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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Endocrinol.</journal-id>
<journal-title>Frontiers in Endocrinology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Endocrinol.</abbrev-journal-title>
<issn pub-type="epub">1664-2392</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fendo.2022.871352</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Endocrinology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Favorable Genotypes of Type III Interferon Confer Risk of Dyslipidemia in the Population With Obesity</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Xu</surname>
<given-names>Tiantian</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/880837"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Peng</surname>
<given-names>Bo</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1670929"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Mengmeng</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1183655"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Qingjing</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yang</surname>
<given-names>Junya</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Qu</surname>
<given-names>Minli</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1564493"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Na</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lin</surname>
<given-names>Lizhen</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Wu</surname>
<given-names>Jing</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/524616"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Department of Endocrinology, Xiangya Hospital, Central South University</institution>, <addr-line>Changsha</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Hunan Engineering Research Center for Obesity and its Metabolic Complications, Xiangya Hospital, Central South University</institution>, <addr-line>Changsha</addr-line>, <country>China</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University</institution>, <addr-line>Changsha</addr-line>, <country>China</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Keck School of Medicine, University of Southern California</institution>, <addr-line>Los Angeles, CA</addr-line>, <country>United States</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>School of Health and Related Research, University of Sheffield</institution>, <addr-line>Sheffield</addr-line>, <country>United Kingdom</country>
</aff>
<aff id="aff6">
<sup>6</sup>
<institution>National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University</institution>, <addr-line>Changsha</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Xunde Xian, Peking University, China</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Jianquan Luo, Central South University, China; Yan Shu, University of Maryland, Baltimore, United States</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Jing Wu, <email xlink:href="mailto:wujing0731@163.com">wujing0731@163.com</email>
</p>
</fn>
<fn fn-type="equal" id="fn003">
<p>&#x2020;These authors have contributed equally to this work</p>
</fn>
<fn fn-type="other" id="fn002">
<p>This article was submitted to Obesity, a section of the journal Frontiers in Endocrinology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>16</day>
<month>06</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>13</volume>
<elocation-id>871352</elocation-id>
<history>
<date date-type="received">
<day>08</day>
<month>02</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>28</day>
<month>04</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Xu, Peng, Liu, Liu, Yang, Qu, Liu, Lin and Wu</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Xu, Peng, Liu, Liu, Yang, Qu, Liu, Lin and Wu</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>Studies have indicated that the chronic state of inflammation caused by obesity leads to dyslipidemia. However, how the polymorphisms involved in these inflammatory pathways affect the lipid metabolism in people with obesity is poorly understood. We investigated the associations of inflammation-related gene polymorphisms with dyslipidemia in individuals with obesity living in China.</p>
</sec>
<sec>
<title>Methods</title>
<p>This case&#x2013;control study in a population with obesity involved 194 individuals with dyslipidemia and 103 individuals without dyslipidemia. Anthropometric indices of obesity, fasting plasma glucose, blood pressure, blood lipids, and C-reactive protein were evaluated. The genes we tested were <italic>IL6</italic> (interleukin 6), <italic>IL6R</italic> (interleukin 6 receptor), <italic>FOXP3</italic> (forkhead box P3), <italic>TLR2</italic> (toll-like receptor 2), <italic>TLR4</italic> (toll-like receptor 4), <italic>IFNL3</italic> (interferon lambda 3, formerly known as <italic>IL28B</italic>), and <italic>IFNL4</italic> (interferon lambda 4, formerly known as <italic>IL29</italic>). Polymorphisms were genotyped using matrix-assisted laser desorption/ionization-time of flight mass spectrometry.</p>
</sec>
<sec>
<title>Results</title>
<p>There were significant differences in the allelic and genotype frequencies of <italic>IFNL3</italic> (<italic>IL28B</italic>) rs12971396, rs8099917, rs11882871, rs12979860, rs4803217 between non-dyslipidemia and dyslipidemia groups in people with obesity. These single nucleotide polymorphisms (SNPs) of <italic>IFNL3</italic> were highly linked (D&#x2032; and r &gt; 0.90), so the result of one SNP could represent the result of other SNPs. For <italic>IFNL3</italic> rs12971396, people with the homozygous genotype (the major group) carried a higher risk of dyslipidemia than people with the heterozygous genotype (<italic>P</italic> &lt; 0.001, OR = 4.46, 95%CI, 1.95&#x2013;10.22).</p>
</sec>
<sec>
<title>Conclusions</title>
<p>The favorable genotypes of type III interferon, which have a beneficial role in anti-virus function, were associated with dyslipidemia in a Chinese population with obesity. Type III interferon could have a pathologic role and confer risk of dyslipidemia in people with obesity and chronic inflammation.</p>
</sec>
</abstract>
<kwd-group>
<kwd>type III interferon</kwd>
<kwd>
<italic>IFNL3</italic>
</kwd>
<kwd>dyslipidemia</kwd>
<kwd>obesity</kwd>
<kwd>single nucleotide polymorphism</kwd>
</kwd-group>
<counts>
<fig-count count="1"/>
<table-count count="4"/>
<equation-count count="0"/>
<ref-count count="42"/>
<page-count count="7"/>
<word-count count="3733"/>
</counts>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p>Obesity has become an epidemic worldwide. In China, obesity has increased rapidly: the standardized prevalence of obesity and overweight in adults was 19.3% in 2013 and 25.6% in 2018 (<xref ref-type="bibr" rid="B1">1</xref>). Obesity and its metabolic complications take a major toll on public-healthcare systems and increase the health risks of individuals (<xref ref-type="bibr" rid="B2">2</xref>&#x2013;<xref ref-type="bibr" rid="B4">4</xref>). One of the most common obesity-associated complications, dyslipidemia, plays a major part in the development of atherosclerosis and cardiovascular diseases, which cause high mortality and represent 32% of all global deaths and 38% of premature deaths under the age of 70 years (<xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B6">6</xref>). Dyslipidemia has also been reported to be a risk factor for various types of cancer (<xref ref-type="bibr" rid="B7">7</xref>&#x2013;<xref ref-type="bibr" rid="B9">9</xref>). Recent studies have revealed abnormalities of lipid metabolism in tumor cells to accelerate disease progression and to alter lipid metabolism, which can influence tumor growth (<xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B11">11</xref>).</p>
<p>Obesity is accompanied by chronic low-grade inflammation. Studies have indicated that the chronic state of inflammation caused by obesity leads to dyslipidemia (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B13">13</xref>). Obesity increases intestinal permeability, which results in higher circulating levels of lipopolysaccharide (LPS) (<xref ref-type="bibr" rid="B14">14</xref>). This intestinal-derived LPS can initiate an inflammatory cascade and induce cytokine secretion (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B16">16</xref>). Such increased inflammation can impair cholesterol efflux, and inhibit triglycerides (TG) clearance by reducing lipoprotein lipase (LPL) activity and reducing very-low-density lipoprotein-associated apolipoprotein-E levels (<xref ref-type="bibr" rid="B17">17</xref>). Different lipid species due to obesity may also contribute to inflammation; free fatty acids can promote inflammation by binding indirectly to the toll-like receptors (TLRs) <italic>TLR4</italic> and <italic>TLR2</italic> (<xref ref-type="bibr" rid="B18">18</xref>).</p>
