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The anti-cyclic citrullinated peptide response in tuberculosis patients is not citrulline-dependent and sensitive to treatment.

Elkayam O, Segal R, Bendayan D, van Uitert R, Onnekink C, Pruijn GJ - Arthritis Res. Ther. (2010)

Bottom Line: In the subset of 33 patients with a follow-up test six months after starting treatment, the mean levels of antibodies to 0401Cit, 0401Arg, 0722Cit and 0722Arg significantly decreased after treatment.The presence of anti-0401Cit/Arg and anti-0722Cit/Arg was found to be significantly correlated with the presence of HIV.ACPA may be found in patients with TB.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine F and the Department of Rheumatology, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel. oribe14@netvision.net.il

ABSTRACT

Introduction: Patients with tuberculosis (TB) frequently produce anti-citrullinated protein antibodies (ACPA). The objective of this study is to characterize the citrulline-dependence of the ACPA reactivity in sera of patients with mycobacterium infections.

Methods: Serum samples of 134 patients with untreated mycobacterium infections (122 TB, 12 nontuberculous mycobacterium) were tested for antibodies against both the citrullinated (Cit) and the non-citrullinated (Arg) form of 2 cyclic synthetic peptides. In 33 patients, a follow-up sample was tested six months after starting anti-mycobacterial drugs.

Results: A substantial proportion of patients with mycobacterial infections demonstrated antibodies against 0401Cit, 0401Arg, 0722Cit and 0722Arg. Fourteen patients demonstrated anti-0401Cit, 83 anti-0401Arg, 22 anti-0722Cit and 61 anti-0722Arg, while none of these antibodies were detected in the 20 healthy controls. All the patients but one, who were anti-0401Cit and anti-0722Cit positive, demonstrated reactivity against the respective Arg peptide. In the subset of 33 patients with a follow-up test six months after starting treatment, the mean levels of antibodies to 0401Cit, 0401Arg, 0722Cit and 0722Arg significantly decreased after treatment. All the patients who were anti-0401Cit and anti-0722Cit positive turned negative after treatment. The presence of anti-0401Cit/Arg and anti-0722Cit/Arg was found to be significantly correlated with the presence of HIV.

Conclusions: ACPA may be found in patients with TB. In most of the cases, the reactivity is citrulline independent. A positive cyclic citrullinated peptide (CCP) test in these patients should therefore be interpreted with care, and preferably followed by a control ELISA with a non-citrullinated antigen.

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Effect of anti-mycobacterial treatment on the reactivity with peptides 0401Cit, 0401Arg, 0722Cit, 0722Arg, CCPlus and ArgPlus. Comparison of the levels of antibodies against each of the peptides in sera from 33 TB patients before and after treatment.
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Figure 3: Effect of anti-mycobacterial treatment on the reactivity with peptides 0401Cit, 0401Arg, 0722Cit, 0722Arg, CCPlus and ArgPlus. Comparison of the levels of antibodies against each of the peptides in sera from 33 TB patients before and after treatment.

Mentions: Patients were treated with anti-tuberculous drugs to eradicate the mycobacteria and the reactivity with the (citrullinated) peptides was assessed six months after starting treatment. Serum samples from 33 patients were available for these analyses. The mean levels of antibodies to 0401Cit, 0401Arg, 0722Cit and 0722Arg significantly decreased after treatment (Table 2, Figure 3). Almost all of the patients who were anti-0401Cit and anti-0722Cit positive turned negative after treatment. Eighteen patients who were anti-0401Arg positive and 13 who were anti-0722Arg positive turned negative after treatment. Most of the remaining patients that were reactive with the Arg peptides before treatment (4 and 3 sera, respectively) showed reduced levels of reactivity after treatment. Although the reactivity of this group of patients with the CCPlus peptides was relatively low and, as a consequence, not much difference was observed before and after treatment, the recognition of the ArgPlus peptides was also clearly diminished after treatment.


