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Wang J, Xue Y, Zhou L. New Classification of Rheumatoid Arthritis Based on Immune Cells and Clinical Characteristics. J Inflamm Res 2024; 17:3293-3305. [PMID: 38800595 PMCID: PMC11128232 DOI: 10.2147/jir.s395566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Background Rheumatoid arthritis (RA) is a chronic systemic immune disease characterized by joint synovitis, but there are differences in clinical manifestations and serum test results among different patients. Methods This is a bioinformatics study. We first obtained the gene expression profile of RA and normal synovium from the database, and screened the differentially expressed immune related genes for enrichment analysis. Subsequently, we classified RA into three subtypes by unsupervised clustering of serum gene expression profiles based on immune enrichment scores. Then, the enrichment and clinical characteristics of different subtypes were analyzed. Finally, according to the infiltration of different subtypes of immune cells, diagnostic markers were screened and verified by qRT-PCR. Results C1 subtype is related to the increase of neutrophils, C-reactive protein and erythrocyte sedimentation rate, and joint pain is more significant in patients. C2 subtype is related to the expression of CD8+T cells and Tregs, and patients have mild joint pain symptoms. The RF value of C3 subtype is higher, and the expression of various immune cells is increased. CD4 T cells, NK cells activated, macrophages M1 and neutrophils are immune cells significantly infiltrated in synovium and serum of RA patients. IFNGR1, TRAC, IFITM1 can be used as diagnostic markers of different subtypes. Conclusion In this study, RA patients were divided into different immune molecular subtypes based on gene expression profile, and immune diagnostic markers were screened, which provided a new idea for the diagnosis and treatment of RA.
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Affiliation(s)
- Jiaqian Wang
- Department of Orthopaedic, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Yuan Xue
- Department of Orthopaedic, Wuxi Ninth People’s Hospital of Soochow University, Wuxi, 214000, People’s Republic of China
| | - Liang Zhou
- Department of Orthopaedic, Lianshui County People’s Hospital, Huai‘an, People’s Republic of China
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Perera J, Delrosso CA, Nerviani A, Pitzalis C. Clinical Phenotypes, Serological Biomarkers, and Synovial Features Defining Seropositive and Seronegative Rheumatoid Arthritis: A Literature Review. Cells 2024; 13:743. [PMID: 38727279 PMCID: PMC11083059 DOI: 10.3390/cells13090743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disorder which can lead to long-term joint damage and significantly reduced quality of life if not promptly diagnosed and adequately treated. Despite significant advances in treatment, about 40% of patients with RA do not respond to individual pharmacological agents and up to 20% do not respond to any of the available medications. To address this large unmet clinical need, several recent studies have focussed on an in-depth histological and molecular characterisation of the synovial tissue to drive the application of precision medicine to RA. Currently, RA patients are clinically divided into "seropositive" or "seronegative" RA, depending on the presence of routinely checked antibodies. Recent work has suggested that over the last two decades, long-term outcomes have improved significantly in seropositive RA but not in seronegative RA. Here, we present up-to-date differences in epidemiology, clinical features, and serological biomarkers in seronegative versus seropositive RA and discuss how histological and molecular synovial signatures, revealed by recent large synovial biopsy-based clinical trials, may be exploited to refine the classification of RA patients, especially in the seronegative group.
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Affiliation(s)
- James Perera
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, UK
| | - Chiara Aurora Delrosso
- Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Alessandra Nerviani
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Biomedical Sciences, Humanitas University & IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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Zhang G, Xu J, Du D, Liu Y, Dai L, Zhao Y. Diagnostic values, association with disease activity and possible risk factors of anti-PAD4 in rheumatoid arthritis: a meta-analysis. Rheumatology (Oxford) 2024; 63:914-924. [PMID: 37824204 DOI: 10.1093/rheumatology/kead545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Anti-peptidyl arginine deaminase 4 (anti-PAD4) antibody has been a subject of investigation in RA in the last two decades. This meta-analysis investigated the diagnostic values, association with disease activity and possible risk factors of anti-PAD4 antibody in rheumatoid arthritis. METHOD We searched studies from five databases up to 1 December 2022. Bivariate mixed-effect models were used to pool the diagnostic accuracy indexes, and the summary receiver operating characteristics (SROC) curve was plotted. The quality of diagnostic studies was assessed using QUADAS-2. Non-diagnostic meta-analyses were conducted using the random-effects model. Sensitivity analysis, meta-regression, subgroup analyses and Deeks' funnel plot asymmetry test were used to address heterogeneity. RESULT Finally, 24 journal articles and one letter were included. Anti-PAD4 antibody had a good diagnostic value between RA and healthy individuals, but it might be lower between RA and other rheumatic diseases. Moreover, anti-PAD4 could slightly enhance RA diagnostic sensitivity with a combination of ACPA or ACPA/RF. Anti-PAD4 antibody was positively correlated with HLA-SE and negatively correlated with ever or current smoking in patients with RA. RA patients with anti-PAD4 antibody had higher DAS28, ESR, swollen joint count (SJC) and the possibility of having interstitial lung disease (ILD) and pulmonary fibrosis compared with those without. CONCLUSION Our study suggests that anti-PAD4 antibody is a potentially useful diagnostic biomarker and clinical indicator for RA. Further mechanistic studies are required to understand the impact of HLA-SE and smoking on the production of anti-PAD4 antibody.
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Affiliation(s)
- Guangyue Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayi Xu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongru Du
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Lunzhi Dai
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zhao
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Cappelli LC, Hines D, Wang H, Bingham CO, Darrah E. Anti-Peptidylarginine Deiminase 4 Autoantibodies and Disease Duration as Predictors of Treatment Response in Rheumatoid Arthritis. ACR Open Rheumatol 2024; 6:81-90. [PMID: 38058274 PMCID: PMC10867292 DOI: 10.1002/acr2.11630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Given that autoantibodies to peptidylarginine deiminase 4 (PAD4) are associated with erosive disease in established rheumatoid arthritis (RA), this study was conducted to compare the clinical and prognostic use of anti-PAD4 antibodies in patients with early and established RA. METHODS Sera from patients with early (duration <2 years; n = 422) or established (duration ≥2 years; n = 359) RA from two randomized clinical trials of tofacitinib ± methotrexate compared with adalimumab + MTX or MTX alone were evaluated for the presence of anti-PAD4 and anti-PAD3/4 antibodies at baseline and posttreatment time points. Summary statistics were calculated for demographic, clinical, and serological characteristics, and generalized estimating equations were used to model clinical outcomes by disease duration according to anti-PAD4 status. RESULTS Anti-PAD4 antibodies were present in 22% and 40% of patients with early and established RA, respectively, stable following treatment, and associated with baseline joint damage only in established RA. In early RA, baseline anti-PAD4 antibodies were associated with a greater improvement in disease activity score 28-joint count using C-reactive protein levels after treatment compared with individuals with negative anti-PAD4 (P = 0.049). Tofacitinib ± MTX was more broadly efficacious than MTX alone at improving clinical outcomes in early and established RA, irrespective of anti-PAD4 status (P < 0.05 for all), whereas adalimumab + MTX exhibited differential benefits in achieving disease activity score remission in early RA (P = 0.036) and American College of Rheumatology 20 responses in established RA (P = 0.002). CONCLUSION Differences in prevalence, clinical associations, and treatment-response outcomes according to anti-PAD4 antibody status in early and established RA suggests the existence of a therapeutic window to prevent the accumulation of irreversible joint damage in early patients with RA with anti-PAD4 antibodies.
