Abstract

Anti-citrullinated protein antibodies (ACPAs) are highly specific for rheumatoid arthritis (RA) and have long been regarded as pathogenic. Despite substantial in vitro evidence supporting this claim, reports investigating the pro-inflammatory effects of ACPAs in animal models of arthritis are rare and include mixed results. Here, we sequenced the plasmablast antibody repertoire of a RA patient and functionally characterized the encoded ACPAs.We expressed ACPAs from the antibody repertoire of a RA patient and characterized their autoantigen specificities on antigen arrays and ELISAs. Binding affinities were estimated by bio-layer interferometry. Select ACPAs (n=9) were tested in the collagen-antibody induced arthritis (CAIA) mouse model, to evaluate their effects on joint inflammation.Recombinant ACPAs bound preferentially, and with high affinity (nM range), to citrullinated (cit) autoantigens (primarily histones and fibrinogen), and to auto-citrullinated peptidylarginine deiminase 4 (PAD4). ACPAs were grouped for in vivo testing based on their predominant cit-antigen specificities. Unexpectedly, injections of recombinant ACPAs significantly reduced paw thickness and arthritis severity in CAIA mice, as compared to isotype-matched control antibodies (p=0.001). Bone erosion, synovitis, and cartilage damage were also significantly reduced (p=0.01). This amelioration of CAIA was observed for all the ACPAs tested and was independent of cit-PAD4 and cit-fibrinogen specificities. Further, disease amelioration was more prominent when ACPAs were injected at earlier stages of CAIA than at later phases of the model.Recombinant, patient-derived ACPAs ameliorated CAIA. Their anti-inflammatory effects were more preventative than therapeutic. This study highlights a potential protective role for ACPAs in arthritis.

View details for DOI 10.1002/art.42679

View details for PubMedID 37610274