<p>Gene polymorphisms occur frequently in a population, and may explain individual variation in disease risk. Various studies have reported an association between dyslipidemia and single-nucleotide polymorphisms (SNPs) of genes which confer different susceptibility to diseases (<xref ref-type="bibr" rid="B19">19</xref>). However, most genetic studies have examined individual or combined components of metabolic indices (e.g., body mass index (BMI), blood pressure (BP), lipid metabolism, glucose metabolism) rather than to treat dyslipidemia as a binary trait. Dyslipidemia is affected by several factors (especially obesity), so it is important to control these confounders strictly to obtain convincing evidence of which gene polymorphisms are associated with dyslipidemia. Moreover, the genes identified in previous studies have mostly been involved in metabolism-related pathways (<xref ref-type="bibr" rid="B19">19</xref>&#x2013;<xref ref-type="bibr" rid="B21">21</xref>). Whether polymorphisms of inflammation-related genes affect lipid metabolism is poorly understood. Taken together, due to the limitations of previous studies, the associations between polymorphisms of genes involved in proinflammatory pathways and dyslipidemia have not been identified. Better control of confounding factors (e.g., obesity and other metabolic indices) are needed to resolve this question.</p>
<p>To exclude the confounding effects of obesity, we focused specifically on a population with obesity and separated them into two groups by treating dyslipidemia as a binary trait. We took other confounders such as age, sex, and BP into consideration. We aimed to investigate the effect of gene polymorphisms involved in the inflammatory pathway [<italic>IL6</italic> (interleukin 6), <italic>IL6R</italic> (interleukin 6 receptor), <italic>FOXP3</italic> (forkhead box P3), <italic>TLR2</italic> (toll-like receptor 2), <italic>TLR4</italic> (toll-like receptor 4), <italic>IFNL3</italic> (interferon lambda 3, formerly known as <italic>IL28B</italic>), and <italic>IFNL4</italic> (interferon lambda 4, formerly known as <italic>IL29</italic>)] on lipid metabolism in Chinese individuals with obesity.</p>
</sec>
<sec id="s2">
<title>Patients and Methods</title>
<sec id="s2_1">
<title>Study Cohort</title>
<p>We conducted a case&#x2013;control study involving people of Chinese origin aged 18&#x2013;50 years. Patients with obesity (BMI &#x2265;28 kg/m<sup>2</sup> and/or male waist circumference (WC) &#x2265;90 cm or female WC &#x2265;85 cm) were recruited from an Outpatient Clinic of Xiangya Hospital within Central South University (Changsha, China). &#x201c;Dyslipidemia&#x201d; was defined according to the 2016 Chinese guideline for the management of dyslipidemia published by the National Expert Committee (<xref ref-type="bibr" rid="B22">22</xref>). Dyslipidemia was diagnosed as triglycerides (TG)&#x2009;&#x2265;1.56&#x2009;mmol/L, and/or low-density lipoprotein-cholesterol (LDL-C)&#x2009;&#x2265;3.19&#x2009;mmol/L, and/or total cholesterol (TC)&#x2009;&#x2265;5.6&#x2009;mmol/L, and/or high-density lipoprotein-cholesterol (HDL-C)&#x2009;&#x2264;0.88&#x2009;mmol/L. Considering the effect of drug treatment on metabolic status, we only included patients who denied a history of drug treatment. We also excluded people with a history of diabetes mellitus or infectious diseases. Finally, 297 individuals with obesity (103 without dyslipidemia and 194 with dyslipidemia) were invited to participate in our study, all of whom agreed.</p>
</sec>
<sec id="s2_2">
<title>Collection of Clinical and Biochemical Data and Genotyping</title>
<p>The clinical and biochemical data we collected were sex, age, height, weight, BMI, waist-to-hip ratio (WHR), systemic blood pressure (SBP), diastolic blood pressure (DBP), as well as levels of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), TC, TG HDL-C, LDL-C, aspartate aminotransferase (AST), alanine transaminase (ALT), free fatty acid (FFA), apolipoprotein A1 (APOA1), apolipoprotein B (APOB), and high-sensitive C-reactive protein (hs-CRP). Polymorphisms were genotyped using the MassARRAY<sup>&#xae;</sup> matrix-assisted laser desorption ionization time-of-flight mass spectrometry system (Sequenom, San Diego, CA, USA) after polymerase chain reaction (PCR) amplification (<xref ref-type="bibr" rid="B23">23</xref>). Considering the pathophysiology of the dyslipidemia observed in inflammation, and based on our literature search, we selected genes and the SNPs involved in abnormal lipid metabolism caused by inflammation (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B13">13</xref>, <xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B24">24</xref>&#x2013;<xref ref-type="bibr" rid="B26">26</xref>). The polymorphisms we tested were: <italic>IL6</italic> rs10242595, rs1524107, rs2069845; <italic>IL6R</italic> rs2229238, rs4845617; <italic>FOXP3</italic> rs11091253, rs143012151, rs148307134, rs28935477, rs369083462, rs3761548, rs376158, rs782511378; <italic>TLR2</italic> rs1439166, rs3804099, rs3804100, rs1337, rs5743708; <italic>TLR4</italic> rs545307676, rs78293159, rs138158233, rs5030710; <italic>IFNL3</italic> (<italic>IL28B</italic>) rs12971396, rs4803219, rs8099917, rs11882871, rs12979860, rs4803217; <italic>IFNL4</italic> (<italic>IL29</italic>) rs373455854, rs748154928, rs747979593. The primers used for the SNPs are listed in <xref ref-type="supplementary-material" rid="SM1">
<bold>Table S1</bold>
</xref>. The PCR conditions were 94&#xb0;C for 3 min; 40 cycles at 94&#xb0;C for 30 s, 56&#xb0;C for 25 s, 72&#xb0;C for 30 s; final extension step at 72&#xb0;C for 3 min. The detailed procedure has been documented (<uri xlink:href="http://www.gene-quantification.de/sequenom/">www.gene-quantification.de/sequenom/</uri>).</p>
</sec>
<sec id="s2_3">
<title>Statistical Analyses</title>
<p>Statistical analyses were undertaken using SPSS 20.0 (IBM, Armonk, NY, USA). Tests for deviation from the Hardy&#x2013;Weinberg equilibrium as well as allelic and genotypic frequencies were undertaken with SNPStats (<uri xlink:href="http://www.snpstats.net/start.htm/">www.snpstats.net/start.htm/</uri>). Analyses of linkage disequilibrium and haplotypes were also undertaken with SNPStats. Continuous variables are expressed as the mean &#xb1; standard deviation. Categorical variables are expressed as frequencies and percentages. Differences in clinical parameters and biological parameters were compared between groups by independent-sample <italic>t</italic>-tests (continuous variables) and chi-square tests (categorical variables). We adjusted for confounding factors (including sex and age) in the regression analysis. For a comparison of clinical characteristics, <italic>P</italic> &lt; 0.05 (two-sided) was considered significant. For the analysis of SNPs, because we undertook statistical tests with multiple genes and multiple SNPs simultaneously, the <italic>P</italic>-value threshold was adjusted with the Bonferroni correction to be <italic>P</italic> &lt; 0.003 (two-sided). The <italic>post hoc</italic> statistical-power test was done with the <italic>post hoc</italic> calculator (<uri xlink:href="https://clincalc.com/stats/Power.aspx/">https://clincalc.com/stats/Power.aspx/</uri>).</p>
</sec>
</sec>
<sec id="s3">
<title>Results</title>
<sec id="s3_1">
<title>Clinical and Biochemical Characteristics of Participants</title>
<p>A total of 621 participants with obesity were recruited. After implementing the exclusion criteria, finally we evaluated 297 participants (103 individuals without dyslipidemia and 194 individuals with dyslipidemia). <xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref> shows the clinical and biochemical characteristics of the study cohort (150 women and 147 men). There were no significant differences between the two groups with respect to sex, age, BMI, or WHR (<italic>P</italic> &gt; 0.05). Levels of HbA1C and FPG were higher in the group of people with obesity who had dyslipidemia (<italic>P</italic> = 0.01 and 0.006, respectively). SBP and DBP were comparable between groups (<italic>P</italic> = 0.76 and 0.06, respectively). The typical lipid profile (TC, TG, LDL-C and HDL-C) of individuals in the non-dyslipidemia group was within the normal range whereas, in the dyslipidemia group, at least one of four parameters was abnormal. On average, levels of TC, TG, and LDL-C were significantly higher in the dyslipidemia group than in the non-dyslipidemia group (<italic>P</italic> &lt; 0.001). In contrast, the HDL-C level was significantly lower in the dyslipidemia group compared with that in the non-dyslipidemia group (<italic>P</italic> &lt; 0.001). The other lipid indices (FFA, APOA1, APOB) showed no significant difference between the non-dyslipidemia group and dyslipidemia group. Levels of ALT and AST were higher in people with obesity who had dyslipidemia (<italic>P</italic> &lt; 0.01). The level of the inflammation marker hs-CRP was high in the non-dyslipidemia group (4.11 &#xb1; 3.41 mg/L) and dyslipidemia group (4.08 &#xb1; 4.15 mg/L). Hence, patients with obesity had chronic inflammation and were at a high risk of cardiovascular disease.</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Clinical and biochemical characteristics of the studied groups.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">Characteristic</th>
<th valign="top" align="center">Obesity without dyslipidemia (n=103)</th>
<th valign="top" align="center">Obesity with dyslipidemia (n=194)</th>
<th valign="top" align="center">
<italic>P</italic> value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Sex (F/M)</td>
<td valign="top" align="center">55/48</td>
<td valign="top" align="center">95/99</td>
<td valign="top" align="center">.47</td>
</tr>
<tr>
<td valign="top" align="left">Age (year)</td>
