Increased citrullinated glial fibrillary acidic protein in secondary progressive multiple sclerosis

In this study, we demonstrate that grossly unaffected white matter from secondary progressive multiple sclerosis (SP-MS) patients is heavily citrullinated, as compared to normal white matter from control patients. Citrullination was most pronounced at plaque interfaces and was shown to colocalize with glial fibrillary acidic protein (GFAP)-immunoreactivity using dual color immunofluorescence. In contrast, the plaques themselves weakly stained for citrullinated proteins compared to control white matter and usually contained a blood vessel with surrounding astrocytes that were positive both for citrullinated proteins and GFAP. In SP-MS brain samples, but not in normal brains, long fibers of colocalized GFAP- and citrullinated proteins extended into the gray matter. Increased numbers of astrocytes containing citrullinated proteins and GFAP were also present at the junction between the gray and white matter in SP-MS brains. Western blot analysis of acidic brain proteins from nonplaque-containing white matter showed upregulation of multiple citrullinated GFAP proteins in SP-MS brains as compared to controls. Our results demonstrate that increased amounts of citrullinated GFAP are present in SP-MS brains, but also shows that these proteins are present in areas of MS brains that were grossly normal appearing. These data raise the possibility that citrullination of GFAP contributes to the pathophysiology of MS.