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Autoantibodies like ACPA, anti-CarP, and AAPA were found in the saliva of rheumatoid arthritis patients. However, these anti-modified protein antibodies were not detected in the lower gastrointestinal tract, suggesting oral mucosa as a site of production.

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Area of Science:

  • Rheumatology
  • Immunology
  • Gastroenterology

Background:

  • Anti-modified protein antibodies (AMPA), including anti-citrullinated protein antibodies (ACPA), are found in rheumatoid arthritis (RA) patient secretions.
  • Previous studies detected AMPA in sputum and saliva, but the gut's role remains unexamined.

Purpose of the Study:

  • To investigate the presence of AMPA (ACPA, anti-carbamylated protein antibodies [anti-CarP], and anti-acetylated protein antibodies [AAPA]) in various mucosal sites, including the intestinal tract, of RA patients.
  • To determine if mucosal autoantibody production occurs in the lower gastrointestinal tract.

Main Methods:

  • Paired fecal, ileal wash, saliva, and serum samples were collected from RA patients and healthy volunteers across three cohorts.
  • In-house enzyme-linked immunosorbent assays were used to analyze AMPA in secretions, with unmodified peptides as controls.
  • Total IgA and anti-Escherichia coli IgA were measured in fecal samples to confirm assay functionality.

Main Results:

  • ACPA, anti-CarP, and AAPA IgA were detected in the saliva of seropositive RA patients (9%-40% prevalence).
  • No AMPA were found in fecal or ileal wash samples from RA patients or healthy donors.
  • Assays confirmed the presence of IgA and specific anti-E. coli IgA in feces, indicating assay sensitivity.

Conclusions:

  • ACPA, anti-CarP, and AAPA IgA are present in the saliva of ACPA-seropositive RA patients.
  • No evidence of AMPA was found in the lower gastrointestinal tract (feces/ileal wash) of RA patients.
  • These findings suggest that mucosal autoantibody secretion in RA may occur in the oral cavity, not the lower gut.