Anti–Citrullinated Protein Antibodies With Multiple Specificities Ameliorate Collagen Antibody–Induced Arthritis in a Time‐Dependent Manner

Objective 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 proinflammatory effects of ACPAs in animal models of arthritis are rare and include mixed results. Here, we sequenced the plasmablast antibody repertoire of a patient with RA and functionally characterized the encoded ACPAs. Methods We expressed ACPAs from the antibody repertoire of a patient with RA and characterized their autoantigen specificities on antigen arrays and enzyme‐linked immunosorbent assays. 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. Results Recombinant ACPAs bound preferentially and with high affinity (nanomolar range) to citrullinated (cit) autoantigens (primarily histones and fibrinogen) and to auto‐cit 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 with 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. Furthermore, disease amelioration was more prominent when ACPAs were injected at earlier stages of CAIA than at later phases of the model. Conclusion Recombinant patient‐derived ACPAs ameliorated CAIA. Their antiinflammatory effects were more preventive than therapeutic. This study highlights a potential protective role for ACPAs in arthritis. image