rs4986791 — TLR4 Thr399Ile

Missense variant in Toll-like receptor 4 that co-segregates with Asp299Gly on the same haplotype, together reducing LPS-driven innate immune signaling and altering gram-negative bacterial recognition

See your personal result for TLR4

Upload your DNA data to find out which genotype you carry and what it means for you.

Upload your DNA data

Works with 23andMe, AncestryDNA, and other DNA test exports. Results in under 60 seconds.

TLR4 Thr399Ile — The Silent Partner in Immune Recognition

Toll-like receptor 4 (TLR4)11 Toll-like receptor 4 (TLR4)
The primary innate immune receptor for lipopolysaccharide (LPS), a structural component of Gram-negative bacterial cell walls orchestrates your body's first response to bacterial threats. The Thr399Ile variant (rs4986791) — a C-to-T transition at coding position 1196 that replaces threonine with isoleucine at protein position 39922 replaces threonine with isoleucine at protein position 399
This occurs in the extracellular domain of TLR4 — is an important functional variant in its own right, yet one that has long lived in the shadow of its neighbor.

Unlike the Asp299Gly variant (rs4986790), Thr399Ile does not independently disrupt TLR4 signaling in isolated cell-culture experiments. But in living humans, these two variants almost always travel together on the same chromosome. They co-segregate on a single haplotype33 They co-segregate on a single haplotype
Most carriers of Thr399Ile are also carriers of Asp299Gly, and vice versa. This tight genetic coupling means their combined effect on immune recognition — reduced LPS sensing, dampened cytokine production, altered neutrophil responses — is the relevant biology for nearly everyone carrying either variant. The T allele occurs at about 6.4% frequency in Europeans but is exceptionally rare in East Asians (0.04%); interestingly, South Asians and Finns show notably higher frequencies (~10.5% and ~12.2% respectively).

GWAS analyses provide an independent line of evidence: rs4986791 is among the strongest genetic determinants of TLR4:MD-2 protein complex levels in blood (MD-2 is the co-receptor that enables TLR4 to recognize LPS), with effect sizes reaching beta = −0.94 to −1.27 at p < 10⁻³⁴, indicating the T allele substantially reduces circulating TLR4/MD-2 complex abundance regardless of the co-occurring Asp299Gly variant.

The Mechanism

Thr399Ile sits in the extracellular domain of TLR4, in a region involved in forming the receptor complex with MD-2 and LPS. While functional studies using isolated Thr399Ile-only constructs found no independent disruption of LPS-induced NF-κB signaling, the variant reduces TLR4:MD-2 protein complex abundance at the cell surface. When combined with Asp299Gly on the same haplotype, neutrophils show reduced phosphorylation of IκB44 reduced phosphorylation of IκB
IκB is the inhibitor of NF-κB; its reduced phosphorylation means NF-κB stays in its inactive state, blunting inflammatory gene transcription, diminished IL-6 and TNF-α production after LPS stimulation, and reduced suppression of apoptosis — the combination yielding a pronounced loss-of-function phenotype in real-world immune contexts.

The Evidence

The inflammatory bowel disease evidence is among the most replicated findings. A meta-analysis of 49 case-control studies found significant associations between rs4986791 and IBD risk55 A meta-analysis of 49 case-control studies found significant associations between rs4986791 and IBD risk
Analysis included both Crohn's disease and ulcerative colitis. A separate meta-analysis confirmed significantly higher frequencies of Thr399Ile in patients with IBD, Crohn's disease, and ulcerative colitis66 A separate meta-analysis confirmed significantly higher frequencies of Thr399Ile in patients with IBD, Crohn's disease, and ulcerative colitis
The 399Ile allele carriage was elevated in UC patients as well as CD patients in this analysis. These findings are biologically coherent: reduced TLR4 recognition of gut-resident bacteria is thought to impair mucosal immune homeostasis, allowing commensals to trigger aberrant inflammation.

For sepsis, the picture is clearer than for Asp299Gly. A meta-analysis of 17 studies encompassing 2,212 cases and 3,880 controls found an odds ratio of 1.16 (95% CI: 0.70–1.91, p = 0.57) for Thr399Ile and sepsis77 A meta-analysis of 17 studies encompassing 2,212 cases and 3,880 controls found an odds ratio of 1.16 (95% CI: 0.70–1.91, p = 0.57) for Thr399Ile and sepsis
This non-significant result held across Caucasian populations. There is no meaningful independent association between this variant and sepsis susceptibility.

