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Research Article
Revised

IL1B gene variants, but not TNF, CXCL8, IL6 and IL10, modify the course of cystic fibrosis in Polish patients.

[version 3; peer review: 1 approved, 2 approved with reservations]
* Equal contributors
PUBLISHED 22 Nov 2022
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OPEN PEER REVIEW
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This article is included in the Genomics and Genetics gateway.

This article is included in the Cell & Molecular Biology gateway.

Abstract

Background: The main aim of this study was to evaluate whether selected polymorphic variants in genes from the inflammatory pathway can be predictors of pulmonary or digestive manifestation of cystic fibrosis, as well as of severity of lung disease.
Materials and methods: Using pyrosequencing and sequencing we have genotyped 12 variants in TNF (rs361525, rs1800629), CXCL8 (rs4073, rs2227306, rs2227307, rs188378669), IL1B (rs16944, rs1143634, rs1142639, rs1143627), IL6 (rs1800795) and IL10 (rs1800896) genes in a cohort of 55 Polish patients with diagnosed cystic fibrosis and controls. In our study group, a pulmonary manifestation of disease revealed 44 of subjects (80%), and digestive symptoms dominated in 11 (20%) of analyzed individuals. Severe lung dysfunction has occurred in 20 (36.4%) of patients.
Results: We proved, that two promoter variants of IL1B, rs1143627 (c.-118G > A) and rs16944 (c.-598T > C) are presented significantly more often  in patients with severe character of lung disease compared to mild (82.5% vs. 62.8%, p-value 0.030, and 87.5% vs. 64.3%, p-value 0.008, respectively) in cystic fibrosis course. Haplotype AC formed by both changes had also a higher frequency (80%) in patients with severe course compared to the mild character (61.4%) of disease. However, the frequency of promoter variant TNF c.-308C > T (rs1800629) was presented at a significantly lower level in the patient’s group compared to healthy controls (2.7% vs. 15%, p-value 0.001). Furthermore, the presence of methicillin-resistant Staphylococcus aureus significantly correlated with the lower FEV1% in patients (p-value 0.01).
Conclusions: Genetic variants, rs1143627 and rs16944, of IL1B are promising candidates as predictors of the severe character of lung disease in Polish patients with cystic fibrosis.

Keywords

cystic fibrosis, modifier genes, inflammatory mediators, IL1B

Revised Amendments from Version 2

Version 3 of this manuscript additionally include information about age of patients classified to severe and mild phenotype of the disease. Furthermore, the reference numbered 21 and the text was added to clarify the disease severity classification of patients. We also provided information about CF genotypes among patients group in the Table 4 containing analysed polymorphisms. Additionally, the information that patients were clinically stable at the time of study recruitment was added.

See the authors' detailed response to the review by Daniel J. Smith
See the authors' detailed response to the review by Tadeusz Przybyłowski

Introduction

Recent scientific outcomes confirm that the clinical phenotype of cystic fibrosis (CF) (OMIM: 219700) is determined not only by classes of mutations in the CFTR gene (cystic fibrosis transmembrane regulator) but in association with environmental factors and genetic variations in modifier genes.13 The hypothesis about the role of modifier genes in CF was born based on the observations, that patients with the same CFTR genotype presented diverse manifestations and course of the disease.4 Today, over 2000 different CFTR mutations have been reported and F508del is by far the most common.5 Although mutations in the CFTR gene are well known and classified, the contribution of modulatory genes in CF is currently still investigated. Among analyzed candidate genes are those involved in the inflammatory process, as well as in immunity and antioxidant molecules.6 However, the results of the majority of global research on modifier genes’ role in CF are inconclusive.

CF is a multi-organ disease, whereas chronic pulmonary inflammation and respiratory failure consist of the main cause of death in those patients. There is evidence, that the inflammatory process in the lung is associated with an imbalance between pro- and anti-inflammatory mediators.7 Among important pro-inflammatory cytokines produced during the response are tumor necrosis factor-alpha (TNF-α), interleukins (IL) 8, 6, 1, and 1B, while among cytokines inducing the opposite effect are transforming growth factor-beta 1 (TGFB1) and IL10.810

