Objective Citrullinated proteins are immunogenic in rheumatoid arthritis (RA), particularly in patients that carry shared epitope (SE)-coding HLA-DRB1 alleles. The mechanism underlying this association is unknown. We have previously identified SE as a ligand that interacts with cell surface calreticulin (CRT) and activates immune dysregulation. The objective of this study was to determine the effect of CRT citrullination on SE signaling. Methods CRT-SE binding affinity was measured by surface plasmon resonance. The role of individual CRT arginine residues was determined by site-directed mutagenesis. Nitric oxide levels were measured using a fluorochrome-based assay. CRT citrullination in synovial tissues and cell cultures was determined by 2-dimensional gel electrophoresis, immunoblotting and mass spectrometry techniques. Results Synovial tissues and fibroblast-like synoviocytes from RA patients were found to express higher abundance of citrullinated CRT compared to OA samples. Citrullinated CRT showed more robust interaction with the SE ligand, and transduced SE signaling at a 10,000-fold higher potency, compared to non-citrullinated CRT. Site-directed mutation analysis identified Arg205, which is spatially adjacent to the SE binding site in the CRT P-domain, as a dominant inhibitor of SE-CRT interaction and signaling, while a more remote arginine residue, Arg261 was found to enhance these SE functions. Conclusion Citrullinated CRT is over-abundant in the RA synovium, and potentiates SE-activated signaling in vitro. These findings could introduce a new mechanistic model of gene-environment interaction in RA.
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