rs4986790 — TLR4 Asp299Gly

TLR4 Asp299Gly — A Double-Edged Sword in Immune Recognition

Toll-like receptor 4 (TLR4)¹¹ Toll-like receptor 4 (TLR4)
TLR4 is the primary innate immune receptor for lipopolysaccharide (LPS), a component of Gram-negative bacterial cell walls serves as the body's frontline defense against bacterial infections. The Asp299Gly variant (rs4986790), caused by an A-to-G transition at position 896 in the gene's coding sequence, replaces aspartic acid with glycine at amino acid position 299²² replaces aspartic acid with glycine at amino acid position 299
This occurs in the extracellular domain of TLR4, which directly binds to LPS complexes. This seemingly small change profoundly alters how your immune system responds to bacterial threats.

The G variant is relatively common among Europeans (about 8% carry at least one copy) but virtually absent in East Asian and African populations. This geographic distribution³³ geographic distribution
Population-specific selection pressures likely shaped the frequency of this variant across different ancestries reflects thousands of years of evolutionary adaptation to local pathogens.

The Mechanism

The glycine substitution disrupts the extracellular structure of TLR4, reducing its ability to recognize and bind bacterial LPS. When Gram-negative bacteria invade, their LPS is normally transferred to the TLR4/MD-2 complex via CD14⁴⁴ When Gram-negative bacteria invade, their LPS is normally transferred to the TLR4/MD-2 complex via CD14
This process initiates a signaling cascade through adaptor proteins MyD88 and TRIF, ultimately activating NFκB and triggering inflammatory cytokine production. Carriers of the 299Gly variant show blunted responses to inhaled LPS⁵⁵ blunted responses to inhaled LPS
A hallmark finding in early functional studies with reduced production of pro-inflammatory cytokines including IL-6, TNF-α, and IL-8.

Functional studies demonstrate that the Asp299Gly polymorphism interferes with recruitment of MyD88 and TRIF⁶⁶ Functional studies demonstrate that the Asp299Gly polymorphism interferes with recruitment of MyD88 and TRIF
These are critical adaptor proteins in the TLR4 signaling pathway, effectively dampening the inflammatory cascade before it fully activates. The variant also increases sensitivity to CD14 inhibition, suggesting altered protein-protein interactions in the receptor complex.

The Evidence

The clinical consequences of this altered immune recognition are complex and sometimes contradictory. Meta-analyses of inflammatory bowel disease show significantly higher frequencies of Asp299Gly in both Crohn's disease and ulcerative colitis patients⁷⁷ Meta-analyses of inflammatory bowel disease show significantly higher frequencies of Asp299Gly in both Crohn's disease and ulcerative colitis patients
Pooled analysis across 13 studies demonstrated this association. The G allele frequency reaches 19% in Crohn's disease patients versus 10% in controls, and colonic localization of Crohn's disease is strongly associated with G allele carriage⁸⁸ colonic localization of Crohn's disease is strongly associated with G allele carriage
43% of patients with colonic Crohn's disease carried the variant versus 12% with other localizations.

For cardiovascular disease, the picture flips. Meta-analysis across multiple studies showed the G allele associates with reduced atherosclerosis risk⁹⁹ Meta-analysis across multiple studies showed the G allele associates with reduced atherosclerosis risk
This protective effect extends to lower CRP levels and reduced vascular inflammation. One study found TLR4 Asp299Gly associates with reductions in angiographic coronary artery disease¹⁰¹⁰ TLR4 Asp299Gly associates with reductions in angiographic coronary artery disease
Odds ratio 0.43 for carriers in a population of 1,010 patients.

The sepsis story remains murky. Early studies suggested increased susceptibility to Gram-negative septic shock¹¹¹¹ Early studies suggested increased susceptibility to Gram-negative septic shock
This seemed logical given reduced LPS recognition, but subsequent meta-analyses found no strong association or even a marginal protective effect¹²¹² subsequent meta-analyses found no strong association or even a marginal protective effect
Analysis of 2,328 sepsis cases and 2,495 controls showed OR 0.71 in the dominant model, though not statistically significant. The variant may reduce excessive inflammatory responses that drive septic shock.

A 2025 study of 1,410 individuals across four populations found the polymorphic G allele significantly protective against periodontal inflammatory destruction¹³¹³ A 2025 study of 1,410 individuals across four populations found the polymorphic G allele significantly protective against periodontal inflammatory destruction
Functional assays showed enhanced IL-8 secretion and increased sensitivity to CD14 inhibition in cells expressing the variant. For infectious diseases, associations are pathogen-specific: increased risk of neurocysticercosis¹⁴¹⁴ increased risk of neurocysticercosis
Study of 190 patients showed strong association with symptomatic disease, possible increased susceptibility to Helicobacter pylori¹⁵¹⁵ possible increased susceptibility to Helicobacter pylori, and association with HIV-1 infection risk¹⁶¹⁶ association with HIV-1 infection risk
OR 2.16 for heterozygotes in a study of 160 HIV-1 positive patients.

Practical Implications

The blunted inflammatory response means your body may not mount as vigorous a defense against certain bacterial infections, yet this same dampened reactivity might protect you from inflammatory diseases where the immune system overreacts. The evidence suggests you need to be thoughtful about infection prevention while potentially benefiting from reduced chronic inflammation.

For inflammatory bowel disease, particularly if you have colonic symptoms, this variant increases risk significantly and may influence disease course. The cardiovascular protective effect is substantial enough that some researchers have explored whether this variant could inform statin therapy decisions, though this remains experimental.

Interactions

The Asp299Gly variant commonly co-segregates with another TLR4 variant, Thr399Ile (rs4986791)¹⁷¹⁷ Thr399Ile (rs4986791)
These two SNPs are in strong linkage disequilibrium. Most individuals carrying Asp299Gly also carry Thr399Ile, creating a haplotype with compounded effects on LPS signaling. When both variants are present, the reduction in inflammatory signaling is more pronounced than with either variant alone, particularly affecting neutrophil apoptosis and NF-κB activation.

Other immune-related SNPs may modulate the effects of rs4986790. The CD14-260 C>T polymorphism affects expression of CD14, the co-receptor that delivers LPS to TLR4, potentially amplifying or dampening the Asp299Gly effect. NOD2 variants, particularly common in Crohn's disease, may compound IBD risk when combined with TLR4 variants since both affect bacterial recognition in the gut mucosa.