Proteins, IL8 and TNF-α, play a crucial role in the pathophysiology of CF lung disease due to their participation in the recruitment and activation of neutrophils on the respiratory epithelial surface, which is a primary component of the innate immune response.11 Thus, genes CXCL8 and TNF coding for those cytokines, which expression is regulated by sequence variants, are highlighted as potential modifier genes in the severity of lung disease in CF. Although numerous polymorphic variants have been described in the CXCL8 gene, the association only between polymorphisms rs4073 (c.-251T>A), rs2227306 (c.781C>T), rs2227307 (c.396T>G), pulmonary function, and clinical severity markers in CF patients was confirmed in several studies.8,12 The most often analyzed changes in the TNF gene are located in the promoter region, such as c.-238G>A (rs361525) having a variable effect on gene expression and c.-308A>G (rs1800629) associated with increased gene transcription, worst pulmonary function, and early pulmonary symptoms in patients with CF.13,14 in contrast to studies performed by Schmitt-Grohé et al.15 and Khorrami et al.16 There is also proven, that some of TNF and CXCL8 polymorphisms are associated with Pseudomonas aeruginosa (PA) chronic colonization in CF patients.14,17 Furthermore, modulating effects on the CF also have shown IL1B and IL10 genes, where the most common SNPs were associated with severe lung disease in pediatric American and Australian populations.18,19 Whereas, in French and German pediatric CF patients those results were not shared.8

Results of up to now performed studies, searching for genes that modify the course and phenotype of CF, mostly concern the association with pulmonary exacerbation. However, based on our long-term observations of CF patients we state, that around 20% of CF patients manifest a pronounced exacerbation of symptoms from the digestive system. We hypothesized, that this possibly may be predicted by polymorphic changes at immunologically relevant genes. Within this context, we have selected 12 polymorphisms located in five genes CXCL8 (rs4073, rs2227306, rs2227307, rs188378669), TNF (rs361525, rs1800629), IL1B (rs16944, rs1143634, rs1142639, rs1143627), IL6 (rs1800795), and IL10 (rs1800896) for correlation analysis, as candidate genetic modulators of the pulmonary or digestive manifestation and severity of the disease among Polish CF patients.

Materials and methods

Patients and clinical data

The study was approved by the local Ethics Committee of the University of Medical Sciences in Poznan, Poland (resolution no. 675/15), and all experiments were performed following the relevant guidelines and regulations of this Committee. Written informed consent was obtained from each patient. 55 Polish patients (20 males and 35 females) between the ages of 20-52 with diagnosed CF were enrolled for this study. The patient group was collected in 12 months (from January to December 2016) in the Department of Pulmonology, Allergology and Lung Oncology of the Clinical Hospital of Poznan University of Medical Sciences in Poland. Diagnosis of CF in all patients was performed by sweat chloride test results (> 60 mmol/L) or/and identification of CFTR gene mutations. Detailed information about each patient including sex, age, BMI, age of diagnosis, presence of F508del mutation, pulmonary function parameters, function of internal organs, complications, and hospitalizations were recorded. Additionally, a control group of 50 healthy individuals was collected. A detailed characteristics of the study cohort with clinical and demographic data are presented in Table 1.

Table 1. Baseline characteristics of study participants.

Subjects characteristicPatients n = 55Controls n = 50
Sex (M/F)20 (36%)/35 (64%)19 (38%)/31 (62%)
Age (years)
 Mean (range)28 (20-52)31 (22-45)
Ethnicity (Caucasian)55 (100%)50 (100%)
BMI
 Mean (range)20.2 (15-27.8)23.3 (17.5-26)
 Malnutrition21 (38.2%)2 (4%)
Diagnosis (years)
 Mean (range)7.8 (1-36)-
Predominant manifestation of CF-
 Pulmonary44 (80%)
 Digestive11 (20%)
CF genotype (F508del)-
 Homozygote13 (23.6%)
 Heterozygote31 (56.4%)
 Nil11 (20%)
Notably severe character of CF20 (36.4%)-
FEV1%-
 Mean (range)53.5 (10.6-106.8)
FVC%-
 Mean (range)67 (26.1-112.4)
TLC%-
 Mean (range)109.4 (78.7-151.6)
RV%-
 Mean (range)219.2 (88.8-391.6)
DLCO-
 Mean (range)59.7 (16.8-88)
Pulmonary complications (emphysema, hemoptysis)25 (45.5%)-
Lung transplantation/death14 (25.5%)-
Diabetes/impaired glucose tolerance29 (52.7%)-
Exocrine insufficiency38 (69%)-
Liver dysfunction19 (34.5%)-
Hospitalizations per year-
 Mean (range)1.9 (0-8)