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Affiliation(s)
| | - David Hines
- Johns Hopkins School of MedicineBaltimoreMaryland
| | - Hong Wang
- Johns Hopkins School of MedicineBaltimoreMaryland
| | | | - Erika Darrah
- Johns Hopkins School of MedicineBaltimoreMaryland
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Palterer B, Vitiello G, Del Carria M, D'Onofrio B, Martinez-Prat L, Mahler M, Cammelli D, Parronchi P. Anti-protein arginine deiminase antibodies are distinctly associated with joint and lung involvement in rheumatoid arthritis. Rheumatology (Oxford) 2023; 62:2410-2417. [PMID: 36440916 DOI: 10.1093/rheumatology/keac667] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES RA is a chronic inflammatory disease in which possible interstitial lung disease (ILD) is an extra-articular manifestation that carries significant morbidity and mortality. RF and ACPA are included in the RA classification criteria but prognostic and diagnostic biomarkers for disease endotyping and RA-ILD are lacking. Anti-protein arginine deiminase antibodies (anti-PAD) are a novel class of autoantibodies identified in RA. This study aimed to assess clinical features, ACPA and anti-PAD antibodies in RA patients with articular involvement and ILD. METHODS We retrospectively collected joint erosions, space narrowing, clinical features and lung involvement of a cohort of 71 patients fulfilling the 2010 ACR/EULAR RA classification criteria. Serum samples from these patients were tested for ACPA IgG (QUANTA Flash CCP3), and anti-PAD3 and anti-PAD4 IgG, measured with novel assays based on a particle-based multi-analyte technology (PMAT). RESULTS Anti-PAD4 antibodies were significantly associated with radiographic injury (P = 0.027) and erosions (P = 0.02). Similarly, ACPA levels were associated with erosive disease (P = 0.014). Anti-PAD3/4 double-positive patients displayed more joint erosions than patients with anti-PAD4 antibodies only or negative for both (P = 0.014 and P = 0.037, respectively). RA-ILD (15.5%, 11/71 patients) was associated with older age (P < 0.001), shorter disease duration (P = 0.045) and less erosive disease (P = 0.0063). ACPA were elevated in RA-ILD, while anti-PAD4 were negatively associated (P = 0.043). CONCLUSION Anti-PAD4 and anti-PAD3 antibodies identify RA patients with higher radiographic injury and bone erosions. In our cohort, ILD is associated with lower radiographic and erosive damage, as well as low levels of anti-PAD4 antibodies.
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Affiliation(s)
- Boaz Palterer
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianfranco Vitiello
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Del Carria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Bernardo D'Onofrio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | | | | | - Daniele Cammelli
- Dipartimento Medico-Geriatrico, SOD Immunoallergologia, AOU Careggi, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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6
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Wilson TM, Solomon JJ, Humphries SM, Swigris JJ, Ahmed F, Wang H, Darrah E, Demoruelle MK. Serum antibodies to peptidylarginine deiminase-4 in rheumatoid arthritis associated-interstitial lung disease are associated with decreased lung fibrosis and improved survival. Am J Med Sci 2023; 365:480-487. [PMID: 36918112 PMCID: PMC10247162 DOI: 10.1016/j.amjms.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/29/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Interstitial lung disease (ILD) is a leading cause of mortality in rheumatoid arthritis (RA), particularly in those with the usual interstitial pneumonia subtype (RA-UIP). Serum antibodies to peptidylarginine deiminase type 4 (anti-PAD4), particularly a subset that cross-react with PAD3 (PAD3/4XR), have been associated with imaging evidence of ILD. We aimed to determine the specificity of anti-PAD4 antibodies in RA-ILD and to examine associations with markers of ILD severity. METHODS 48 RA-ILD and 31 idiopathic pulmonary fibrosis (IPF) patients were identified from the National Jewish Health Biobank. RA-ILD subtype was defined by imaging pattern on high-resolution chest computed tomography (CT), and serum was tested for anti-PAD4 and anti-PAD3/4XR antibodies. Antibody prevalence, measures of ILD severity (% predicted forced vital capacity, FVC; % predicted diffusion capacity carbon monoxide, DLCO; quantitative CT fibrosis) and mortality were compared between groups. RESULTS Anti-PAD4 antibodies were present in 9/48 (19%) subjects with RA-ILD and no subjects with IPF. Within RA-ILD, anti-PAD4 antibodies were found almost exclusively in RA-UIP (89%). Within RA-UIP subjects, % predicted FVC was higher in anti-PAD4+ subjects, and this finding was most strongly associated with anti-PAD3/4XR antibodies. In addition, quantitative CT fibrosis score was lower in anti-PAD4+ RA-UIP subjects, including those with mono-reactive anti-PAD4 antibodies and anti-PAD3/4XR antibodies. Anti-PAD4+ RA-UIP subjects also exhibited decreased mortality. CONCLUSIONS We demonstrate the presence of serum anti-PAD4 antibodies in a subset of patients with RA-UIP that were notably associated with better lung function, less fibrosis and decreased mortality.
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Affiliation(s)
- Timothy M Wilson
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Joshua J Solomon
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Stephen M Humphries
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Jeffrey J Swigris
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Faduma Ahmed
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Hong Wang
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Erika Darrah
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
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7
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Lin Q, Zhou B, Song X, Ye W, Li Q, Shi T, Cheng C, Li Y, Wei X. Genetic variant in SPAG16 is associated with the susceptibility of ACPA-positive rheumatoid arthritis possibly via regulation of MMP-3. J Orthop Surg Res 2022; 17:511. [PMID: 36434627 PMCID: PMC9701044 DOI: 10.1186/s13018-022-03405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES In two previously published genome-wide association studies, a cluster of variants of sperm-associated antigen16 (SPAG16) were reported to be associated with the radiological progression rate of ACPA-positive rheumatoid arthritis (RA) patients from North American and Southern European ancestry. In this study, we aimed to investigate whether the reported RA-risk loci in SPAG16 are associated with the disease in the Chinese population and to further validate the functional role of the susceptible locus in RA tissues. METHODS A total of 500 ACPA-positive RA patients and 1000 age-matched healthy subjects were recruited. Two SNPs of SPAG16, including rs7607479 (C/T) and rs6435818 (A/C), were genotyped, and the genotyping data were compared with chi-square test. Gene expression analysis was performed in synovial tissues obtained from 40 RA patients and 30 non-RA controls surgically treated for bone fracture. The tissue expression of SPAG16 and matrix metalloproteinase 3 (MMP-3) was compared between the two groups by the Student's t test. The relationship between serum indexes and mRNA expression of SPAG16 and MMP-3 were evaluated by Spearman's correlation analysis. RESULT For rs7607479, the frequency of genotype TT was significantly higher in RA patients than in the controls (49.0% vs. 40.4%, p = 0.002). The RA patients were found to have significantly lower frequency of allele C than the controls (30.9% vs. 36.8%, p = 0.001). As for rs6435818, there was no significant difference of genotype or allele frequency between the two groups. The mRNA expression of MMP-3 was 1.63-fold higher in the RA patients than in the controls (p < 0.001). The expression of SPAG16 was comparable between the two groups (p = 0.43). The mRNA expression of MMP-3 was 1.39-fold higher in patients with genotype TT than in the patients with genotype CC (p = 0.006). The mRNA expression level of MMP-3 was significantly correlated with serum rheumatoid factor (r = 0.498, p < 0.001) and C-reactive protein (r = 0.272, p = 0.01), weakly correlated with erythrocyte sedimentation rate (r = 0.236, p = 0.09). CONCLUSIONS We validated a common genetic risk factor in ACPA-positive patients with RA, which is associated with the tissue production of MMP-3 and disease progression. Further functional analysis into the role of rs7607479 in MMP-3 expression can shed new light on the genetic architecture of ACPA-positive RA.