<td valign="top" align="char" char="&#xb1;">32.22 &#xb1; 10.56</td>
<td valign="top" align="char" char="&#xb1;">32.10 &#xb1; 8.64</td>
<td valign="top" align="center">.92</td>
</tr>
<tr>
<td valign="top" align="left">BMI (kg/m<sup>2</sup>)</td>
<td valign="top" align="char" char="&#xb1;">33.70 &#xb1; 5.02</td>
<td valign="top" align="char" char="&#xb1;">33.61 &#xb1; 5.06</td>
<td valign="top" align="center">.89</td>
</tr>
<tr>
<td valign="top" align="left">WHR</td>
<td valign="top" align="char" char="&#xb1;">0.95 &#xb1; 0.06</td>
<td valign="top" align="char" char="&#xb1;">0.95 &#xb1; 0.11</td>
<td valign="top" align="center">.69</td>
</tr>
<tr>
<td valign="top" align="left">HbA1C</td>
<td valign="top" align="char" char="&#xb1;">5.75 &#xb1; 0.91</td>
<td valign="top" align="char" char="&#xb1;">6.14 &#xb1; 1.54</td>
<td valign="top" align="center">.01</td>
</tr>
<tr>
<td valign="top" align="left">FPG (mmol/L)</td>
<td valign="top" align="char" char="&#xb1;">5.73 &#xb1; 1.57</td>
<td valign="top" align="char" char="&#xb1;">6.39 &#xb1; 2.59</td>
<td valign="top" align="center">.006</td>
</tr>
<tr>
<td valign="top" align="left">SBP (mmHg)</td>
<td valign="top" align="char" char="&#xb1;">124.87 &#xb1; 19.03</td>
<td valign="top" align="char" char="&#xb1;">125.66 &#xb1; 22.07</td>
<td valign="top" align="center">.76</td>
</tr>
<tr>
<td valign="top" align="left">DBP (mmHg)</td>
<td valign="top" align="char" char="&#xb1;">85.55 &#xb1; 10.73</td>
<td valign="top" align="char" char="&#xb1;">88.07 &#xb1; 11.18</td>
<td valign="top" align="center">.06</td>
</tr>
<tr>
<td valign="top" align="left">TC (mmol/L)</td>
<td valign="top" align="char" char="&#xb1;">4.35 &#xb1; 0.58</td>
<td valign="top" align="char" char="&#xb1;">5.43 &#xb1; 1.04</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left">TG (mmol/L)</td>
<td valign="top" align="char" char="&#xb1;">1.07 &#xb1; 0.29</td>
<td valign="top" align="char" char="&#xb1;">2.83 &#xb1; 1.94</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left">HDL-C (mmol/L)</td>
<td valign="top" align="char" char="&#xb1;">1.38 &#xb1; 0.33</td>
<td valign="top" align="char" char="&#xb1;">1.15 &#xb1; 0.26</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left">LDL-C (mmol/L)</td>
<td valign="top" align="char" char="&#xb1;">2.49 &#xb1; 0.46</td>
<td valign="top" align="char" char="&#xb1;">3.59 &#xb1; 0.83</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left">ALT (U/L)</td>
<td valign="top" align="char" char="&#xb1;">37.96 &#xb1; 33.96</td>
<td valign="top" align="char" char="&#xb1;">57.83 &#xb1; 44.59</td>
<td valign="top" align="center">.005</td>
</tr>
<tr>
<td valign="top" align="left">AST (U/L)</td>
<td valign="top" align="char" char="&#xb1;">29.30 &#xb1; 16.55</td>
<td valign="top" align="char" char="&#xb1;">40.33 &#xb1; 26.13</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left">FFA (mmol/L)</td>
<td valign="top" align="char" char="&#xb1;">0.61 &#xb1; 0.23</td>
<td valign="top" align="char" char="&#xb1;">0.61 &#xb1; 0.23</td>
<td valign="top" align="center">.84</td>
</tr>
<tr>
<td valign="top" align="left">APOA1 (g/L)</td>
<td valign="top" align="char" char="&#xb1;">1.29 &#xb1; 0.20</td>
<td valign="top" align="char" char="&#xb1;">1.34 &#xb1; 0.24</td>
<td valign="top" align="center">.14</td>
</tr>
<tr>
<td valign="top" align="left">APOB (g/L)</td>
<td valign="top" align="char" char="&#xb1;">1.54 &#xb1; 4.75</td>
<td valign="top" align="char" char="&#xb1;">1.09 &#xb1; 0.26</td>
<td valign="top" align="center">.38</td>
</tr>
<tr>
<td valign="top" align="left">hs-CRP (mg/L)</td>
<td valign="top" align="char" char="&#xb1;">4.11 &#xb1; 3.41</td>
<td valign="top" align="char" char="&#xb1;">4.08 &#xb1; 4.15</td>
<td valign="top" align="center">.95</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>BMI, body mass index; WHR, waist-to-hip ratio; FPG, fasting plasma glucose; SBP, systemic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, serum total triacylglycerol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; ALT, alanine transaminase; AST, aspartate aminotransferase; FFA, free fatty acid; APOA1, apolipoprotein A1; APOB, apolipoprotein B; hs-CRP, high-sensitive C-reactive protein.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="s3_2">
<title>Distributions and Associations of Alleles and Genotypes With Dyslipidemia in a Population With Obesity</title>
<p>We undertook the Hardy&#x2013;Weinberg equilibrium test, analyses of allele and genotype frequencies, and linkage-disequilibrium analyses using SNPStats employing the function &#x201c;Single SNP analysis&#x201d;. The polymorphisms we screened were for <italic>IL6</italic>, <italic>IL6R</italic>, <italic>FOXP3</italic>, <italic>TLR2</italic>, <italic>TLR4</italic>, <italic>IFNL3</italic> (<italic>IL28B</italic>), and <italic>IFNL4</italic> (<italic>IL29</italic>). Polymorphisms of <italic>IFNL3</italic> (rs12971396, rs4803219, rs8099917, rs11882871, rs12979860, rs4803217) varied between the non-dyslipidemia group and dyslipidemia group (<italic>P</italic> &lt; 0.05).</p>
<p>The allelic and genotypic frequencies of these single-nucleotide sites of <italic>IFNL3</italic> in the study cohort were consistent with the Hardy&#x2013;Weinberg equilibrium (<italic>P</italic> &gt; 0.05). <xref ref-type="table" rid="T2">
<bold>Table&#xa0;2</bold>
</xref> shows the allele frequencies of six single-nucleotide sites of <italic>IFNL3</italic> (rs12971396, rs4803219, rs8099917, rs11882871, rs12979860, rs4803217) between people with obesity without dyslipidemia and cases with obesity with dyslipidemia. After using the Bonferroni correction, we adjusted the <italic>P</italic>-value threshold to <italic>P</italic> &lt; 0.003. We included five SNPs of <italic>IFNL3</italic> (rs12971396, rs8099917, rs11882871, rs12979860, rs4803217) for analysis of multiple SNPs.</p>
<table-wrap id="T2" position="float">
<label>Table&#xa0;2</label>
<caption>
<p>Hardy&#x2013;Weinberg equilibrium test and allelic frequencies.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">SNP</th>
<th valign="top" align="center">Allele</th>
<th valign="top" align="center">Obesity without dyslipidemia (n=103)</th>
<th valign="top" align="center">Obesity with dyslipidemia (n=194)</th>
<th valign="top" align="center">
<italic>&#x3c7;&#xb2;</italic>
</th>
<th valign="top" align="center">
<italic>P</italic> value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">rs12971396</td>
<td valign="top" align="left">C</td>
<td valign="top" align="center">182 (88)</td>
<td valign="top" align="center">373 (96)</td>
<td valign="top" align="center">13.29</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">G</td>
<td valign="top" align="center">24 (12)</td>
<td valign="top" align="center">15 (4)</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">Total (2n)</td>
<td valign="top" align="center">206</td>
<td valign="top" align="center">388</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HWE <italic>P</italic>
</td>
<td valign="top" align="center">0.35</td>
<td valign="top" align="center">&gt;0.99</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">rs4803219</td>
<td valign="top" align="left">C</td>
<td valign="top" align="center">183 (89)</td>
<td valign="top" align="center">370 (95)</td>
<td valign="top" align="center">8.92</td>
<td valign="top" align="center">.003</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">T</td>
<td valign="top" align="center">23 (11)</td>
<td valign="top" align="center">18 (5)</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">Total (2n)</td>
<td valign="top" align="center">206</td>
<td valign="top" align="center">388</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HWE <italic>P</italic>
</td>
<td valign="top" align="center">0.61</td>
<td valign="top" align="center">&gt;0.99</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">rs8099917</td>
<td valign="top" align="left">T</td>
<td valign="top" align="center">181 (88)</td>
<td valign="top" align="center">373 (96)</td>
<td valign="top" align="center">14.65</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">G</td>
<td valign="top" align="center">25 (12)</td>
<td valign="top" align="center">15 (4)</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">Total (2n)</td>
<td valign="top" align="center">206</td>
<td valign="top" align="center">388</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HWE <italic>P</italic>
</td>
<td valign="top" align="center">0.35</td>
<td valign="top" align="center">&gt;0.99</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">rs11882871</td>
<td valign="top" align="left">A</td>
<td valign="top" align="center">181 (88)</td>
<td valign="top" align="center">371 (96)</td>
<td valign="top" align="center">12.31</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">G</td>
<td valign="top" align="center">25 (12)</td>
<td valign="top" align="center">17 (4)</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">Total (2n)</td>
<td valign="top" align="center">206</td>
<td valign="top" align="center">388</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HWE <italic>P</italic>
</td>
<td valign="top" align="center">0.35</td>
<td valign="top" align="center">&gt;0.99</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">rs12979860</td>
<td valign="top" align="left">C</td>
<td valign="top" align="center">181 (88)</td>
<td valign="top" align="center">371 (96)</td>
