/TT genotype were shown to have a higher frequency of the NS5A Y93H substitution than those who carried the ΔG allele. Consistent with those results, the IFNL4 rs12979860-C/C genotype was strongly shown to be associated with the prevalence of the Y93H variant in patients infected with HCV genotype 1b.
Hepatic inflammation and fibrosis IFNL4 genotypes associated with increased HCV clearance and treatment response have also been linked to increased hepatic inflammation and fibrosis progression, which can lead to development of cirrhosis and liver cancer.