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Affiliation(s)
- Qingxi Lin
- grid.41156.370000 0001 2314 964XDepartment of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, LinShan Road No. 188, Nanjing City, 210008 China
| | - Bingxiang Zhou
- grid.41156.370000 0001 2314 964XDepartment of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, LinShan Road No. 188, Nanjing City, 210008 China
| | - Xiaoxiao Song
- grid.41156.370000 0001 2314 964XDepartment of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, LinShan Road No. 188, Nanjing City, 210008 China
| | - Wei Ye
- grid.41156.370000 0001 2314 964XDepartment of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, LinShan Road No. 188, Nanjing City, 210008 China
| | - Qinglong Li
- grid.41156.370000 0001 2314 964XDepartment of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, LinShan Road No. 188, Nanjing City, 210008 China
| | - Tong Shi
- grid.41156.370000 0001 2314 964XDepartment of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, LinShan Road No. 188, Nanjing City, 210008 China
| | - Chen Cheng
- Department of Orthopaedic Surgery, The JiangYan TCM Hospital of Taizhou City, JiangYan Road No. 699, Taizhou City, 225500 China
| | - Yetian Li
- grid.412679.f0000 0004 1771 3402Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road No. 218, Hefei City, 230022 China
| | - Xing Wei
- grid.41156.370000 0001 2314 964XDepartment of Orthopedics, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, LinShan Road No. 188, Nanjing City, 210008 China
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Gómez-Bañuelos E, Shi J, Wang H, Danila MI, Bridges SL, Giles JT, Sims GP, Andrade F, Darrah E. Heavy Chain Constant Region Usage in Antibodies to Peptidylarginine Deiminase 4 as a Marker of Disease Subsets in Rheumatoid Arthritis. Arthritis Rheumatol 2022; 74:1746-1754. [PMID: 35675168 PMCID: PMC9617771 DOI: 10.1002/art.42262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/03/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study of autoantibody isotypes in autoimmune diseases is useful for identifying clinically relevant endotypes. This study was undertaken to study the prevalence and clinical significance of different isotypes and IgG subclasses of anti-peptidylarginine deiminase 4 (anti-PAD4) autoantibodies in individuals with rheumatoid arthritis (RA). METHODS In 196 RA subjects and 64 healthy controls, anti-PAD4 antibody types were determined using enzyme-linked immunosorbent assay. We investigated associations between anti-PAD4 antibodies and clinical outcomes, and relevant features were confirmed in an independent RA cohort. RESULTS Anti-PAD4 IgG1, anti-PAD4 IgG2, anti-PAD4 IgG3, anti-PAD4 IgG4, anti-PAD4 IgA, and anti-PAD4 IgE antibodies were more frequent in RA patients than healthy controls (P < 0.001). Anti-PAD4 IgG1, anti-PAD4 IgG3, and anti-PAD4 IgE were associated with distinct clinical features. Anti-PAD4 IgG1 was predictive of progressive radiographic joint damage (odds ratio [OR] 4.88, P = 0.005), especially in RA patients without baseline joint damage (40% versus 0%, P = 0.003) or in those negative for anti-cyclic citrullinated peptide and/or rheumatoid factor (OR 32; P = 0.009). IgG1 was also associated with higher levels of C-reactive protein (P = 0.006) and interleukin-6 (P = 0.021). RA patients with anti-PAD4 IgG3 had higher baseline joint damage scores (median Sharp/van der Heijde score 13 versus 7, P = 0.046), while those with anti-PAD4 IgE had higher Disease Activity Score in 28 joints (median 4.0 versus 3.5, P = 0.025), more frequent rheumatoid nodules (31% versus 16%, P = 0.025), and more frequent interstitial lung disease (ground-glass opacification) (24% versus 9%, P = 0.014). Anti-PAD4 IgG1 antibody associations with joint damage were corroborated in an independent RA cohort. CONCLUSION Anti-PAD4 IgG1, anti-PAD4 IgG3, and anti-PAD4 IgE antibodies identify discrete disease subsets in RA, suggesting that heavy chain usage drives distinct effector mechanisms of anti-PAD4 antibodies in RA.
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Affiliation(s)
- E Gómez-Bañuelos
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Shi
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Wang
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - MI Danila
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - SL Bridges
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - JT Giles
- Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - GP Sims
- Early Respiratory & Inflammation, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - F Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Darrah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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The lack of association between PADI4_94 or PADI4_104 polymorphisms and RF, ACPA and anti-PAD4 in patients with rheumatoid arthritis. Sci Rep 2022; 12:11882. [PMID: 35831381 PMCID: PMC9279283 DOI: 10.1038/s41598-022-15726-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that leads to chronic inflammation of synovial tissue, ultimately causing joint damage, disability, and premature mortality. The peptidylarginine deiminase (PAD) family of proteins is involved in the production of anticitrullinated peptide antibodies (ACPA), which are clinically relevant markers of RA. ACPA recognizes citrullinated proteins generated mainly by PAD4. Polymorphisms of the PADI4 gene have been associated with RA in Asian populations, but in Europeans these associations are still difficult to estimate. A total of 147 subjects, 122 patients with RA, 52 ± 12.3 aged, 84.4% women and 25 healthy controls, 53 ± 8.4 aged, 72% women were enrolled in the study. Two single nucleotide polymorphisms (SNPs) of the PADI4 gene (PADI4_94, rs2240340 and PADI4_104, rs1748033) were genotyped using a real-time polymerase chain reaction. Genetic models (co-dominant-1 and 2, dominant, over-dominant, and recessive) were applied to find the associations between genotypes and ACPA as well as PAD4 antibodies (anti-PAD4) levels. We found no relationship between the distribution of genotypes in different genetic models and the levels of anti-PAD4, ACPA and RF antibodies. There were also no differences with respect to the haplotypes. Genetic variants PADI4_94 and PADI4_104 may not be clinically relevant as prognostic factors in patients with established RA.
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Thirugnanasambandham I, Radhakrishnan A, Kuppusamy G, Kumar Singh S, Dua K. PEPTIDYLARGININE DEIMINASE-4: MEDICO-FORMULATIVE STRATEGY TOWARDS MANAGEMENT OF RHEUMATOID ARTHRITIS. Biochem Pharmacol 2022; 200:115040. [DOI: 10.1016/j.bcp.2022.115040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022]
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11
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Lamacchia C, Courvoisier DS, Jarlborg M, Bas S, Roux-Lombard P, Möller B, Ciurea A, Finckh A, Bentow C, Martinez-Prat L, Mahler M, Gabay C, Nissen MJ. Predictive value of anti-CarP and anti-PAD3 antibodies alone or in combination with RF and ACPA for the severity of rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:4598-4608. [PMID: 33502443 DOI: 10.1093/rheumatology/keab050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/14/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to analyse the predictive value of anti-carbamylated protein (anti-CarP) and anti-peptidyl-arginine deiminase type-3 (anti-PAD3) antibodies, alone or in combination with RF and ACPA, to identify patients at high risk of developing severe RA outcomes. METHODS Patients within the Swiss Clinical Quality Management registry with a biobank sample were tested for RF, ACPA, anti-CarP, and anti-PAD3 antibodies. We examined the association of each autoantibody with DAS28, HAQ and radiographic damage (Ratingen) at baseline and longitudinally. RESULTS Analyses included 851 established RA patients and 516 disease controls [axial spondyloarthritis (axSpA = 320) and PsA (196)]. Anti-CarP and anti-PAD3 antibodies were, respectively, present in 22.4% and 10.7% of the whole RA population, and in 13.2% and 3.8% of the RF and ACPA double seronegative patients. At baseline, RA patients with anti-PAD3 had higher DAS28 (4.2 vs 3.7; P= 0.005) and significantly more radiographic damage (14.9 vs 8.8; P= 0.02) than anti-PAD3-negative patients. In the ACPA-negative subgroup, baseline Ratingen scores were significantly higher in anti-PAD3-positive patients (P= 0.01). The combination of anti-PAD3, RF IgM, and ACPA was associated with significantly higher baseline radiographic scores than the double seropositive group (P= 0.04). The presence of any two of the previous autoantibodies was associated with significantly greater radiographic progression over 10 years than if all were absent (P= 0.02). There were no differences in RA outcome measures with regards to anti-CarP. CONCLUSIONS Anti-PAD3 antibodies are associated with higher disease activity and joint damage scores in RA patients.