<td valign="top" align="center">12.31</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">T</td>
<td valign="top" align="center">25 (12)</td>
<td valign="top" align="center">17 (4)</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">Total (2n)</td>
<td valign="top" align="center">206</td>
<td valign="top" align="center">388</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HWE <italic>P</italic>
</td>
<td valign="top" align="center">0.35</td>
<td valign="top" align="center">&gt;0.99</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left">rs4803217</td>
<td valign="top" align="left">C</td>
<td valign="top" align="center">181 (88)</td>
<td valign="top" align="center">369 (95)</td>
<td valign="top" align="center">10.28</td>
<td valign="top" align="center">.001</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">A</td>
<td valign="top" align="center">25 (12)</td>
<td valign="top" align="center">19 (5)</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">Total (2n)</td>
<td valign="top" align="center">206</td>
<td valign="top" align="center">388</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">HWE <italic>P</italic>
</td>
<td valign="top" align="center">0.35</td>
<td valign="top" align="center">&gt;0.99</td>
<td valign="top" align="center"/>
<td valign="top" align="center"/>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>SNP, single-nucleotide polymorphism; P, Pearson&#x2019;s P value; HWE, Hardy&#x2013;Weinberg equilibrium. The results are presented as No. (%).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>The allele and genotype distributions of these five single-nucleotide sites of <italic>IFNL3</italic> were nearly identical. Linkage-disequilibrium analysis (<xref ref-type="supplementary-material" rid="SM1">
<bold>Table S2</bold>
</xref>) indicated that these sites were highly correlated with each other (values of D&#x2032; and r were &gt;0.90). The haplotype analysis also indicated that these SNPs of <italic>IFNL3</italic> were combined and inherited together (<xref ref-type="supplementary-material" rid="SM1">
<bold>Table S3</bold>
</xref>). Hence, we chose rs12971396 as a representative SNP for further analysis. With regard to the rs12971396 polymorphism of <italic>IFNL3</italic>, the C allele was the major allele in the non-dyslipidemia and dyslipidemia groups (88% and 96%, respectively). There was a significantly higher proportion of the C allele in the group with obesity with dyslipidemia than the group with obesity without dyslipidemia (&#x3c7;&#xb2; = 13.29, <italic>P</italic> &lt; 0.001).</p>
<p>There were two genotypes of <italic>IFNL3</italic> rs12971396 in the study cohort: homozygotic and heterozygotic (<xref ref-type="table" rid="T3">
<bold>Table&#xa0;3</bold>
</xref>). The homozygote contained two major alleles. The heterozygote contained one major allele and one minor allele. The proportion of the <italic>IFNL3</italic> rs12971396 CC genotype was significantly higher in the dyslipidemia group, whereas the CG genotype had a lower proportion (<xref ref-type="table" rid="T3">
<bold>Table&#xa0;3</bold>
</xref>). These findings indicated that the CC genotype of rs12971396 was probably a risk factor for dyslipidemia in the population with obesity (OR = 3.57, 95%CI, 1.82&#x2013;7.14). Taking into consideration confounding factors such as levels of HbA1C, FPG, AST, and ALT, which were not comparable between groups, we carried out binary logistic regression analysis of dyslipidemia and genotype (<xref ref-type="table" rid="T4">
<bold>Table&#xa0;4</bold>
</xref>), setting those possible confounders as covariates. Results suggested that, after adjustment for the glucose metabolism and liver function, the rs12979860 CC genotype was a significant risk factor that led to dyslipidemia,</p>
<table-wrap id="T3" position="float">
<label>Table&#xa0;3</label>
<caption>
<p>Genotypic frequencies between obesity with/without dyslipidemia.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">SNP</th>
<th valign="top" align="center">Genotype</th>
<th valign="top" align="center">Obesity without dyslipidemia (n=103)</th>
<th valign="top" align="center">Obesity with dyslipidemia (n=194)</th>
<th valign="top" align="center">OR (95%CI)</th>
<th valign="top" align="center">
<italic>P</italic> value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">rs12971396</td>
<td valign="top" align="left">C/C</td>
<td valign="top" align="center">79 (77)</td>
<td valign="top" align="center">179 (92)</td>
<td valign="top" rowspan="2" align="center">3.57 (1.82~7.14)</td>
<td valign="top" rowspan="2" align="center">&lt;.001</td>
</tr>
<tr>
<td valign="top" align="left"/>
<td valign="top" align="left">C/G</td>
<td valign="top" align="center">24 (23)</td>
<td valign="top" align="center">15 (8)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>SNP, single-nucleotide polymorphism; P, Pearson&#x2019;s P value. The results are presented as No. (%).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T4" position="float">
<label>Table&#xa0;4</label>
<caption>
<p>Binary logistic regression analysis of dyslipidemia and genotype.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">SNP</th>
<th valign="top" align="center">
<italic>&#x3b2;</italic>
</th>
<th valign="top" align="center">SE<italic>&#x3b2;</italic>
</th>
<th valign="top" align="center">OR</th>
<th valign="top" align="center">95% CI</th>
<th valign="top" align="center">
<italic>P</italic> value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" colspan="6" align="left">rs12971396</td>
</tr>
<tr>
<td valign="top" align="left">HbA1C</td>
<td valign="top" align="center">0.050</td>
<td valign="top" align="center">0.207</td>
<td valign="top" align="center">1.05</td>
<td valign="top" align="center">0.70~1.58</td>
<td valign="top" align="center">.81</td>
</tr>
<tr>
<td valign="top" align="left">FPG</td>
<td valign="top" align="center">0.141</td>
<td valign="top" align="center">0.127</td>
<td valign="top" align="center">1.15</td>
<td valign="top" align="center">0.90~1.48</td>
<td valign="top" align="center">.27</td>
</tr>
<tr>
<td valign="top" align="left">ALT</td>
<td valign="top" align="center">0.016</td>
<td valign="top" align="center">0.009</td>
<td valign="top" align="center">1.02</td>
<td valign="top" align="center">0.99~1.03</td>
<td valign="top" align="center">.07</td>
</tr>
<tr>
<td valign="top" align="left">AST</td>
<td valign="top" align="center">0.005</td>
<td valign="top" align="center">0.014</td>
<td valign="top" align="center">1.01</td>
<td valign="top" align="center">0.98~1.03</td>
<td valign="top" align="center">.75</td>
</tr>
<tr>
<td valign="top" align="left">(CC vs. CG)</td>
<td valign="top" align="center">1.50</td>
<td valign="top" align="center">0.423</td>
<td valign="top" align="center">4.46</td>
<td valign="top" align="center">1.95~10.22</td>
<td valign="top" align="center">&lt;.001</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>SNP, single-nucleotide polymorphism; FPG, fasting plasma glucose; ALT, alanine transaminase; AST, aspartate aminotransferase. HbA1C, FPG, ALT, AST and genotype are independent variables, group (non-dyslipidemia or dyslipidemia) is the binary dependent variable.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>To suppress the interference of glucose metabolism upon gene polymorphisms, we excluded patients who had an abnormal level of HbA1C (&gt;6.1%) or FPG (&gt;5.6 mmol/L). Under this circumstance, the <italic>IFNL3</italic> rs12971396 allele and genotype frequencies between the two groups continued to show significantly different distributions. Further, the major genotypes carried an even higher risk for the development of dyslipidemia than the minor genotypes (OR = 5.56, <italic>P</italic> = 0.001) (<xref ref-type="supplementary-material" rid="SM1">
<bold>Table S4</bold>
</xref>).</p>
<p>The percentage of people with dyslipidemia who had different <italic>IFNL3</italic> rs12971396 genotypes is presented in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>. We normalized the sample number of the non-dyslipidemia group and dyslipidemia group to compare them. Overall, the percentage of people with dyslipidemia who had the homozygous genotype was 53%, which was much higher than the percentage of people with dyslipidemia who had the heterozygous genotype (24%). These data also suggested that the homozygotic genotype of these <italic>IFNL3</italic> loci was a risk factor for dyslipidemia in people who were obese.</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Percentage of dyslipidemia in different genotypes of IFNL3 rs12971396.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fendo-13-871352-g001.tif"/>
</fig>
<p>The allele and genotype frequencies of other genes [<italic>IL6</italic>, <italic>IL6R</italic>, <italic>FOXP3</italic>, <italic>TLR2</italic>, <italic>TLR4</italic> and <italic>IFNL4</italic> (<italic>IL29</italic>)] did not show a significant difference between the two study groups (<xref ref-type="supplementary-material" rid="SM1">
<bold>Table S5</bold>
</xref>).</p>
</sec>
</sec>
<sec id="s4">
<title>Discussion</title>
<p>We discovered the polymorphisms of <italic>IFNL3</italic> (<italic>IL28B</italic>), an inflammation-related gene, to be associated with dyslipidemia in a population with obesity in China. The major allele and homozygotic genotypes were risk factors of dyslipidemia in individuals with obesity.</p>