Pulmonary function tests, using Jaeger MasterScreen system (Erich Jaeger GmbH; Würzburg, Germany) were performed to assess lung function. All spirometric examinations were carried out with the subject seated, using a nose clip and a disposable mouthpiece. Using spirometric measurements, values of expiratory forced vital capacity (FVC) and forced expiratory volume in one second (FEV1%) were obtained and were expressed as the percentage of predicted values according to European Community for Steel and Coal.20

At the same time the body plethysmography for assessing residual volume (RV), total lung capacity (TLC), and diffusing capacity of the lungs for carbon monoxide (DLCO) were performed.

Patients were divided in the context of lung function impairment, based on the FEV1% values, while they were clinically stable, 1 - within the norm (FEV1% ≥ 70) and mild pulmonary obstruction (FEV1% 40-70) (35 subjects in total), 2 - severe pulmonary obstruction (FEV1% ≤ 40) (20 subjects in total).21 The “severe” group of patients did not differ significantly in age from patients in the “mild” group (mean age was 27.11 and 30.75, respectively; p-value was 0.055).

In an attempt to analyze the correlation between the genotype and manifestation of CF, patients were divided into two subgroups depending on the dominant symptoms - the group with the manifestation primarily from the respiratory system (44 individuals) and the group of patients with prevalent gastrointestinal symptoms (11 individuals). The division was made by the specialists from the pulmonology field conducting the patients, based on the clinical data and interview. To the digestive predominant phenotype were enrolled patients with the coexistence of at least two of listed conditions: 1) diabetes or glucose metabolism impairment, 2) pancreatic insufficiency, 3) liver disease or cirrhosis, 4) nagging pain or dysfunction of the digestive system. All patients with GI predominant phenotype represented “mild” lung impairment. Specialists determining the patients phenotype were not involved in the analysis of genotype assessment. Results of genotyping did not influence the assessment of phenotypic description.

Genotyping

Genomic DNA of each patient was extracted from the peripheral blood samples (5 mL) using the standard method with guanidine isothiocyanate (GTC). Detection of the single nucleotide polymorphisms (SNPs) in five genes: CXCL8 (rs4073, rs2227306, rs2227307, rs188378669), TNF (rs361525, rs1800629), IL1B (rs16944, rs1143634, rs1142639, rs1143627), IL6 (rs1800795) and IL10 (rs1800896) was performed using pyrosequencing or Sanger sequencing. Primers for the pyrosequencing analysis were designed using PyroMark Assay Design Software (Biotage, Uppsala, Sweden) and for Sanger sequencing using Primer3Plus software. Primer details are shown in Table 2. Amplification of targeted DNA regions was carried out on Applied Biosystems 2720 Thermal Cycler (Applied Biosystems, Foster City, CA) on the total volume of 30 uL containing 0.75 U of FIREPol® DNA Polymerase, 2.5 μL 10× buffer, 2.0 μL dNTP mix (2.5 mM each dNTP), 1.5 mM MgCl2 solution, 80 ng DNA and 0.2 μM of each primer. All reagents were obtained from Solis BioDyne (Tartu, Estonia). The amplification products were analyzed in 1.5% agarose gels electrophoresis. Pyrosequencing was performed by the PSQ™ 96MA system (Qiagen) using PyroMark™ Gold Q96 Reagents (Qiagen GmbH, Hilden, Germany), according to the manufacturer instructions. Direct sequencing was performed using BigDye Terminator v3.1 Cycle Sequencing Kit (Thermo Fisher Scientific) on the Applied Biosystems 3500 and Series Genetic Analyzers.

Table 2. Primer details.