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Affiliation(s)
| | | | | | | | | | - Burkhard Möller
- Department of Rheumatology, Immunology and Allergy, Bern University Hospital, Bern
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | | | - Chelsea Bentow
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | | | - Michael Mahler
- Research and Development, Inova Diagnostics, San Diego, CA, USA
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12
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Ptacek J, Hawtin RE, Sun D, Louie B, Evensen E, Mittleman BB, Cesano A, Cavet G, Bingham CO, Cofield SS, Curtis JR, Danila MI, Raman C, Furie RA, Genovese MC, Robinson WH, Levesque MC, Moreland LW, Nigrovic PA, Shadick NA, O’Dell JR, Thiele GM, Clair EWS, Striebich CC, Hale MB, Khalili H, Batliwalla F, Aranow C, Mackay M, Diamond B, Nolan GP, Gregersen PK, Bridges SL. Diminished cytokine-induced Jak/STAT signaling is associated with rheumatoid arthritis and disease activity. PLoS One 2021; 16:e0244187. [PMID: 33444321 PMCID: PMC7808603 DOI: 10.1371/journal.pone.0244187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/05/2020] [Indexed: 12/11/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic and incurable autoimmune disease characterized by chronic inflammation in synovial lining of joints. To identify the signaling pathways involved in RA, its disease activity, and treatment response, we adapted a systems immunology approach to simultaneously quantify 42 signaling nodes in 21 immune cell subsets (e.g., IFNα→p-STAT5 in B cells) in peripheral blood mononuclear cells (PBMC) from 194 patients with longstanding RA (including 98 patients before and after treatment), and 41 healthy controls (HC). We found multiple differences between patients with RA compared to HC, predominantly in cytokine-induced Jak/STAT signaling in many immune cell subsets, suggesting pathways that may be associated with susceptibility to RA. We also found that high RA disease activity, compared to low disease activity, was associated with decreased (e.g., IFNα→p-STAT5, IL-10→p-STAT1) or increased (e.g., IL-6→STAT3) response to stimuli in multiple cell subsets. Finally, we compared signaling in patients with established, refractory RA before and six months after initiation of methotrexate (MTX) or TNF inhibitors (TNFi). We noted significant changes from pre-treatment to post-treatment in IFNα→p-STAT5 signaling and IL-10→p-STAT1 signaling in multiple cell subsets; these changes brought the aberrant RA signaling profiles toward those of HC. This large, comprehensive functional signaling pathway study provides novel insights into the pathogenesis of RA and shows the potential of quantification of cytokine-induced signaling as a biomarker of disease activity or treatment response.
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Affiliation(s)
- Jason Ptacek
- Nodality, Inc., South San Francisco, California, United States of America
| | - Rachael E. Hawtin
- Nodality, Inc., South San Francisco, California, United States of America
| | - Dongmei Sun
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Brent Louie
- Nodality, Inc., South San Francisco, California, United States of America
| | - Erik Evensen
- Nodality, Inc., South San Francisco, California, United States of America
| | | | - Alessandra Cesano
- Nodality, Inc., South San Francisco, California, United States of America
| | - Guy Cavet
- Nodality, Inc., South San Francisco, California, United States of America
| | - Clifton O. Bingham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Stacey S. Cofield
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Jeffrey R. Curtis
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Maria I. Danila
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Chander Raman
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Richard A. Furie
- The Feinstein Institute for Medical Research and Northwell Health, Manhasset, New York, United States of America
| | - Mark C. Genovese
- Stanford University School of Medicine, Stanford, California, United States of America
| | - William H. Robinson
- Stanford University School of Medicine, Stanford, California, United States of America
| | | | - Larry W. Moreland
- University of Colorado Anschutz Medical Campus, Boulder, Colorado, United States of America
| | - Peter A. Nigrovic
- Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - Nancy A. Shadick
- Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - James R. O’Dell
- University of Nebraska Medical Center, Lincoln, Nebraska, United States of America
| | - Geoffrey M. Thiele
- University of Nebraska Medical Center, Lincoln, Nebraska, United States of America
| | - E. William St Clair
- Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Matthew B. Hale
- Stanford University School of Medicine, Stanford, California, United States of America
| | - Houman Khalili
- The Feinstein Institute for Medical Research and Northwell Health, Manhasset, New York, United States of America
| | - Franak Batliwalla
- The Feinstein Institute for Medical Research and Northwell Health, Manhasset, New York, United States of America
| | - Cynthia Aranow
- The Feinstein Institute for Medical Research and Northwell Health, Manhasset, New York, United States of America
| | - Meggan Mackay
- The Feinstein Institute for Medical Research and Northwell Health, Manhasset, New York, United States of America
| | - Betty Diamond
- The Feinstein Institute for Medical Research and Northwell Health, Manhasset, New York, United States of America
| | - Garry P. Nolan
- Nodality, Inc., South San Francisco, California, United States of America
| | - Peter K. Gregersen
- The Feinstein Institute for Medical Research and Northwell Health, Manhasset, New York, United States of America
| | - S. Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
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13
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Kalyanaraman B. Do free radical NETwork and oxidative stress disparities in African Americans enhance their vulnerability to SARS-CoV-2 infection and COVID-19 severity? Redox Biol 2020; 37:101721. [PMID: 32961440 PMCID: PMC7490257 DOI: 10.1016/j.redox.2020.101721] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023] Open
Abstract
This review focuses on the hypothetical mechanisms for enhanced vulnerability of African Americans to SARS-CoV-2 infection, COVID-19 severity, and increased deaths. A disproportionately higher number of African Americans are afflicted with autoimmune and inflammatory diseases (e.g., diabetes, hypertension, obesity), and SARS-CoV-2 has helped expose these health disparities. Several factors including socioeconomic status, inferior health care, and work circumstances contribute to these disparities. Identifying potential inflammatory biomarkers and decreasing basal levels in high-risk individuals with comorbidities through preventive measures is critical. Immune cells, particularly neutrophils, protect us against pathogens (bacteria, fungi, and viruses) through increased generation of free radicals or oxidants and neutrophil extracellular traps (NETs) that ensnare pathogens, killing them extracellularly. However, continued generation of NETs coupled with the lack of prompt removal pose danger to host cells. NET levels are increased during pro-inflammatory diseases. COVID-19 patients exhibit elevated NET levels, depending upon disease severity. Conceivably, high-risk individuals with elevated basal NET levels would exhibit hyper-inflammation when infected with SARS-CoV-2, amplifying disease severity and deaths. Drugs inhibiting oxidant formation and vitamin supplements decreased NET formation in mice models of inflammation. Thus, it is conceivable that preventive treatments lowering NET levels and inflammation in high-risk individuals could mitigate SARS-CoV-2-induced complications and decrease mortality.
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Affiliation(s)
- Balaraman Kalyanaraman
- Department of Biophysics, Free Radical Research Center, Center for Disease Prevention Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA.