<p>
<italic>IFNL3</italic> (also known as <italic>IFN-&#x3bb;3</italic>, formerly known as <italic>IL28B</italic>) is a type III IFN believed to have roles in modulation of the immune response during infection/inflammation (<xref ref-type="bibr" rid="B27">27</xref>). In contrast to type I IFNs (IFN-&#x3b1; and IFN-&#x3b2;), which are secreted by infected cells and can result in immunopathology during viral infections, type III IFN (IFNL) responses are restricted primarily to mucosal surfaces and are thought to confer antiviral protection without driving damaging proinflammatory responses (<xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B28">28</xref>). Due to this ability to maintain antiviral activity and limit immunopathology, the development of IFNLs for clinical use as an alternative treatment to IFN&#x3b1; against viral infections (e.g., hepatitis C, coronavirus disease-2019) has been of interest recently (<xref ref-type="bibr" rid="B29">29</xref>&#x2013;<xref ref-type="bibr" rid="B31">31</xref>). However, despite many studies indicating the benefits of type III IFNs in the protection and treatment for multiple infectious diseases, the long-term influence and pathophysiological role of IFNLs remain controversial. Several recent studies have shown that the role of IFNLs can be quite diverse and controversial depending on the timing, location, and level of the expression during chronic disease and severe disease (<xref ref-type="bibr" rid="B32">32</xref>&#x2013;<xref ref-type="bibr" rid="B35">35</xref>).</p>
<p>The function of IFNLs and their ability to regulate immunity is further impacted by several SNPs. Many studies have identified <italic>IFNL3</italic> polymorphisms to be correlated with the outcome of hepatitis-C infection. Scholars have found that major alleles and favorable genotypes lead to higher expression of <italic>IFNL3</italic>, better response to therapy, and viral clearance in patients (<xref ref-type="bibr" rid="B36">36</xref>&#x2013;<xref ref-type="bibr" rid="B42">42</xref>). Unlike other research limited to infectious diseases, we investigated people with obesity. We revealed that <italic>IFNL3</italic> favorable genotypes could increase the risk of dyslipidemia, which is opposite to its beneficial role observed in viral diseases.</p>
<p>In this study, we linked the polymorphisms of an inflammatory gene to dyslipidemia. Genetic studies on dyslipidemia have identified only the genes involved in metabolism-related pathways and not inflammation-related pathways, and their study groups had some important confounders, such as obesity and other metabolic abnormalities (<xref ref-type="bibr" rid="B19">19</xref>&#x2013;<xref ref-type="bibr" rid="B21">21</xref>). To exclude those confounders, we recruited participants with obesity and divided them into two groups depending if they had dyslipidemia. The age, sex, BMI, and blood pressure were comparable between groups. We found significant associations of five highly linked SNPs of <italic>IFNL3</italic> (rs12971396, rs8099917, rs11882871, rs12979860, rs4803217) with dyslipidemia in the population with obesity. Upon comparison of allelic frequencies (<xref ref-type="table" rid="T2">
<bold>Table&#xa0;2</bold>
</xref>) with <italic>P</italic> &lt; 0.05 (two-sided) and frequency of the <italic>IFNL3</italic> rs12971396 C-allele of 88% in the non-dyslipidemia group and 96% in the dyslipidemia group, the power to detect an association between rs12971396 polymorphism and dyslipidemia reached 91.5%. Therefore, the significant differences in the gene polymorphisms in our study are convincing. To further adjust the effects of glucose metabolism and liver function, we undertook logistic regression analysis and confirmed that polymorphisms of <italic>IFNL3</italic> rs12971396 (as a representative locus) were associated with dyslipidemia in people with obesity. People with a homozygous genotype carried a higher risk (OR = 4.46, 95%CI, 1.95&#x2013;10.22, <italic>P</italic> &lt; 0.001) of dyslipidemia than those with a heterozygous genotype (<xref ref-type="table" rid="T4">
<bold>Table&#xa0;4</bold>
</xref>). After excluding people with abnormal levels of FPG or HbA1C, the associations between <italic>IFNL3</italic> polymorphisms with dyslipidemia became even stronger (OR = 5.56, 95%CI, 1.75&#x2013;16.67, <italic>P</italic> = 0.001) (<xref ref-type="supplementary-material" rid="SM1">
<bold>Table S4</bold>
</xref>). These results with strict control of confounding factors provided evidence that polymorphisms of <italic>IFNL3</italic> (an inflammation-related gene) were associated with dyslipidemia in individuals with obesity, which has not been reported previously. The major genotype of <italic>IFNL3</italic>, which can upregulate the IFLN3 expression (proved by previous research), could be a risk factor of dyslipidemia. These data suggest that <italic>IFNL3</italic> has a detrimental effect and could disturb lipid metabolism in people with obesity.</p>
<p>In summary, our findings shed new light on the nature of IFNLs and inspire rethinking of the pathophysiological role of IFNLs in clinical practice, especially in a population with obesity or with a low-grade inflammation state. In-depth study of how IFNLs affect lipid metabolism in people with obesity might uncover other meaningful features of the mechanism of action of IFNLs.</p>
</sec>
<sec id="s5">
<title>Conclusions</title>
<p>We found <italic>IFNL3</italic> (<italic>IL28B</italic>) polymorphisms to be associated with dyslipidemia in a population with obesity in China. These results indicate that <italic>IFNL3</italic> could have a pathologic role in obesity and chronic inflammation.</p>
</sec>
<sec id="s6" sec-type="data-availability">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Material</bold>
</xref>. Further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="s7" sec-type="ethics-statement">
<title>Ethics Statement</title>
<p>The studies involving human participants were reviewed and approved by Xiangya Hospital of Central South University. The patients/participants provided their written informed consent to participate in this study.</p>
</sec>
<sec id="s8" sec-type="author-contributions">
<title>Author Contributions</title>
<p>Conceptualization: JW, TX, BP. Data curation: TX, BP, ML, QL, MQ, LL, NL. Formal analysis: TX, BP, ML, JY. Funding acquisition: JW, NL. Investigation: TX, BP, ML, JY. Supervision: JW, TX. Validation: JW, BP, ML, QL, JY, MQ, LL. Writing&#x2014;original draft: TX, BP, JW. Writing&#x2014;review &amp; editing: all authors. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec id="s9" sec-type="funding-information">
<title>Funding</title>
<p>The study was financially supported by the Key Research &amp; Development Plan, Hunan, China (2020SK2066), the Project of Hunan Health Committee, Hunan, China (20201923), and the National Natural Science Foundation of China (82170849).</p>
</sec>
<sec id="s10" sec-type="COI-statement">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s11" sec-type="disclaimer">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<sec id="s12" sec-type="supplementary-material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fendo.2022.871352/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fendo.2022.871352/full#supplementary-material</ext-link>
</p>
  <supplementary-material xlink:href="DataSheet_1.docx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wang</surname> <given-names>M</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>PS</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>W</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>C</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>X</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>L</given-names>
</name>
<etal/>
</person-group>. <article-title>Prevalence and Changes of BMI Categories in China and Related Chronic Diseases: Cross-Sectional National Health Service Surveys (NHSSs) From 2013 to 2018</article-title>. <source>EClinicalMedicine</source> (<year>2020</year>) <volume>26</volume>:<fpage>100521</fpage>. doi: <pub-id pub-id-type="doi">10.1016/j.eclinm.2020.100521</pub-id>
</citation>
</ref>
<ref id="B2">
<label>2</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ng</surname> <given-names>M</given-names>
</name>
<name>
<surname>Fleming</surname> <given-names>T</given-names>
</name>
<name>
<surname>Robinson</surname> <given-names>M</given-names>
</name>
<name>
<surname>Thomson</surname> <given-names>B</given-names>
</name>
<name>
<surname>Graetz</surname> <given-names>N</given-names>
</name>
<name>
<surname>Margono</surname> <given-names>C</given-names>
</name>
<etal/>
</person-group>. <article-title>Global, Regional, and National Prevalence of Overweight and Obesity in Children and Adults During 1980-2013: A Systematic Analysis for the Global Burden of Disease Study 2013</article-title>. <source>Lancet</source> (<year>2014</year>) <volume>384</volume>:<page-range>766&#x2013;81</page-range>. doi: <pub-id pub-id-type="doi">10.1016/S0140-6736(14)60460-8</pub-id>
</citation>
</ref>
<ref id="B3">
<label>3</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lavie</surname> <given-names>CJ</given-names>
</name>
<name>
<surname>Laddu</surname> <given-names>D</given-names>
</name>
<name>
<surname>Arena</surname> <given-names>R</given-names>