GeneSNPPrimer NamePrimer sequenceProduct length
TNFc.-238G > A (rs361525)TNF_238_F*5’-CTCCAGGGTCCTACACACAAAT-3’188 bp
TNF_238_R5’-CATCTGGAGGAAGCGGTAGTG-3’
TNF_238_Seq5’-CCCATCCTCCCTGCT-3’-
c.-308C > T (rs1800629)TNF_308_F*5’-GCCCCTCCCAGTTCTAGTTCT-3’184 bp
TNF_308_R5’-ATTCCGAGGGGGGTCTTC-3’
TNF_308_Seq5’-GGCTGAACCCCGTCC-3’-
CXCL8c.-251T > A (rs4073)CXCL8_251_F5’-ATCTTGTTCTAACACCTGCCACTC-3’112 bp
CXCL8_251_R*5’-AAGCTCCACAATTTGGTGAATTA-3’
CXCL8_251_Seq5’-TAGAAATAAAAAAGCATACA-3’-
c.781C > T (rs2227306)CXCL8_781_F*5’-GAAGGCAATTTCTATGCTGGAGAG-3’225 bp
CXCL8_781_R5’-CCTGAATATTCTCCTAGCCCTTGA-3’
CXCL8_781_Seq5’-CATAACTGACAACATTGAAC-3’-
c.396T > G (rs2227307)CXCL8_396_F5’-GCGTTTTCCTATGTCTAAATGTGA-3’357 bp
CXCL8_396_R*5’-CAAATCTGAGGCTTGTCAATGA-3’
CXCL8_396_Seq5’-CTGCTTTTATAATTTATACC-3’-
c.91G > T (rs188378669)CXCL8_91_F5’-ATCACTTTTTCCCCCAACAG-3’246 bp
CXCL8_91_R5’-CCTAACACCTGGAACTTTCCTAAA-3’
IL1Bc.-598T > C (rs16944)IL1B_598_F*5’-TGAGGGTGTGGGTCTCTACCTT-3’112 bp
IL1B_598_R5’-AAGCTCCACAATTTGGTGAATTA-3’
IL1B_598_Seq5’-TAGAAATAAAAAAGCATACA-3’-
c.315G > A (rs1143634)IL1B _315_F5’-CGTGCACATAAGCCTCGTTATC-3’59 bp
IL1B _315_R*5’-GCTCCACATTTCAGAACCTATCTT-3’
IL1B _315_Seq5’-CATAACTGACAACATTGAAC-3’-
c.597+76G > A (rs1142639)IL1B _597_F*5’-TTGAAGGTTGCACGCAGTTAA-3’143 bp
IL1B _597_R5’-TCAGCCTCCTGCTACCACTTATT-3’
IL1B _597_Seq5’-CAGACAACCACCTTCTC-3’-
c.-118G > A (rs1143627)IL1B _118_F5’-GTGCCTTGTGCCTCGAAGAG-3’86 bp
IL1B _118_R*5’-TCAGCCTCCTACTTCTGCTTTTGA-3’
IL1B _118_Seq5’-CCCTCGCTGTTTTTAT-3’-
IL6c.-237G > C (rs1800795)IL6 _237_F*5’-TGCACTTTTCCCCCTAGTTGT-3’82 bp
IL6 _237_R5’-TGGGGCTGATTGGAAACCT-3’
IL6 _237_Seq5’-TGTGACGTCCTTTAGCA-3’-
IL10c.-1117A > G (rs1800896)IL10 _1117_F5’-AACTGGCTCCCCTTACCTTCTA-3’151 bp
IL10 _1117_R*5’-AGGCTGGATAGGAGGTCCCTTACT-3’
IL10_1117_Seq5’-AAGGCTTCTTTGGGA-3’-

* Primers labelled with biotin for pyrosequencing.

Statistical analysis

Conformance of genotypes distribution of all analyzed polymorphisms with the Hardy-Weinberg equilibrium (HWE) was assessed using Fisher’s exact test. The pair-wise linkage disequilibrium (LD) of variants located in genes TNF, CXCL8, and IL1B was evaluated by Lewontin’s D′ using Haploview software version 4.2. The correlation analyses between genotypes and clinical data were performed using the chi-square test and Fisher’s exact test.

For all calculations, STATISTICA 12.0 software (Stat Soft, 2014) was used. The level of significance was set at p < 0.05.

Results

Allele frequencies and linkage disequilibrium analysis

A total of 55 CF Polish patients and 50 healthy controls were successfully genotyped for selected 12 polymorphisms located in genes CXCL8, TNF, IL1B, IL6, and IL10. Genotypes distribution for all SNPs met the requirements of HWE. No relevant differences in variant allele frequency between both groups were demonstrated. Only TNF c.-308C > T variant was observed significantly less often in the patient group (2.7%) compared to controls (15%), where the p-value was 0.001. All obtained frequencies of each genotype and allele are presented in Table 3.