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14
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Kolarz B, Ciesla M, Dryglewska M, Majdan M. Peptidyl Arginine Deiminase Type 4 Gene Promoter Hypo-Methylation in Rheumatoid Arthritis. J Clin Med 2020; 9:jcm9072049. [PMID: 32629762 PMCID: PMC7408948 DOI: 10.3390/jcm9072049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 11/21/2022] Open
Abstract
Protein citrullination is carried out by peptidylarginine deiminase type 4 (PAD4) enzyme. As a consequence of this process, post-translationally modified proteins are formed that become antigens for anti-citrullinated protein antibodies (ACPA). The study aimed at identifying whether the PADI4 gene is subject to epigenetic regulation through methylation of its promoter region, whether the degree of methylation differs in healthy individuals vs. rheumatoid arthritis (RA) patients and changes in correlation with ACPA, anti-PAD4 and disease activity. A total of 125 RA patients and 30 healthy controls were enrolled. Quantitative real-time methylation-specific PCR was used to analyze the methylation status. ACPA and anti-PAD4 antibodies were determined in serum by enzyme-linked immunosorbent immunoassay. The differences were observed in the degree of PADI4 gene promoter methylation between RA patients and HC, along with an upward trend for the methylation in RA, which was inversely proportional to the disease activity. A weak or modest negative correlation between the degree of PADI4 gene methylation and anti-PAD4, disease activity score (DAS28) and ACPA level has been found. The elevated methylation is associated with lower disease activity, lower levels of ACPA and aPAD4. The methylation degree in this area is growing up during effective treatment and might play a role in the RA pathophysiology and therefore could be a future therapeutic target.
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Affiliation(s)
- Bogdan Kolarz
- College of Medical Sciences, University of Rzeszow, al. Kopisto 2A/24, 35-359 Rzeszow, Poland;
- Correspondence: ; Tel.: +48-501-549-606
| | - Marek Ciesla
- College of Medical Sciences, University of Rzeszow, al. Kopisto 2A/24, 35-359 Rzeszow, Poland;
| | - Magdalena Dryglewska
- Department of Rheumatology and Connective Tissue Disease, Medical University of Lublin, al. Raclawickie 1, 20-059 Lublin, Poland; (M.D.); (M.M.)
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Disease, Medical University of Lublin, al. Raclawickie 1, 20-059 Lublin, Poland; (M.D.); (M.M.)
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15
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Curran AM, Naik P, Giles JT, Darrah E. PAD enzymes in rheumatoid arthritis: pathogenic effectors and autoimmune targets. Nat Rev Rheumatol 2020; 16:301-315. [PMID: 32341463 DOI: 10.1038/s41584-020-0409-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/11/2022]
Abstract
Peptidylarginine deiminases (PADs) have an important role in the pathogenesis of rheumatoid arthritis (RA) owing to their ability to generate citrullinated proteins - the hallmark autoantigens of RA. Of the five PAD enzyme isoforms, PAD2 and PAD4 are the most strongly implicated in RA at both genetic and cellular levels, and PAD inhibitors have shown therapeutic efficacy in mouse models of inflammatory arthritis. PAD2 and PAD4 are additionally targeted by autoantibodies in distinct clinical subsets of patients with RA, suggesting anti-PAD antibodies as possible biomarkers for RA diagnosis and prognosis. This Review weighs the evidence that supports a pathogenic role for PAD enzymes in RA as both promoters and targets of the autoimmune response, as well as discussing the mechanistic and therapeutic implications of these findings in the wider context of RA pathogenesis. Understanding the origin and consequences of dysregulated PAD enzyme activity and immune responses against PAD enzymes will be important to fully comprehend the pathogenic mechanisms involved in this disease and for the development of novel strategies to treat and prevent RA.
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Affiliation(s)
- Ashley M Curran
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pooja Naik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jon T Giles
- Division of Rheumatology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Erika Darrah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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16
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Mahler M, Martinez-Prat L, Sparks JA, Deane KD. Precision medicine in the care of rheumatoid arthritis: Focus on prediction and prevention of future clinically-apparent disease. Autoimmun Rev 2020; 19:102506. [PMID: 32173516 DOI: 10.1016/j.autrev.2020.102506] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
There is an emerging understanding that an individual's risk for future rheumatoid arthritis (RA) can be determined using a combination of factors while they are still in a state where clinically-apparent inflammatory arthritis (IA) is not yet present. Indeed, this concept has underpinned several completed and ongoing prevention trials in RA. Importantly, risk factors can be divided into modifiable (e.g. smoking, exercise, dental care and diet) and non-modifiable factors (e.g. genetics, sex, age). In addition, there are now several biomarkers including autoantibodies, inflammatory markers and imaging techniques that are highly predictive of future clinically-apparent IA/RA. Although none of the prevention studies have yet provided major breakthroughs, several of them have provided valuable insights that can help to improve the design of future clinical trials and enable RA prevention. In aggregate, these findings suggest that the most accurate disease prediction models will require the combination of demographic and clinical information, biomarkers and potentially medical imaging data to identify individuals for intervention. This review summarizes some of the key aspects around precision medicine in RA with special focus on disease prediction and prevention.
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Affiliation(s)
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin D Deane
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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17
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Fert-Bober J, Darrah E, Andrade F. Insights into the study and origin of the citrullinome in rheumatoid arthritis. Immunol Rev 2019; 294:133-147. [PMID: 31876028 DOI: 10.1111/imr.12834] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/08/2019] [Indexed: 12/11/2022]
Abstract
The presence of autoantibodies and autoreactive T cells to citrullinated proteins and citrullinating enzymes in patients with rheumatoid arthritis (RA), together with the accumulation of citrullinated proteins in rheumatoid joints, provides substantial evidence that dysregulated citrullination is a hallmark feature of RA. However, understanding mechanisms that dysregulate citrullination in RA has important challenges. Citrullination is a normal process in immune and non-immune cells, which is likely activated by different conditions (eg, inflammation) with no pathogenic consequences. In a complex inflammatory environment such as the RA joint, unique strategies are therefore required to dissect specific mechanisms involved in the abnormal production of citrullinated proteins. Here, we will review current models of citrullination in RA and discuss critical components that, in our view, are relevant to understanding the accumulation of citrullinated proteins in the RA joint, collectively referred to as the RA citrullinome. In particular, we will focus on potential caveats in the study of citrullination in RA and will highlight methods to precisely detect citrullinated proteins in complex biological samples, which is a confirmatory approach to mechanistically link the RA citrullinome with unique pathogenic pathways in RA.
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Affiliation(s)
- Justyna Fert-Bober
- The Smidt Heart Institute, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Erika Darrah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Felipe Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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18
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Martinez-Prat L, Palterer B, Vitiello G, Parronchi P, Robinson WH, Mahler M. Autoantibodies to protein-arginine deiminase (PAD) 4 in rheumatoid arthritis: immunological and clinical significance, and potential for precision medicine. Expert Rev Clin Immunol 2019; 15:1073-1087. [DOI: 10.1080/1744666x.2020.1668778] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Laura Martinez-Prat
- Research and Development, Inova Diagnostics, San Diego, CA, USA
- Department of Experimental Science, Francisco de Vitoria University, Madrid, Spain
| | - Boaz Palterer
- specialist in Allergy and Clinical Immunology, Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
| | - Gianfranco Vitiello
- resident in Allergy and Clinical Immunology, Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
| | - Paola Parronchi
- (Allergy and Clinical Immunology), Laboratory Head, Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
| | - William H. Robinson
- (Immunology and Rheumatology), Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
- Geriatric Research Education and Clinical [GRECC] Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Michael Mahler
- Research and Development, Inova Diagnostics, San Diego, CA, USA
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19
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Jonsson MK, Kantyka T, Falkowski K, Aliko A, Aga AB, Lillegraven S, Sexton J, Fevang BT, Mydel P, Haavardsholm EA. Peptidylarginine deiminase 4 (PAD4) activity in early rheumatoid arthritis. Scand J Rheumatol 2019; 49:87-95. [PMID: 31544586 DOI: 10.1080/03009742.2019.1641216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Peptidylarginine deiminases (PADs) are a family of calcium-dependent enzymes catalysing the conversion of arginine residues to citrulline, which may constitute a risk factor in rheumatoid arthritis (RA) pathogenesis. We investigated PAD activation by serum (PADAct) in early RA, and the associations between PAD activation and disease characteristics, treatment response, and progression of radiographic damage.Method: Sera from disease-modifying anti-rheumatic drug (DMARD)-naïve early RA patients (n = 225), classified according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and healthy controls (n = 63) were analysed for PAD4 activating capacity at 0, 3, 12, and 24 months using a high-performance liquid chromatography fluorometric method. Associations for PADAct were evaluated by Mann-Whitney U and chi-squared tests. Changes in PADAct levels were compared using the Wilcoxon signed-rank test.Results: PADAct positivity occurred in 42% (n = 95) of the patients and was more prevalent in anti-citrullinated protein antibody (ACPA)-positive vs ACPA-negative patients (47% vs 20%, p = 0.002), but not in rheumatoid factor (RF)-positive vs RF-negative patients (44% vs 38%, p = 0.49). PADAct-positive were younger than PADAct-negative patients [mean ± sd 48.7 ± 13.5 vs 53.2 ± 13.7 years, p = 0.011]. Median [25th, 75th percentile] PADAct levels were higher in patients than in controls (8768 [7491, 11 393] vs 7046 [6347, 7906], p < 0.0001) and decreased after initiation of DMARD treatment, but were not associated with treatment response or progression of radiographic damage after 2 years of follow-up.Conclusion: Serum capacity to activate PAD4 was associated with ACPA and RF positivity and earlier disease onset in early RA patients, and decreased after initiation of DMARD treatment, indicating that anti-PAD treatment could potentially be beneficial in RA.