</name>
<name>
<surname>Ortega</surname> <given-names>FB</given-names>
</name>
<name>
<surname>Alpert</surname> <given-names>MA</given-names>
</name>
<name>
<surname>Kushner</surname> <given-names>RF</given-names>
</name>
</person-group>. <article-title>Reprint of: Healthy Weight and Obesity Prevention: JACC Health Promotion Series</article-title>. <source>J Am Coll Cardiol</source> (<year>2018</year>) <volume>72</volume>:<page-range>3027&#x2013;52</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.jacc.2018.10.024</pub-id>
</citation>
</ref>
<ref id="B4">
<label>4</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pan</surname> <given-names>XF</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>L</given-names>
</name>
<name>
<surname>Pan</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>Epidemiology and Determinants of Obesity in China</article-title>. <source>Lancet Diabetes Endocrinol</source> (<year>2021</year>) <volume>9</volume>:<page-range>373&#x2013;92</page-range>. doi: <pub-id pub-id-type="doi">10.1016/S2213-8587(21)00045-0</pub-id>
</citation>
</ref>
<ref id="B5">
<label>5</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Howard</surname> <given-names>BV</given-names>
</name>
<name>
<surname>Ruotolo</surname> <given-names>G</given-names>
</name>
<name>
<surname>Robbins</surname> <given-names>DC</given-names>
</name>
</person-group>. <article-title>Obesity and Dyslipidemia</article-title>. <source>Endocrinol Metab Clin North Am</source> (<year>2003</year>) <volume>32</volume>:<page-range>855&#x2013;67</page-range>. doi: <pub-id pub-id-type="doi">10.1016/S0889-8529(03)00073-2</pub-id>
</citation>
</ref>
<ref id="B6">
<label>6</label>
<citation citation-type="web">
<person-group person-group-type="author">
<collab>World Health Organization</collab>
</person-group>. <source>Cardiovascular Diseases (CVDs)</source> (<year>2021</year>). Available at: <uri xlink:href="https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)">https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)</uri> (Accessed <access-date>November 1, 2021</access-date>).</citation>
</ref>
<ref id="B7">
<label>7</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhao</surname> <given-names>P</given-names>
</name>
<name>
<surname>Xia</surname> <given-names>N</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>H</given-names>
</name>
<name>
<surname>Deng</surname> <given-names>T</given-names>
</name>
</person-group>. <article-title>The Metabolic Syndrome Is a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis</article-title>. <source>Obes Facts</source> (<year>2020</year>) <volume>13</volume>:<page-range>384&#x2013;96</page-range>. doi: <pub-id pub-id-type="doi">10.1159/000507554</pub-id>
</citation>
</ref>
<ref id="B8">
<label>8</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yao</surname> <given-names>X</given-names>
</name>
<name>
<surname>Tian</surname> <given-names>Z</given-names>
</name>
</person-group>. <article-title>Dyslipidemia and Colorectal Cancer Risk: A Meta-Analysis of Prospective Studies</article-title>. <source>Cancer Causes Control</source> (<year>2015</year>) <volume>26</volume>:<page-range>257&#x2013;68</page-range>. doi: <pub-id pub-id-type="doi">10.1007/s10552-014-0507-y</pub-id>
</citation>
</ref>
<ref id="B9">
<label>9</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Esposito</surname> <given-names>K</given-names>
</name>
<name>
<surname>Chiodini</surname> <given-names>P</given-names>
</name>
<name>
<surname>Capuano</surname> <given-names>A</given-names>
</name>
<name>
<surname>Bellastella</surname> <given-names>G</given-names>
</name>
<name>
<surname>Maiorino</surname> <given-names>MI</given-names>
</name>
<name>
<surname>Parretta</surname> <given-names>E</given-names>
</name>
<etal/>
</person-group>. <article-title>Effect of Metabolic Syndrome and its Components on Prostate Cancer Risk: Meta-Analysis</article-title>. <source>J Endocrinol Invest</source> (<year>2013</year>) <volume>36</volume>:<page-range>132&#x2013;39</page-range>. doi: <pub-id pub-id-type="doi">10.1007/BF03346748</pub-id>
</citation>
</ref>
<ref id="B10">
<label>10</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>W</given-names>
</name>
<name>
<surname>Chakraborty</surname> <given-names>B</given-names>
</name>
<name>
<surname>Safi</surname> <given-names>R</given-names>
</name>
<name>
<surname>Kazmin</surname> <given-names>D</given-names>
</name>
<name>
<surname>Chang</surname> <given-names>CY</given-names>
</name>
<name>
<surname>McDonnell</surname> <given-names>DP</given-names>
</name>
</person-group>. <article-title>Dysregulated Cholesterol Homeostasis Results in Resistance to Ferroptosis Increasing Tumorigenicity and Metastasis in Cancer</article-title>. <source>Nat Commun</source> (<year>2021</year>) <volume>12</volume>:<fpage>5103</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41467-021-25354-4</pub-id>
</citation>
</ref>
<ref id="B11">
<label>11</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lien</surname> <given-names>EC</given-names>
</name>
<name>
<surname>Westermark</surname> <given-names>AM</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Yuan</surname> <given-names>C</given-names>
</name>
<name>
<surname>Li</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Lau</surname> <given-names>AN</given-names>
</name>
<etal/>
</person-group>. <article-title>Low Glycaemic Diets Alter Lipid Metabolism to Influence Tumour Growth</article-title>. <source>Nature</source> (<year>2021</year>) <volume>599</volume>:<page-range>302&#x2013;07</page-range>. doi: <pub-id pub-id-type="doi">10.1038/s41586-021-04049-2</pub-id>
</citation>
</ref>
<ref id="B12">
<label>12</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cox</surname> <given-names>AJ</given-names>
</name>
<name>
<surname>West</surname> <given-names>NP</given-names>
</name>
<name>
<surname>Cripps</surname> <given-names>AW</given-names>
</name>
</person-group>. <article-title>Obesity, Inflammation, and the Gut Microbiota</article-title>. <source>Lancet Diabetes Endocrinol</source> (<year>2015</year>) <volume>3</volume>:<page-range>207&#x2013;15</page-range>. doi: <pub-id pub-id-type="doi">10.1016/S2213-8587(14)70134-2</pub-id>
</citation>
</ref>
<ref id="B13">
<label>13</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Emanuela</surname> <given-names>F</given-names>
</name>
<name>
<surname>Grazia</surname> <given-names>M</given-names>
</name>
<name>
<surname>Marco</surname> <given-names>DR</given-names>
</name>
<name>
<surname>Maria</surname> <given-names>PL</given-names>
</name>
<name>
<surname>Giorgio</surname> <given-names>F</given-names>
</name>
<name>
<surname>Marco</surname> <given-names>B</given-names>
</name>
</person-group>. <article-title>Inflammation as a Link Between Obesity and Metabolic Syndrome</article-title>. <source>J Nutr Metab</source> (<year>2012</year>) <volume>2012</volume>:<fpage>476380</fpage>. doi: <pub-id pub-id-type="doi">10.1155/2012/476380</pub-id>
</citation>
</ref>
<ref id="B14">
<label>14</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Amar</surname> <given-names>J</given-names>
</name>
<name>
<surname>Chabo</surname> <given-names>C</given-names>
</name>
<name>
<surname>Waget</surname> <given-names>A</given-names>
</name>
<name>
<surname>Klopp</surname> <given-names>P</given-names>
</name>
<name>
<surname>Vachoux</surname> <given-names>C</given-names>
</name>
<name>
<surname>Bermudez-Humaran</surname> <given-names>LG</given-names>
</name>
<etal/>
</person-group>. <article-title>Intestinal Mucosal Adherence and Translocation of Commensal Bacteria at the Early Onset of Type 2 Diabetes: Molecular Mechanisms and Probiotic Treatment</article-title>. <source>EMBO Mol Med</source> (<year>2011</year>) <volume>3</volume>:<page-range>559&#x2013;72</page-range>. doi: <pub-id pub-id-type="doi">10.1002/emmm.201100159</pub-id>
</citation>
</ref>
<ref id="B15">
<label>15</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hug</surname> <given-names>H</given-names>
</name>
<name>
<surname>Mohajeri</surname> <given-names>MH</given-names>
</name>
<name>
<surname>La Fata</surname> <given-names>G</given-names>
</name>
</person-group>. <article-title>Toll-Like Receptors: Regulators of the Immune Response in the Human Gut</article-title>. <source>Nutrients</source> (<year>2018</year>) <volume>10</volume>(<issue>2</issue>):<page-range>203&#x2013;19</page-range>. doi: <pub-id pub-id-type="doi">10.3390/nu10020203</pub-id>
</citation>
</ref>
<ref id="B16">
<label>16</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Li</surname> <given-names>D</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>M</given-names>
</name>
</person-group>. <article-title>Pattern Recognition Receptors in Health and Diseases</article-title>. <source>Signal Transduct Target Ther</source> (<year>2021</year>) <volume>6</volume>:<fpage>291</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41392-021-00687-0</pub-id>
</citation>
</ref>
<ref id="B17">
<label>17</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Esteve</surname> <given-names>E</given-names>
</name>
<name>
<surname>Ricart</surname> <given-names>W</given-names>
</name>
<name>
<surname>Fernandez-Real</surname> <given-names>JM</given-names>
</name>