Emerging evidence links rs4986791 to cancer susceptibility. A meta-analysis of 87 case-control studies found the T allele associated with increased cancer risk (OR 0.74 for C vs T model)88 A meta-analysis of 87 case-control studies found the T allele associated with increased cancer risk (OR 0.74 for C vs T model)
The study spanned prostate, lung, gastric, hepatocellular, and colorectal cancers, among others. A separate case-control study found rs4986791 variant genotypes associated with increased acute myeloid leukemia (AML) susceptibility, OR 1.61 (95% CI: 1.001–2.59) in the dominant model99 rs4986791 variant genotypes associated with increased acute myeloid leukemia (AML) susceptibility, OR 1.61 (95% CI: 1.001–2.59) in the dominant model
The combined effect of rs4986790 + rs4986791 yielded OR 3.14 for AML development. For respiratory disease, a meta-analysis of 11 studies found significant asthma association especially among Asian populations1010 a meta-analysis of 11 studies found significant asthma association especially among Asian populations
One pediatric study found CT genotype children were more likely to develop severely persistent asthma.

Practical Implications

Because Thr399Ile almost always co-occurs with Asp299Gly, the practical actions for carriers mirror those for Asp299Gly carriers — vigilant infection prevention, attention to gastrointestinal symptoms, and awareness of IBD risk. The additional evidence here for asthma and cancer susceptibility adds nuance: the T allele appears to be a general marker of altered innate pattern recognition, with downstream consequences across multiple inflammatory and immune-surveillance pathways.

The significantly reduced TLR4:MD-2 complex levels in T allele carriers suggest a mechanistically grounded reason for the reduced immune surveillance: there are simply fewer functional receptor complexes available to detect bacterial signals at mucosal surfaces.

Interactions

Thr399Ile (rs4986791) and Asp299Gly (rs4986790) co-segregate on the same haplotype in virtually all carriers1111 co-segregate on the same haplotype in virtually all carriers
In population studies, essentially every Thr399Ile carrier also carries Asp299Gly. This means interpreting either variant in isolation is biologically incomplete. The compound haplotype shows more pronounced impairment of innate immune responses than either variant alone, including reduced neutrophil NF-κB activation and cytokine production. This interaction is the most important genetic context for rs4986791 — for most carriers, the functional picture is the same as for the compound double carrier. TLR4 co-receptor variants such as the CD14 -260 C>T polymorphism, which alters CD14 expression and LPS delivery to TLR4, may further modulate the effect of this haplotype on mucosal immunity and IBD risk.

Genotype Interpretations

What each possible genotype means for this variant.

CC Normal Responder Normal

Standard TLR4 function with normal gram-negative bacterial recognition

You have two copies of the common form of TLR4 at this position. About 88% of people of European descent share this genotype. Your TLR4:MD-2 receptor complex is present at normal levels, and this particular variant does not alter your innate immune responses to gram-negative bacteria. This variant almost always co-occurs with Asp299Gly (rs4986790) on the same haplotype, and the combined effect is the relevant biology for most carriers.

CT Reduced Responder Intermediate

Reduced TLR4:MD-2 complex levels and modestly dampened innate immune responses

GWAS analyses in large population cohorts demonstrate that the T allele is one of the strongest genetic determinants of reduced TLR4:MD-2 complex abundance in peripheral blood. This protein-level reduction translates to fewer functional LPS-recognition complexes at mucosal surfaces, which may partly explain the IBD associations observed across multiple meta-analyses.

When Thr399Ile co-occurs with Asp299Gly (the typical haplotype), neutrophils from carriers show reduced IκB phosphorylation, lower IL-6 and TNF-α after LPS stimulation, and altered apoptotic responses. These findings are consistent with the epidemiological data linking the haplotype to susceptibility to Gram-negative infections, IBD, and certain cancers.

Notably, no significant association with sepsis susceptibility was found in a meta-analysis of 17 studies (OR 1.16, p = 0.57), distinguishing Thr399Ile from some broader infection-risk narratives around TLR4 variants.

TT Blunted Responder Reduced

Substantially reduced TLR4:MD-2 complex levels and markedly dampened innate immune signaling

Homozygous Thr399Ile carriers are exceedingly rare, and most published studies have few or no TT individuals in their cohorts. The functional data from the combined Asp299Gly/Thr399Ile haplotype — reduced neutrophil NF-κB activation, impaired cytokine release, and lower apoptosis suppression after LPS — represents the best available evidence for the effect of homozygosity.

The IBD evidence is strongest for allele-dosage effects: carrying more Thr399Ile alleles correlates with higher disease risk in replicated meta-analyses. Cancer susceptibility data (AML, multiple solid tumor types) also suggests a general role for reduced innate immune surveillance when TLR4 signaling is chronically dampened.

From a sepsis perspective, meta-analytic data do not show a significant independent association with sepsis risk for rs4986791 alone, which is reassuring. The primary concerns remain IBD, chronic mucosal inflammation, and reduced immune surveillance of microbial threats at mucosal surfaces.