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Affiliation(s)
- M K Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - T Kantyka
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Malopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland
| | - K Falkowski
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - A Aliko
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - A B Aga
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - S Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - B T Fevang
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - P Mydel
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - E A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
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20
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Yadav R, Yoo DG, Kahlenberg JM, Bridges SL, Oni O, Huang H, Stecenko A, Rada B. Systemic levels of anti-PAD4 autoantibodies correlate with airway obstruction in cystic fibrosis. J Cyst Fibros 2019; 18:636-645. [PMID: 30638826 PMCID: PMC6620172 DOI: 10.1016/j.jcf.2018.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/15/2022]
Abstract
Cystic fibrosis (CF) airway disease is characterized by the long-term presence of neutrophil granulocytes. Formation of neutrophil extracellular traps (NETs) and/or autoantibodies directed against extracellular components of NETs are possible contributors to neutrophil-mediated lung damage in CF. The goal of this study was to measure their levels in CF adults compared to healthy controls and subjects with rheumatologic diseases known to develop NET-related autoantibodies and pathologies, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Sera were analyzed from the following number of subjects: 37 CF, 23 healthy controls (HC), 20 RA, and 21 SLE. CF had elevated serum myeloperoxidase (MPO) concentrations (347.5±56.1 ng/ml, mean+/-S.E.M., p = .0132) compared to HC (144.5±14.6 ng/ml) but not of neutrophil elastase (NE) complexed with alpha-1-antitrypsin, cell-free DNA or NE-DNA complexes. The peptidylarginine deiminase 4 (PAD4) enzyme is required for NET formation and associated DNA release in neutrophils. Serum levels of anti-PAD4 antibodies (Ab) were elevated in CF (p = .0147) compared to HC and showed an inverse correlation with a measure of lung function, FEV1% predicted (r = -0.5020, p = .015), as did MPO levels (r = -0.4801, p = .0026). Anti-PAD4 Ab levels in CF sera associated with lung infection by P. aeruginosa, but not that by S. aureus, age, sex, CF-related diabetes or the presence of musculoskeletal pain. Serum levels of anti-citrullinated protein Abs (ACPAs) and anti-nucleosome Abs were not elevated in CF compared to HC (p = .7498, p = .0678). In summary, adult CF subjects develop an autoimmune response against NET components that correlates with worsening lung disease.
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Affiliation(s)
- Ruchi Yadav
- Department of Infectious Diseases, College of Veterinary Medicine, The University of Georgia, Athens, GA, USA
| | - Dae-Goon Yoo
- Department of Infectious Diseases, College of Veterinary Medicine, The University of Georgia, Athens, GA, USA
| | - J Michelle Kahlenberg
- Division of Rheumatology, University of Michigan, School of Medicine, Ann Arbor, MI, USA
| | - S Louis Bridges
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Oluwadamilola Oni
- Department of Infectious Diseases, College of Veterinary Medicine, The University of Georgia, Athens, GA, USA
| | - Hanwen Huang
- Department of Epidemiology & Biostatistics, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Arlene Stecenko
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Balázs Rada
- Department of Infectious Diseases, College of Veterinary Medicine, The University of Georgia, Athens, GA, USA.
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21
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Darrah E, Yu F, Cappelli LC, Rosen A, O'Dell JR, Mikuls TR. Association of Baseline Peptidylarginine Deiminase 4 Autoantibodies With Favorable Response to Treatment Escalation in Rheumatoid Arthritis. Arthritis Rheumatol 2019; 71:696-702. [PMID: 30507066 DOI: 10.1002/art.40791] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/27/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine if the baseline presence of autoantibodies to peptidylarginine deiminase 4 (PAD4) predicts therapeutic response to biologic and conventional disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) in whom methotrexate (MTX) monotherapy was unsuccessful. METHODS Baseline serum from 282 RA patients in whom MTX monotherapy was unsuccessful was screened for the presence of anti-PAD4 antibodies by immunoprecipitation. Clinical response to either triple DMARD (MTX, sulfasalazine, and hydroxychloroquine) or MTX/etanercept combination therapy was determined at 24 and 48 weeks post-treatment initiation. Disease activity was measured using the Disease Activity Score 28-joint assessment (DAS28), and erosive disease was quantified using the Sharp/van der Heijde scoring method. Generalized estimating equations (GEEs) were used to model the clinical responses to treatment in patients with and those without baseline anti-PAD4 antibodies. RESULTS Anti-PAD4 antibody positivity was associated with male sex, a history of never smoking, and anti-citrullinated protein antibodies. At baseline, patients with anti-PAD4 antibodies had longer disease duration and significantly more radiographic joint damage than anti-PAD4-negative patients, but did not differ in disease activity according to the DAS28. In unadjusted analyses and multivariable GEE models, patients with anti-PAD4 antibodies exhibited greater improvements in DAS28 (adjusted P = 0.02 and P = 0.008, respectively) and less radiographic progression (adjusted P = 0.01 and P = 0.002, respectively) compared to anti-PAD antibody-negative patients, independent of treatment received. CONCLUSION Although anti-PAD4 antibodies were associated with worse baseline radiographic joint damage, suggesting a history of active or undiagnosed disease, treatment escalation therapy was more effective in reducing disease activity and slowing the progression of joint damage in this patient subset.
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Affiliation(s)
- Erika Darrah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fang Yu
- University of Nebraska Medical Center, Omaha
| | - Laura C Cappelli
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antony Rosen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James R O'Dell
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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22
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Chang MH, Nigrovic PA. Antibody-dependent and -independent mechanisms of inflammatory arthritis. JCI Insight 2019; 4:125278. [PMID: 30843881 DOI: 10.1172/jci.insight.125278] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Inflammatory arthritis encompasses a set of common diseases characterized by immune-mediated attack on joint tissues. Most but not all affected patients manifest circulating autoantibodies. Decades of study in human and animal arthritis have identified key roles for autoantibodies in immune complexes and through direct modulation of articular biology. However, joint inflammation can arise because of pathogenic T cells and other pathways that are antibody-independent. Here we review the evidence for these parallel tracks, in animal models and in humans, to explore the range of mechanisms engaged in the pathophysiology of arthritis and to highlight opportunities for targeted therapeutic intervention.