</person-group>. <article-title>Dyslipidemia and Inflammation: An Evolutionary Conserved Mechanism</article-title>. <source>Clin Nutr</source> (<year>2005</year>) <volume>24</volume>:<fpage>16</fpage>&#x2013;<lpage>31</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.clnu.2004.08.004</pub-id>
</citation>
</ref>
<ref id="B18">
<label>18</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shi</surname> <given-names>H</given-names>
</name>
<name>
<surname>Kokoeva</surname> <given-names>MV</given-names>
</name>
<name>
<surname>Inouye</surname> <given-names>K</given-names>
</name>
<name>
<surname>Tzameli</surname> <given-names>I</given-names>
</name>
<name>
<surname>Yin</surname> <given-names>H</given-names>
</name>
<name>
<surname>Flier</surname> <given-names>JS</given-names>
</name>
</person-group>. <article-title>
<italic>TLR4</italic> Links Innate Immunity and Fatty Acid-Induced Insulin Resistance</article-title>. <source>J Clin Invest</source> (<year>2006</year>) <volume>116</volume>:<page-range>3015&#x2013;25</page-range>. doi: <pub-id pub-id-type="doi">10.1172/JCI28898</pub-id>
</citation>
</ref>
<ref id="B19">
<label>19</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stancakova</surname> <given-names>A</given-names>
</name>
<name>
<surname>Laakso</surname> <given-names>M</given-names>
</name>
</person-group>. <article-title>Genetics of Metabolic Syndrome</article-title>. <source>Rev Endocr Metab Disord</source> (<year>2014</year>) <volume>15</volume>:<page-range>243&#x2013;52</page-range>. doi: <pub-id pub-id-type="doi">10.1007/s11154-014-9293-9</pub-id>
</citation>
</ref>
<ref id="B20">
<label>20</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zafar</surname> <given-names>U</given-names>
</name>
<name>
<surname>Khaliq</surname> <given-names>S</given-names>
</name>
<name>
<surname>Ahmad</surname> <given-names>HU</given-names>
</name>
<name>
<surname>Manzoor</surname> <given-names>S</given-names>
</name>
<name>
<surname>Lone</surname> <given-names>KP</given-names>
</name>
</person-group>. <article-title>Metabolic Syndrome: An Update on Diagnostic Criteria, Pathogenesis, and Genetic Links</article-title>. <source>Hormones (Athens)</source> (<year>2018</year>) <volume>17</volume>:<fpage>299</fpage>&#x2013;<lpage>313</lpage>. doi: <pub-id pub-id-type="doi">10.1007/s42000-018-0051-3</pub-id>
</citation>
</ref>
<ref id="B21">
<label>21</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rankinen</surname> <given-names>T</given-names>
</name>
<name>
<surname>Sarzynski</surname> <given-names>MA</given-names>
</name>
<name>
<surname>Ghosh</surname> <given-names>S</given-names>
</name>
<name>
<surname>Bouchard</surname> <given-names>C</given-names>
</name>
</person-group>. <article-title>Are There Genetic Paths Common to Obesity, Cardiovascular Disease Outcomes, and Cardiovascular Risk Factors</article-title>? <source>Circ Res</source> (<year>2015</year>) <volume>116</volume>:<page-range>909&#x2013;22</page-range>. doi: <pub-id pub-id-type="doi">10.1161/CIRCRESAHA.116.302888</pub-id>
</citation>
</ref>
<ref id="B22">
<label>22</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhu</surname> <given-names>J</given-names>
</name>
<name>
<surname>Gao</surname> <given-names>R</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>S</given-names>
</name>
<name>
<surname>Lu</surname> <given-names>G</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>D</given-names>
</name>
<name>
<surname>Li</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>2016 Chinese Guidelines for the Management of Dyslipidemia in Adults</article-title>. <source>J Geriatr Cardiol</source> (<year>2018</year>) <volume>15</volume>:<fpage>1</fpage>&#x2013;<lpage>29</lpage>.</citation>
</ref>
<ref id="B23">
<label>23</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Feucherolles</surname> <given-names>M</given-names>
</name>
<name>
<surname>Poppert</surname> <given-names>S</given-names>
</name>
<name>
<surname>Utzinger</surname> <given-names>J</given-names>
</name>
<name>
<surname>Becker</surname> <given-names>SL</given-names>
</name>
</person-group>. <article-title>MALDI-TOF Mass Spectrometry as a Diagnostic Tool in Human and Veterinary Helminthology: A Systematic Review</article-title>. <source>Parasit Vectors</source> (<year>2019</year>) <volume>12</volume>:<fpage>245</fpage>. doi: <pub-id pub-id-type="doi">10.1186/s13071-019-3493-9</pub-id>
</citation>
</ref>
<ref id="B24">
<label>24</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Khovidhunkit</surname> <given-names>W</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>MS</given-names>
</name>
<name>
<surname>Memon</surname> <given-names>RA</given-names>
</name>
<name>
<surname>Shigenaga</surname> <given-names>JK</given-names>
</name>
<name>
<surname>Moser</surname> <given-names>AH</given-names>
</name>
<name>
<surname>Feingold</surname> <given-names>KR</given-names>
</name>
<etal/>
</person-group>. <article-title>Effects of Infection and Inflammation on Lipid and Lipoprotein Metabolism: Mechanisms and Consequences to the Host</article-title>. <source>J Lipid Res</source> (<year>2004</year>) <volume>45</volume>:<page-range>1169&#x2013;96</page-range>. doi: <pub-id pub-id-type="doi">10.1194/jlr.R300019-JLR200</pub-id>
</citation>
</ref>
<ref id="B25">
<label>25</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Howie</surname> <given-names>D</given-names>
</name>
<name>
<surname>Ten</surname> <given-names>BA</given-names>
</name>
<name>
<surname>Cobbold</surname> <given-names>SP</given-names>
</name>
<name>
<surname>Yu</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Kessler</surname> <given-names>BM</given-names>
</name>
<name>
<surname>Waldmann</surname> <given-names>H</given-names>
</name>
</person-group>. <article-title>A Novel Role for Triglyceride Metabolism in Foxp3 Expression</article-title>. <source>Front Immunol</source> (<year>2019</year>) <volume>10</volume>:<elocation-id>1860</elocation-id>. doi: <pub-id pub-id-type="doi">10.3389/fimmu.2019.01860</pub-id>
</citation>
</ref>
<ref id="B26">
<label>26</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Monson</surname> <given-names>EA</given-names>
</name>
<name>
<surname>Crosse</surname> <given-names>KM</given-names>
</name>
<name>
<surname>Duan</surname> <given-names>M</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>W</given-names>
</name>
<name>
<surname>O'Shea</surname> <given-names>RD</given-names>
</name>
<name>
<surname>Wakim</surname> <given-names>LM</given-names>
</name>
<etal/>
</person-group>. <article-title>Intracellular Lipid Droplet Accumulation Occurs Early Following Viral Infection and is Required for an Efficient Interferon Response</article-title>. <source>Nat Commun</source> (<year>2021</year>) <volume>12</volume>:<fpage>4303</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41467-021-24632-5</pub-id>
</citation>
</ref>
<ref id="B27">
<label>27</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Broggi</surname> <given-names>A</given-names>
</name>
<name>
<surname>Granucci</surname> <given-names>F</given-names>
</name>
<name>
<surname>Zanoni</surname> <given-names>I</given-names>
</name>
</person-group>. <article-title>Type III Interferons: Balancing Tissue Tolerance and Resistance to Pathogen Invasion</article-title>. <source>J Exp Med</source> (<year>2020</year>) <volume>217</volume>(<issue>1</issue>):<elocation-id>e20190295</elocation-id>. doi: <pub-id pub-id-type="doi">10.1084/jem.20190295</pub-id>
</citation>
</ref>
<ref id="B28">
<label>28</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ivashkiv</surname> <given-names>LB</given-names>
</name>
<name>
<surname>Donlin</surname> <given-names>LT</given-names>
</name>
</person-group>. <article-title>Regulation of Type I Interferon Responses</article-title>. <source>Nat Rev Immunol</source> (<year>2014</year>) <volume>14</volume>:<fpage>36</fpage>&#x2013;<lpage>49</lpage>. doi: <pub-id pub-id-type="doi">10.1038/nri3581</pub-id>
</citation>
</ref>
<ref id="B29">
<label>29</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Muir</surname> <given-names>AJ</given-names>
</name>
<name>
<surname>Arora</surname> <given-names>S</given-names>
</name>
<name>
<surname>Everson</surname> <given-names>G</given-names>
</name>
<name>
<surname>Flisiak</surname> <given-names>R</given-names>
</name>
<name>
<surname>George</surname> <given-names>J</given-names>
</name>
<name>
<surname>Ghalib</surname> <given-names>R</given-names>
</name>
<etal/>
</person-group>. <article-title>A Randomized Phase 2b Study of Peginterferon Lambda-1a for the Treatment of Chronic HCV Infection</article-title>. <source>J Hepatol</source> (<year>2014</year>) <volume>61</volume>:<page-range>1238&#x2013;46</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.jhep.2014.07.022</pub-id>
</citation>
</ref>
<ref id="B30">
<label>30</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Prokunina-Olsson</surname> <given-names>L</given-names>
</name>
<name>
<surname>Alphonse</surname> <given-names>N</given-names>
</name>
<name>
<surname>Dickenson</surname> <given-names>RE</given-names>
</name>
<name>
<surname>Durbin</surname> <given-names>JE</given-names>
</name>
<name>
<surname>Glenn</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Hartmann</surname> <given-names>R</given-names>
</name>
<etal/>
</person-group>. <article-title>COVID-19 and Emerging Viral Infections: The Case for Interferon Lambda</article-title>. <source>J Exp Med</source> (<year>2020</year>) <volume>217</volume>(<issue>5</issue>):<elocation-id>e20200653</elocation-id>. doi: <pub-id pub-id-type="doi">10.1084/jem.20200653</pub-id>