Table 3. Genotypes and alleles distribution of analyzed polymorphisms among group of Polish CF patients and controls.

SNPGenotypeGroup of CF patients (n = 55)Control group (n = 50)1000 Genomes databaseAllele frequency CF patients vs control group
Number (%)HWE** (p-value)Variant allele freq.Number (%)HWE** (p-value)Variant allele freq.Variant allele freq. (EU population)
TNF c.-238G > A (rs361525)GG48 (87.3)0.6146.4%44 (88)0.17%6%p = 0.853
GA7 (12.7)5 (10)
AA0 (0.0)1 (2)
TNF c.-308C > T (rs1800629)CC52 (94.5)0.8352.7%36 (72)0.88915%13%p = 0.001
CT3 (5.5)13 (26)
TT0 (0.0)1 (2)
CXCL8 c.-251T > A (rs4073)TT16 (29.1)0.41943.6%17 (34)0.91642%42%p = 0.810
TA30 (54.5)24 (48)
AA9 (16.4)9 (18)
CXCL8 c.781C > T (rs2227306)CC16 (29.1)0.41943.6%17 (34)0.91642%39%p = 0.810
CT30 (54.5)24 (48)
TT9 (16.4)9 (18)
CXCL8 c.396T > G (rs2227307)TT16 (29.1)0.41943.6%17 (34)0.91642%42%p = 0.810
TG30 (54.5)24 (48)
GG9 (16.4)9 (18)
CXCL8 c.91G > T (rs188378669)GG54 (98.2)0.9450.9%50 (100)-0%0%p = 1.290
GT1 (1.8)0 (0)
TT0 (0.0)0 (0)
IL1B c.315G > A (rs1143634)GG34 (61.8)0.31120%35 (70)0.57817%25%p = 0.576
GA20 (36.4)13 (26)
AA1 (1.8)2 (4)
IL1B c.-598T > C (rs16944)TT5 (9.1)0.53673%5 (10)0.73670%65%p = 0.662
TC20 (36.4)20 (40)
CC30 (54.5)25 (50)
IL1B c.597+76G > A (rs1143639)GG34 (61.8)0.31120%35 (70)0.57817%24%p = 0.576
GA20 (36.4)13 (26)
AA1 (1.8)2 (4)
IL1B c.-118G > A (rs1143627)GG5 (9.1)0.97470%4 (8)0.59469%65%p = 0.875
GA23 (41.8)23 (46)
AA27 (49.1)23 (46)
IL6 c.-237G > C (rs1800795)GG16 (29.1)0.70147%20 (40)0.40639%42%p = 0.226
GC26 (47.3)21 (42)
CC13 (23.6)9 (18)
IL10 c.1117A > G (rs1800896)AA16 (29)0.18543%20 (40)0.23840%45%p = 0.688
AG31 (56.5)20 (40)
GG8 (14.5)10 (20)

** HWE – Hardy-Weinberg equilibrium (occurs when p > 0.05).

Our haplotype analysis confirmed a strong LD (D' = 1, r2 = 0.928) between variants c.-251T > A (rs4073), c.781C > T (rs2227306) and c.396T > G (rs2227307) in the CXCL8 gene, forming four haplotypes: TCT, ATG, TCG and ACG observed in our CF patient group with frequency 54.6%, 41.8%, 1,8% and 1,8%, respectively. Furthermore, two polymorphic changes located in the promoter region of IL1B gene, c.-118G > A (rs1143627) and c.-598T > C (rs16944) were observed in high LD (D’ = 0.904, r2 = 0.75), constructing a haploblock, where haplotypes AC, GT, GC, AT frequency was 68.1%, 26.3%, 3.7% and 1.9%, respectively. Both haploblocks are presented on the Figure 1.

d6cf3ed7-f56c-4de6-a07c-69141694b95f_figure1.gif

Figure 1. Detected haploblocks in CF patients.

Association analysis of clinical data and genetic diversity

First, we have analyzed all 12 variants in designated, based on clinical data, groups of patients - with different manifestations of CF (with pulmonary or digestive dominant symptoms) and with variable courses of disease (mild or severe) to examine possible association.