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Affiliation(s)
- Margaret H Chang
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter A Nigrovic
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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23
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DARRAH ERIKA, MARTINEZ-PRAT LAURA, MAHLER MICHAEL. Clinical Utility of Antipeptidyl Arginine Deiminase Type 4 Antibodies. J Rheumatol 2019; 46:329-330. [DOI: 10.3899/jrheum.180905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Darrah E, Giles JT, Davis RL, Naik P, Wang H, Konig MF, Cappelli LC, Bingham CO, Danoff SK, Andrade F. Autoantibodies to Peptidylarginine Deiminase 2 Are Associated With Less Severe Disease in Rheumatoid Arthritis. Front Immunol 2018; 9:2696. [PMID: 30515171 PMCID: PMC6255931 DOI: 10.3389/fimmu.2018.02696] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/31/2018] [Indexed: 12/22/2022] Open
Abstract
Objective: Peptidylarginine deiminases (PAD) 2 and 4 are key enzymes in rheumatoid arthritis (RA) pathogenesis due to their ability to generate the protein targets of anti-citrullinated protein antibodies (ACPA). Anti-PAD4 antibodies that cross-react with PAD3 (anti-PAD3/4) have been identified and are associated with severe joint and lung disease. Here, we examined whether anti-PAD2 antibodies were present in patients with RA and defined their clinical significance. Patients and Methods: A PAD2 ELISA was established to screen for anti-PAD2 IgG in sera from RA patients from a prospective observational cohort study (n = 184) and healthy controls (n = 100). RA patient characteristics were compared according to anti-PAD2 antibody status. Multivariable models were constructed to explore the independent associations of anti-PAD2 antibodies with clinical variables. Results: Anti-PAD2 antibodies were found in 18.5% of RA patients and 3% of healthy controls (p < 0.001). Among RA patients, anti-PAD2 antibodies were not associated with traditional genetic or serologic RA risk factors, including HLA-DRβ1 shared epitope alleles, ACPA, rheumatoid factor (RF), or anti-PAD3/4 antibodies. In addition, antibodies to PAD2 were associated with fewer swollen joints, a lower prevalence of interstitial lung disease, and less progression of joint damage. In subset analyses in which patients were stratified by the baseline presence of ACPA/RF or anti-PAD3/4 antibodies, anti-PAD2 antibodies provided additional value in identifying patients with the least progressive joint disease. Conclusions: Anti-PAD2 antibodies represent a novel serologic marker in RA that identifies a genetically and clinically unique subset of patients with less severe joint and lung disease.
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Affiliation(s)
- Erika Darrah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jon T Giles
- Division of Rheumatology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Ryan L Davis
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pooja Naik
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hong Wang
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Maximilian F Konig
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Laura C Cappelli
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Clifton O Bingham
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Felipe Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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25
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Guderud K, Mæhlen MT, Nordang GBN, Viken MK, Andreassen BK, Molberg Ø, Flåm ST, Lie BA. Lack of Association among Peptidyl Arginine Deiminase Type 4 Autoantibodies, PADI4 Polymorphisms, and Clinical Characteristics in Rheumatoid Arthritis. J Rheumatol 2018; 45:1211-1219. [PMID: 29858238 DOI: 10.3899/jrheum.170769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to jointly investigate the role of antipeptidyl arginine deiminase type 4 antibodies (anti-PAD4) and polymorphisms in the PADI4 gene together with clinical variables in rheumatoid arthritis (RA). METHODS Serum IgG autoantibodies to human recombinant PAD4 were identified by DELFIA technique in 745 patients with RA (366 available from previous studies). Genotyping of PADI4 was performed using TaqMan assays in 945 patients and 1118 controls. Clinical data, anticitrullinated protein antibodies (ACPA) status, shared epitope status, and a combined genetic risk score were also available. RESULTS Anti-PAD4 antibodies were detected in 193 (26%) of 745 patients with RA; 149 (77%) of these were also ACPA-positive. No association was observed between anti-PAD4 status and clinical characteristics, PADI4 polymorphisms, or genetic risk scores after stratification for ACPA status. CONCLUSION Taken together, the results from these combined serological, genetic, and clinical analyses suggest that anti-PAD4 appears to be a bystander autoantibody with no current clinical utility in RA.
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Affiliation(s)
- Kari Guderud
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Marthe Thoresen Mæhlen
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Gry Beate Namløs Nordang
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Marte Kathrine Viken
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Bettina Kulle Andreassen
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Øyvind Molberg
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Siri Tennebø Flåm
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway.,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre
| | - Benedicte Alexandra Lie
- From the Department of Medical Genetics, and the Department of Immunology, University of Oslo and Oslo University Hospital; K.G. Jebsen Inflammation Research Centre, University of Oslo; Department of Rheumatology, Oslo University Hospital; Department of Rheumatology, Diakonhjemmet Hospital; Department of Research, Cancer Registry of Norway, Institute for Population-based Research, Oslo, Norway. .,K. Guderud, M Pharm, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; M.T. Mæhlen, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital, and Department of Rheumatology, Diakonhjemmet Hospital; G.B. Nordang, PhD, Department of Medical Genetics, University of Oslo and Oslo University Hospital; M.K. Viken, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre; B.K. Andreassen, PhD, Department of Research, Cancer Registry of Norway, Institute for Population-Based Research; Ø. Molberg, PhD, Department of Rheumatology, Oslo University Hospital; S.T. Flåm, BS, Department of Medical Genetics, and the K.G. Jebsen Inflammation Research Centre, University of Oslo and Oslo University Hospital; B.A. Lie, PhD, Department of Medical Genetics, and Department of Immunology, University of Oslo and Oslo University Hospital, and K.G. Jebsen Inflammation Research Centre.
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Cappelli LC, Konig MF, Gelber AC, Bingham CO, Darrah E. Smoking is not linked to the development of anti-peptidylarginine deiminase 4 autoantibodies in rheumatoid arthritis. Arthritis Res Ther 2018; 20:59. [PMID: 29566742 PMCID: PMC5865363 DOI: 10.1186/s13075-018-1533-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
Background Defining environmental factors responsible for development of autoimmunity in rheumatoid arthritis (RA) is critical for understanding mechanisms of disease initiation and propagation. Notably, a history of cigarette smoking has been implicated in the genesis of RA and is associated with worse disease outcomes. Antibodies to peptidylarginine deiminase 4 (PAD4) are also associated with more severe RA. A subset of patients who have PAD4 autoantibodies that cross-react with PAD3 (anti-PAD3/4) are at the highest risk for interstitial lung disease, and this risk is augmented by a history of cigarette smoking. It is unclear, however, if smoking is etiologically linked to the development of anti-PAD4 antibodies. Methods Patients were included in this study if they had physician-diagnosed RA as well as DNA, serum, and a date-matched clinical assessment (n = 274). Anti-PAD4 and anti-CCP antibodies were measured by immunoprecipitation and ELISA, respectively; shared epitope (SE) status was determined by HLA-DRβ1 genotyping. Logistic regression analysis was used to evaluate associations of smoking with PAD4 antibodies, with adjustment for relevant demographic and clinical features. Stratified analyses by disease duration and shared epitope status were also performed. Results Anti-PAD4 antibodies were present in 25% of RA patients, with 50% of these individuals having anti-PAD3/4 cross-reactive antibodies. Anti-PAD4 antibodies were significantly associated with a longer disease duration, SE alleles, and anti-CCP antibodies. Importantly, there were no significant differences in smoking history between anti-PAD4 positive and negative groups in univariate analyses, stratified analyses, or multivariable models. However, an inverse relationship between smoking and anti-PAD4 antibodies was suggested by a lower prevalence of current smokers among patients with anti-PAD3/4 antibodies compared to antibody negative individuals (p = 0.04). Further, the lowest levels of anti-PAD4 antibodies were observed in current smokers (p = 0.14), and a significant association of SE and anti-PAD4 antibodies was only present among never smokers (p = 0.01). Conclusions Smoking history was not associated with anti-PAD4 antibodies in patients with RA. The finding that anti-PAD4 antibodies were not associated with smoking suggests that other environmental factors may contribute to the development of autoimmunity to PAD4 in these patients.