The anti-cyclic citrullinated peptide response in tuberculosis patients is not citrulline-dependent and sensitive to treatment.

Elkayam O, Segal R, Bendayan D, van Uitert R, Onnekink C, Pruijn GJ - Arthritis Res. Ther. (2010)

Effect of anti-mycobacterial treatment on the reactivity with peptides 0401Cit, 0401Arg, 0722Cit, 0722Arg, CCPlus and ArgPlus. Comparison of the levels of antibodies against each of the peptides in sera from 33 TB patients before and after treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875640&req=5

Figure 3: Effect of anti-mycobacterial treatment on the reactivity with peptides 0401Cit, 0401Arg, 0722Cit, 0722Arg, CCPlus and ArgPlus. Comparison of the levels of antibodies against each of the peptides in sera from 33 TB patients before and after treatment.
Mentions: Patients were treated with anti-tuberculous drugs to eradicate the mycobacteria and the reactivity with the (citrullinated) peptides was assessed six months after starting treatment. Serum samples from 33 patients were available for these analyses. The mean levels of antibodies to 0401Cit, 0401Arg, 0722Cit and 0722Arg significantly decreased after treatment (Table 2, Figure 3). Almost all of the patients who were anti-0401Cit and anti-0722Cit positive turned negative after treatment. Eighteen patients who were anti-0401Arg positive and 13 who were anti-0722Arg positive turned negative after treatment. Most of the remaining patients that were reactive with the Arg peptides before treatment (4 and 3 sera, respectively) showed reduced levels of reactivity after treatment. Although the reactivity of this group of patients with the CCPlus peptides was relatively low and, as a consequence, not much difference was observed before and after treatment, the recognition of the ArgPlus peptides was also clearly diminished after treatment.

Bottom Line: In the subset of 33 patients with a follow-up test six months after starting treatment, the mean levels of antibodies to 0401Cit, 0401Arg, 0722Cit and 0722Arg significantly decreased after treatment.The presence of anti-0401Cit/Arg and anti-0722Cit/Arg was found to be significantly correlated with the presence of HIV.ACPA may be found in patients with TB.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine F and the Department of Rheumatology, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel. oribe14@netvision.net.il

ABSTRACT

Introduction: Patients with tuberculosis (TB) frequently produce anti-citrullinated protein antibodies (ACPA). The objective of this study is to characterize the citrulline-dependence of the ACPA reactivity in sera of patients with mycobacterium infections.

Methods: Serum samples of 134 patients with untreated mycobacterium infections (122 TB, 12 nontuberculous mycobacterium) were tested for antibodies against both the citrullinated (Cit) and the non-citrullinated (Arg) form of 2 cyclic synthetic peptides. In 33 patients, a follow-up sample was tested six months after starting anti-mycobacterial drugs.

Results: A substantial proportion of patients with mycobacterial infections demonstrated antibodies against 0401Cit, 0401Arg, 0722Cit and 0722Arg. Fourteen patients demonstrated anti-0401Cit, 83 anti-0401Arg, 22 anti-0722Cit and 61 anti-0722Arg, while none of these antibodies were detected in the 20 healthy controls. All the patients but one, who were anti-0401Cit and anti-0722Cit positive, demonstrated reactivity against the respective Arg peptide. In the subset of 33 patients with a follow-up test six months after starting treatment, the mean levels of antibodies to 0401Cit, 0401Arg, 0722Cit and 0722Arg significantly decreased after treatment. All the patients who were anti-0401Cit and anti-0722Cit positive turned negative after treatment. The presence of anti-0401Cit/Arg and anti-0722Cit/Arg was found to be significantly correlated with the presence of HIV.

Conclusions: ACPA may be found in patients with TB. In most of the cases, the reactivity is citrulline independent. A positive cyclic citrullinated peptide (CCP) test in these patients should therefore be interpreted with care, and preferably followed by a control ELISA with a non-citrullinated antigen.

Show MeSH
Related in: MedlinePlus