Our study demonstrated that the presence of two polymorphisms, c.-598T > C (rs16944) and c.-118G > A (rs1143627), in IL1B gene significantly correlate with character of disease (Table 4). Higher frequency of variant allele c.-598C was observed in patients with severe character of CF, compared to patients with mild course of disease (87.5% and 64.3%, respectively, χ2 = 6.92; p = 0.008). Similarly, variant allele c.-118A occurred with higher frequency in subjects presented severe character of CF versus those with mild course of disease (82.5% vs. 62.8%, respectively, χ2 = 4.68; p < 0.05).

Table 4. Distribution of analyzed polymorphisms in the studied group of CF patients with different manifestation and course of disease.

SNPGenotypeCF manifestationCourse of disease
Pulmonary (n = 44)Variant allele freq.Digestive (n = 11)Variant allele freq.Pulmonary vs. DigestiveMild (n = 35)Variant allele freq.Severe (n = 20)Variant allele freq.Mild vs. Severe
TNF
rs361525
GG377.9%110%p = 0.475307.1%185%p = 1.008
GA7052
AA0000
TNF
rs1800629
CC422.3%104.5%p = 1.128332.9%192.5%p = 1.146
CT2121
TT0000
CXCL8
rs4073
TT1542%150%p = 0.5011145.7%540%p = 0.561
TA2191614
AA8181
CXCL8
rs2227306
CC1542%150%p = 0.5011145.7%540%p = 0.561
CT2191614
TT8181
CXCL8
rs2227307
TT1542%150%p = 0.5011145.7%540%p = 0.561
TG2191614
GG8181
CXCL8
rs188378669
GG440%110%p = 1.000350%200%p = 1.000
GT0000
TT0000
IL1B
rs1143634
GG2720.5%718.2%p = 1.0002220%1220%p = 1.000
GA164128
AA1010
IL1B
rs16944
TT571.6%077.3%p = 0.915564.3%087.5%p = 0.008
TC155155
CC2461515
IL1B
rs1143639
GG2819.3%622.7%p = 0.7682121.4%1317.5%p = 0.620
GA155137
AA1010
IL1B
rs1143627
GG570.4%068.2%p = 0.835462.8%182.5%p = 0.030
GA167185
AA2341314
IL6
rs1800795
CC1246.6%450%p = 0.774948.6%745%p = 0.718
CG233188
GG9485
IL10
rs1800896
AA1341%350%p = 0.440747.1%935%p = 0.215
AG265238
GG5353
CFTR
F508del
del/del1153.4%236.4%p = 0.5041155.7%245%p = 0.279
del/-2561714
-/-8374

Considering the fact, that analyzed changes formed in our study two haploblocks (in CXCL8 and IL1B genes), an analysis of the haplotypes in the context of the course and manifestation of disease was performed. We proved, that only haplotype AC created by changes c.-118G > A and c.-598T > C in IL1B gene is significantly more often observed in group with severe course of CF in comparison with mild course (80% and 61.4%, respectively; χ2 = 4.055; p = 0.03).

Discussion

Because CF is a multifactorial, life-shortening disorder, the determination of SNPs that would affect the general phenotype or course of the disease is essential, but also challenging due to previous inconclusive results. So far, most of the CF studies were focused on searching modifier genes responsible for the severe pulmonary phenotype of the disease. In our investigation we have analyzed the impact of selected 12 potential candidates of modulator changes, rs4073, rs2227306, rs2227307 and rs188378669 in CXCL8 gene, rs361525 and rs1800629 in TNF gene, rs16944, rs1143634, rs1142639 and rs1143627 in IL1B gene, rs1800795 in IL6 gene and rs1800896 in IL10 gene on CF phenotype in Polish patients, taking into account the severity of symptoms on the side of the digestive, but also, respiratory system. Our hypothesis was that candidate modulator changes may predict digestive character of CF.