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Affiliation(s)
- Laura C Cappelli
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Maximilian F Konig
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Allan C Gelber
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Clifton O Bingham
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA
| | - Erika Darrah
- Division of Rheumatology, The Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA.
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27
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Clinical and immunological aspects of anti-peptidylarginine deiminase type 4 (anti-PAD4) autoantibodies in rheumatoid arthritis. Autoimmun Rev 2018; 17:94-102. [DOI: 10.1016/j.autrev.2017.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022]
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28
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Kriebel K, Hieke C, Müller-Hilke B, Nakata M, Kreikemeyer B. Oral Biofilms from Symbiotic to Pathogenic Interactions and Associated Disease -Connection of Periodontitis and Rheumatic Arthritis by Peptidylarginine Deiminase. Front Microbiol 2018; 9:53. [PMID: 29441048 PMCID: PMC5797574 DOI: 10.3389/fmicb.2018.00053] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022] Open
Abstract
A wide range of bacterial species are harbored in the oral cavity, with the resulting complex network of interactions between the microbiome and host contributing to physiological as well as pathological conditions at both local and systemic levels. Bacterial communities inhabit the oral cavity as primary niches in a symbiotic manner and form dental biofilm in a stepwise process. However, excessive formation of biofilm in combination with a corresponding deregulated immune response leads to intra-oral diseases, such as dental caries, gingivitis, and periodontitis. Moreover, oral commensal bacteria, which are classified as so-called “pathobionts” according to a now widely accepted terminology, were recently shown to be present in extra-oral lesions with distinct bacterial species found to be involved in the onset of various pathophysiological conditions, including cancer, atherosclerosis, chronic infective endocarditis, and rheumatoid arthritis. The present review focuses on oral pathobionts as commensal and healthy members of oral biofilms that can turn into initiators of disease. We will shed light on the processes involved in dental biofilm formation and also provide an overview of the interactions of P. gingivalis, as one of the most prominent oral pathobionts, with host cells, including epithelial cells, phagocytes, and dental stem cells present in dental tissues. Notably, a previously unknown interaction of P. gingivalis bacteria with human stem cells that has impact on human immune response is discussed. In addition to this very specific interaction, the present review summarizes current knowledge regarding the immunomodulatory effect of P. gingivalis and other oral pathobionts, members of the oral microbiome, that pave the way for systemic and chronic diseases, thereby showing a link between periodontitis and rheumatoid arthritis.
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Affiliation(s)
- Katja Kriebel
- Institute of Medical Microbiology, Virology and Hygiene, University of Rostock, Rostock, Germany
| | - Cathleen Hieke
- Institute of Medical Microbiology, Virology and Hygiene, University of Rostock, Rostock, Germany
| | | | - Masanobu Nakata
- Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, Suita-Osaka, Japan
| | - Bernd Kreikemeyer
- Institute of Medical Microbiology, Virology and Hygiene, University of Rostock, Rostock, Germany
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29
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Abstract
PURPOSE OF REVIEW Dysregulated citrullination is a key element that drives the production and maintenance of antibodies to citrullinated proteins, a hallmark in rheumatoid arthritis (RA). This article reviews recent literature on the origin of citrullinated antigens in RA. RECENT FINDINGS The study of synovial fluid from patients with RA has provided important insights into the identity of citrullinated proteins that accumulate in the RA joint (the RA citrullinome) and mechanisms that control their generation. SUMMARY Citrullinating enzymes (peptidylarginine deiminases, PADs) are tightly controlled to limit their hyperactivation. Calcium and redox conditions are important regulators of PAD activity. Studies suggest that citrullination is dysregulated both intra- and extracellularly in RA. In neutrophils, host (i.e., perforin and the membrane attack complex) and bacterial (i.e., toxins) pore-forming proteins induce prominent calcium influx, cytolysis, and hyperactivation of PADs. These factors likely drive hypercitrullination in the RA joint and at extraarticular sites of disease initiation, respectively. As oxidizing conditions present in the extracellular environment are known to inactivate PADs, extracellular citrullination in RA probably requires the constant release of active enzymes from dying cells and may be accelerated by autoantibodies that activate PADs.
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Affiliation(s)
- Erika Darrah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Felipe Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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30
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Dahan S, Segal Y, Watad A, Azrielant S, Shemer A, Maymon D, Stroev YI, Sobolevskaya PA, Korneva EA, Blank M, Gilburd B, Shovman O, Amital H, Ehrenfeld M, Tanay A, Kivity S, Pras E, Chapman J, Damoiseaux J, Cervera R, Putterman C, Shapiro I, Mouthon L, Perricone R, Bizzaro N, Koren O, Riemekasten G, Chereshnev VA, Mazurov VI, Goloviznin M, Gurevich V, Churilov LP, Shoenfeld Y. Novelties in the field of autoimmunity – 1st Saint Petersburg congress of autoimmunity, the bridge between east and west. Autoimmun Rev 2017; 16:1175-1184. [DOI: 10.1016/j.autrev.2017.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 12/16/2022]
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31
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Shi J, Darrah E, Sims GP, Mustelin T, Sampson K, Konig MF, Bingham CO, Rosen A, Andrade F. Affinity maturation shapes the function of agonistic antibodies to peptidylarginine deiminase type 4 in rheumatoid arthritis. Ann Rheum Dis 2017; 77:141-148. [PMID: 29070531 DOI: 10.1136/annrheumdis-2017-211489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The citrullinating enzyme peptidylarginine deiminase type 4 (PAD4) is the target of a polyclonal group of autoantibodies in patients with rheumatoid arthritis (RA). A subgroup of such antibodies, initially identified by cross-reactivity with peptidylarginine deiminase type 3 (PAD3), is strongly associated with progression of radiographic joint damage and interstitial lung disease and has the unique ability to activate PAD4. The features of these antibodies in terms of their T cell-dependent origin, genetic characteristics and effect of individual antibody specificities on PAD4 function remain to be defined. METHODS We used PAD4 tagged with the monomeric fluorescent protein mWasabi to isolate PAD4-specific memory B cells from anti-PAD4 positive patients with RA and applied single cell cloning technologies to obtain monoclonal antibodies. RESULTS Among 44 single B cells, we cloned five antibodies with PAD4-activating properties. Sequence analysis, germline reversion experiments and antigen specificity assays suggested that autoantibodies to PAD4 are not polyreactive and arise from PAD4-reactive precursors. Somatic mutations increase the agonistic activity of these antibodies at low calcium concentrations by facilitating their interaction with structural epitopes that modulate calcium-binding site 5 in PAD4. CONCLUSIONS PAD4-activating antibodies directly amplify a key process in disease pathogenesis, making them unique among other autoantibodies in RA. Understanding the molecular basis for their functionality may inform the design of future PAD4 inhibitors.
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Affiliation(s)
- Jing Shi
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erika Darrah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary P Sims
- Respiratory, Inflammation, and Autoimmunity, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Tomas Mustelin
- Respiratory, Inflammation, and Autoimmunity, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Kevon Sampson
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maximilian F Konig
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clifton O Bingham
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Antony Rosen
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Felipe Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Meta-analysis: diagnostic accuracy of antibody against peptidylarginine deiminase 4 by ELISA for rheumatoid arthritis. Clin Rheumatol 2017; 36:2431-2438. [DOI: 10.1007/s10067-017-3809-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/21/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022]
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