</citation>
</ref>
<ref id="B31">
<label>31</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Grajales-Reyes</surname> <given-names>GE</given-names>
</name>
<name>
<surname>Colonna</surname> <given-names>M</given-names>
</name>
</person-group>. <article-title>Interferon Responses in Viral Pneumonias</article-title>. <source>Science</source> (<year>2020</year>) <volume>369</volume>:<page-range>626&#x2013;27</page-range>. doi: <pub-id pub-id-type="doi">10.1126/science.abd2208</pub-id>
</citation>
</ref>
<ref id="B32">
<label>32</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Apostolou</surname> <given-names>E</given-names>
</name>
<name>
<surname>Tzioufas</surname> <given-names>AG</given-names>
</name>
</person-group>. <article-title>Type-III Interferons in Sjogren's Syndrome</article-title>. <source>Clin Exp Rheumatol</source> (<year>2020</year>) <volume>38 Suppl 126</volume>:<page-range>245&#x2013;52</page-range>.</citation>
</ref>
<ref id="B33">
<label>33</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Eslam</surname> <given-names>M</given-names>
</name>
<name>
<surname>McLeod</surname> <given-names>D</given-names>
</name>
<name>
<surname>Kelaeng</surname> <given-names>KS</given-names>
</name>
<name>
<surname>Mangia</surname> <given-names>A</given-names>
</name>
<name>
<surname>Berg</surname> <given-names>T</given-names>
</name>
<name>
<surname>Thabet</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>IFN-Lambda3, Not IFN-Lambda4, Likely Mediates <italic>IFNL3-IFNL4</italic> Haplotype-Dependent Hepatic Inflammation and Fibrosis</article-title>. <source>Nat Genet</source> (<year>2017</year>) <volume>49</volume>:<fpage>795</fpage>&#x2013;<lpage>800</lpage>. doi: <pub-id pub-id-type="doi">10.1038/ng.3836</pub-id>
</citation>
</ref>
<ref id="B34">
<label>34</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Broggi</surname> <given-names>A</given-names>
</name>
<name>
<surname>Ghosh</surname> <given-names>S</given-names>
</name>
<name>
<surname>Sposito</surname> <given-names>B</given-names>
</name>
<name>
<surname>Spreafico</surname> <given-names>R</given-names>
</name>
<name>
<surname>Balzarini</surname> <given-names>F</given-names>
</name>
<name>
<surname>Lo</surname> <given-names>CA</given-names>
</name>
<etal/>
</person-group>. <article-title>Type III Interferons Disrupt the Lung Epithelial Barrier Upon Viral Recognition</article-title>. <source>Science</source> (<year>2020</year>) <volume>369</volume>:<page-range>706&#x2013;12</page-range>. doi: <pub-id pub-id-type="doi">10.1126/science.abc3545</pub-id>
</citation>
</ref>
<ref id="B35">
<label>35</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sposito</surname> <given-names>B</given-names>
</name>
<name>
<surname>Broggi</surname> <given-names>A</given-names>
</name>
<name>
<surname>Pandolfi</surname> <given-names>L</given-names>
</name>
<name>
<surname>Crotta</surname> <given-names>S</given-names>
</name>
<name>
<surname>Clementi</surname> <given-names>N</given-names>
</name>
<name>
<surname>Ferrarese</surname> <given-names>R</given-names>
</name>
<etal/>
</person-group>. <article-title>The Interferon Landscape Along the Respiratory Tract Impacts the Severity of COVID-19</article-title>. <source>Cell</source> (<year>2021</year>) <volume>184</volume>:<page-range>4953&#x2013;68</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.cell.2021.08.016</pub-id>
</citation>
</ref>
<ref id="B36">
<label>36</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Asselah</surname> <given-names>T</given-names>
</name>
<name>
<surname>De Muynck</surname> <given-names>S</given-names>
</name>
<name>
<surname>Broet</surname> <given-names>P</given-names>
</name>
<name>
<surname>Masliah-Planchon</surname> <given-names>J</given-names>
</name>
<name>
<surname>Blanluet</surname> <given-names>M</given-names>
</name>
<name>
<surname>Bieche</surname> <given-names>I</given-names>
</name>
<etal/>
</person-group>. <article-title>
<italic>IL28B</italic> Polymorphism is Associated With Treatment Response in Patients With Genotype 4 Chronic Hepatitis C</article-title>. <source>J Hepatol</source> (<year>2012</year>) <volume>56</volume>:<page-range>527&#x2013;32</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.jhep.2011.09.008</pub-id>
</citation>
</ref>
<ref id="B37">
<label>37</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rauch</surname> <given-names>A</given-names>
</name>
<name>
<surname>Kutalik</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Descombes</surname> <given-names>P</given-names>
</name>
<name>
<surname>Cai</surname> <given-names>T</given-names>
</name>
<name>
<surname>Di Iulio</surname> <given-names>J</given-names>
</name>
<name>
<surname>Mueller</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Genetic Variation in <italic>IL28B</italic> is Associated With Chronic Hepatitis C and Treatment Failure: A Genome-Wide Association Study</article-title>. <source>Gastroenterology</source> (<year>2010</year>) <volume>138</volume>:<fpage>1338</fpage>&#x2013;<lpage>45, 1341-45</lpage>. doi: <pub-id pub-id-type="doi">10.1053/j.gastro.2009.12.056</pub-id>
</citation>
</ref>
<ref id="B38">
<label>38</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ge</surname> <given-names>D</given-names>
</name>
<name>
<surname>Fellay</surname> <given-names>J</given-names>
</name>
<name>
<surname>Thompson</surname> <given-names>AJ</given-names>
</name>
<name>
<surname>Simon</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Shianna</surname> <given-names>KV</given-names>
</name>
<name>
<surname>Urban</surname> <given-names>TJ</given-names>
</name>
<etal/>
</person-group>. <article-title>Genetic Variation in <italic>IL28B</italic> Predicts Hepatitis C Treatment-Induced Viral Clearance</article-title>. <source>Nature</source> (<year>2009</year>) <volume>461</volume>:<fpage>399</fpage>&#x2013;<lpage>401</lpage>. doi: <pub-id pub-id-type="doi">10.1038/nature08309</pub-id>
</citation>
</ref>
<ref id="B39">
<label>39</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tanaka</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Nishida</surname> <given-names>N</given-names>
</name>
<name>
<surname>Sugiyama</surname> <given-names>M</given-names>
</name>
<name>
<surname>Kurosaki</surname> <given-names>M</given-names>
</name>
<name>
<surname>Matsuura</surname> <given-names>K</given-names>
</name>
<name>
<surname>Sakamoto</surname> <given-names>N</given-names>
</name>
<etal/>
</person-group>. <article-title>Genome-Wide Association of <italic>IL28B</italic> With Response to Pegylated Interferon-Alpha and Ribavirin Therapy for Chronic Hepatitis C</article-title>. <source>Nat Genet</source> (<year>2009</year>) <volume>41</volume>:<page-range>1105&#x2013;09</page-range>. doi: <pub-id pub-id-type="doi">10.1038/ng.449</pub-id>
</citation>
</ref>
<ref id="B40">
<label>40</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Suppiah</surname> <given-names>V</given-names>
</name>
<name>
<surname>Moldovan</surname> <given-names>M</given-names>
</name>
<name>
<surname>Ahlenstiel</surname> <given-names>G</given-names>
</name>
<name>
<surname>Berg</surname> <given-names>T</given-names>
</name>
<name>
<surname>Weltman</surname> <given-names>M</given-names>
</name>
<name>
<surname>Abate</surname> <given-names>ML</given-names>
</name>
<etal/>
</person-group>. <article-title>
<italic>IL28B</italic> is Associated With Response to Chronic Hepatitis C Interferon-Alpha and Ribavirin Therapy</article-title>. <source>Nat Genet</source> (<year>2009</year>) <volume>41</volume>:<page-range>1100&#x2013;04</page-range>. doi: <pub-id pub-id-type="doi">10.1038/ng.447</pub-id>
</citation>
</ref>
<ref id="B41">
<label>41</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Younossi</surname> <given-names>ZM</given-names>
</name>
<name>
<surname>Birerdinc</surname> <given-names>A</given-names>
</name>
<name>
<surname>Estep</surname> <given-names>M</given-names>
</name>
<name>
<surname>Stepanova</surname> <given-names>M</given-names>
</name>
<name>
<surname>Afendy</surname> <given-names>A</given-names>
</name>
<name>
<surname>Baranova</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>The Impact of <italic>IL28B</italic> Genotype on the Gene Expression Profile of Patients With Chronic Hepatitis C Treated With Pegylated Interferon Alpha and Ribavirin</article-title>. <source>J Transl Med</source> (<year>2012</year>) <volume>10</volume>:<fpage>25</fpage>. doi: <pub-id pub-id-type="doi">10.1186/1479-5876-10-25</pub-id>
</citation>
</ref>
<ref id="B42">
<label>42</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Roy</surname> <given-names>S</given-names>
</name>
<name>
<surname>Guha</surname> <given-names>RD</given-names>
</name>
<name>
<surname>Bhushan</surname> <given-names>A</given-names>
</name>
<name>
<surname>Bharatiya</surname> <given-names>S</given-names>
</name>
<name>
<surname>Chinnaswamy</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>Functional Genetic Variants of the IFN-Lambda3 (<italic>IL28B</italic>) Gene and Transcription Factor Interactions on its Promoter</article-title>. <source>Cytokine</source> (<year>2021</year>) <volume>142</volume>:<fpage>155491</fpage>. doi: <pub-id pub-id-type="doi">10.1016/j.cyto.2021.155491</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>