We observed, that in most of our group of patients (80%) the dominating symptoms occurred from the respiratory system and only in 20% of CF patients from the digestive system. Severe character of lung disease, diagnosed based on the FEV1% values, was noted in 20 patients (36%) and mild in 35 individuals (64%). In those subgroups of patients, we have performed a correlation analysis with DNA changes. Obtained variant allele frequencies of analyzed genetic variants, did not much differ from reference values for European population in 1000 Genomes database, except change TNF c.-308C > T (rs1800629) which occurred in our patients group less often (2,7%) than in the database (13%). Also interesting is, that variant CXCL8 c.91G > T, p.Glu31Ter (rs188378669) globally noted with variant allele frequency < 0.1%, was detected in our CF patients at level 0.9% (one heterozygote detected in a cohort of 55 individuals). In our previous study, we proved, that this variant is significantly more common in patients with inflammatory bowel disease (MAF = 2.12%, 15 heterozygotes detected in a cohort of 353 patients) compared to healthy Polish population (MAF = 0.25%, 1 heterozygote identified in a cohort of 200 individuals of Polish population), what may suggest its association with inflammatory diseases (unpublished data). Therefore, studies on a larger group of patients are undoubtedly necessary to verify the participation of this variant in CF, especially since there are no data on the relationship with this disease.

Our study revealed, that among all analyzed genetic changes two of them, c.-598T > C (rs16944) and c.-118G > A (rs1143627) located in the IL1B gene, are significantly associated with the severe character of lung disease in polish CF subjects. Allele C in locus -598 was observed with frequency of 87.5% in patients with severe lung disease compared to patients with mild lung dysfunction (64.3%, p = 0.008, OR = 3.88, C.I. = [1.351-11.190]), while allele A in locus -118 was observed with frequency 82.5% and 62.8% in both groups, respectively (p = 0.03, OR = 2.78, C.I. = [1.079-7.194]). We confirmed high LD between both changes (rs1143627 and rs16944) creating haplotypes AC, GT, GC and AT, where AC was significantly more often observed in subjects with severe course of CF in comparison to mild.

Our findings concerning the impact of polymorphism rs16944 on CF phenotype are consistent with those obtained by de Vries et al.18 They also proved a significant correlation of the variant allele c.-598C of IL1B gene with severe pulmonary dysfunction in total of 152 Australian CF patients. Similarly, Levy et al.19 have reported that IL1B constitutes a clinically relevant modulator of CF lung disease in the study conducted among American patients. However, in their research other SNPs, rs1143634 and rs1143639 demonstrated a consistent association with severe pulmonary phenotype.

In contrast to those results, Corvol et al.8 did not find any correlation between variants c.-598T > C and c.-118G > A in IL1B gene and lung function assessed by spirometry in 329 Caucasian CF children from France and Germany. Additionally, they did not confirm any linkage disequilibrium between those polymorphisms.

Studies mainly highlight the relationship between lung disease in CF and CXCL8 gene polymorphism.2224 IL8 plays a crucial role in the pathophysiology of inflammation of the airways in CF patients caused by a deficiency or absence of the CFTR protein.25 Our study did not confirm this association among Polish patients.

We are aware of several limitations of our research. Our study cohort included only 55 patients and 50 controls. In the next step, verification of our results should be performed on a larger group of patients. This may be crucial in the case of rare variants, as c.91G > T, p.Glu31Ter (rs188378669) in CXCL8 gene, candidate as a modifier of CF. Furthermore, other factors such as BMI, gender, or age of diagnosis was not taken into account in our statistical analyzes.

We should also highlight the strengths of our study. First, the study cohort was represented by detailed characterized patients and homogenous controls group. What is important, the effect of CFTR mutation F508del on the manifestation and course of CF in the studied patients was excluded because the frequency of mutations in the subgroups was similar.

Although this study does not indicate any modulators of digestive manifestation of CF, it constitutes the first report of genes predicting the course of this disease in the Polish population.

Recent studies indicate the important role of the microbiome in the course and manifestation of cystic fibrosis. Scientists underline that both, genotype and microbiome profiles are crucial interconnected factors in disease progression.26

Conclusions

Our data have shown, that from all analyzed pro-inflammatory cytokine genes, only IL1B, but not TNF, CXCL8, IL6, or IL10 clearly play a crucial role in CF manifestation, determining the severe character of lung disease. This is a confirmation of major global results, as well as the first report concerning modulator genes of CF manifestation among Polish patients. Unfortunately, none of the analyzed genetic variants was found as predictors of digestive manifestation of CF disease, which may suggest the participation of also other modulator genes in the final phenotype of the disease.

Data availability statement

All data underlying the results are available as part of the article and no additional source data are required.

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Zakerska-Banaszak O, Gozdzik-Spychalska J, Gabryel M et al. IL1B gene variants, but not TNF, CXCL8, IL6 and IL10, modify the course of cystic fibrosis in Polish patients. [version 3; peer review: 1 approved, 2 approved with reservations]. F1000Research 2022, 11:379 (https://doi.org/10.12688/f1000research.110472.3)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 3
VERSION 3
PUBLISHED 22 Nov 2022
Revised
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2
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Reviewer Report 23 Aug 2024
Agnieszka Swiatecka-Urban, University of Virginia, Charlottesville, Virginia, USA 
Approved with Reservations
VIEWS 2
The authors examined the association of polymorphic variants in genes from the inflammatory pathway with pulmonary or digestive manifestation of cystic fibrosis (CF), and the severity of CF lung disease.

It is an interesting and important study. ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Swiatecka-Urban A. Reviewer Report For: IL1B gene variants, but not TNF, CXCL8, IL6 and IL10, modify the course of cystic fibrosis in Polish patients. [version 3; peer review: 1 approved, 2 approved with reservations]. F1000Research 2022, 11:379 (https://doi.org/10.5256/f1000research.141310.r279792)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Version 2
VERSION 2
PUBLISHED 23 May 2022
Revised
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15
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Reviewer Report 24 Oct 2022
Daniel J. Smith, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia 
Approved with Reservations
VIEWS 15
The article aims to determine whether there are association with polymorphisms in the genes for common pro-inflammatory cytokines and severity of CF lung and GI manifestations.

The major findings, in general, are supported by findings from studies ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Smith DJ. Reviewer Report For: IL1B gene variants, but not TNF, CXCL8, IL6 and IL10, modify the course of cystic fibrosis in Polish patients. [version 3; peer review: 1 approved, 2 approved with reservations]. F1000Research 2022, 11:379 (https://doi.org/10.5256/f1000research.134254.r151823)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 10 Mar 2023
    Oliwia Zakerska-Banaszak, Institute of Human Genetics Polish Academy of Sciences, Poznan, Poland
    10 Mar 2023
    Author Response
    Dear Dr. Daniel J. Smith,

    Thank You very much for reviewing our manuscript and for all valuable comments and suggestions, which we have analyzed step by step.
    We response ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 10 Mar 2023
    Oliwia Zakerska-Banaszak, Institute of Human Genetics Polish Academy of Sciences, Poznan, Poland
    10 Mar 2023
    Author Response
    Dear Dr. Daniel J. Smith,

    Thank You very much for reviewing our manuscript and for all valuable comments and suggestions, which we have analyzed step by step.
    We response ... Continue reading
Version 1
VERSION 1
PUBLISHED 31 Mar 2022
Views
15
Cite
Reviewer Report 16 May 2022
Tadeusz Przybyłowski, Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland 
Approved
VIEWS 15
This is a very interesting paper in which the authors decided to evaluate whether selected polymorphic variants in genes encoding selected inflammatory mediators can predict pulmonary or digestive manifestation of cystic fibrosis and severity of lung involvement. Using advanced genetic ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Przybyłowski T. Reviewer Report For: IL1B gene variants, but not TNF, CXCL8, IL6 and IL10, modify the course of cystic fibrosis in Polish patients. [version 3; peer review: 1 approved, 2 approved with reservations]. F1000Research 2022, 11:379 (https://doi.org/10.5256/f1000research.122087.r135127)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 23 May 2022
    Oliwia Zakerska-Banaszak, Institute of Human Genetics Polish Academy of Sciences, Poznan, Poland
    23 May 2022
    Author Response
    Dear Reviewer, Prof. Przybyłowski,

    We thank you very much for your comments and all the valuable suggestions concerning our manuscript. 

    According to Your questions:
    1. The way
    ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 23 May 2022
    Oliwia Zakerska-Banaszak, Institute of Human Genetics Polish Academy of Sciences, Poznan, Poland
    23 May 2022
    Author Response
    Dear Reviewer, Prof. Przybyłowski,

    We thank you very much for your comments and all the valuable suggestions concerning our manuscript. 

    According to Your questions:
    1. The way
    ... Continue reading

Comments on this article Comments (0)

Version 3
VERSION 3 PUBLISHED 31 Mar 2022
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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