Influence of periodontal disease, Porphyromonas gingivalis and cigarette smoking on systemic anti‐citrullinated peptide antibody titres

Abstract

In subjects with periodontitis, P. gingivalis infection may be responsible for inducing autoimmune responses that characterize rheumatoid arthritis.

Citrullination as a plausible link to periodontitis, rheumatoid arthritis, atherosclerosis and Alzheimer’s disease

“…The loss of tolerance can generate autoantibodies against citrullinated proteins (ACPAs). Increased levels of ACPAs are detected in patients with aggressive periodontitis [32] compared to controls [33]. ACPA-positive patients are also more inclined to have moderate to severe PD than ACPA-negative patients [34].…”

Citrullination: A Specific Target for the Autoimmune Response in Rheumatoid Arthritis

“…In pre-RA, ACPAs already exhibit a pattern of decreased galactosylation that has been found in total IgG in active RA (31). The presence of ACPAs is associated with the shared epitope HLA-DR allele that is the most important genetic risk factor for RA (32), and is also associated with two other established risk factors for RA, smoking and periodontitis (33). These observations have led to hypotheses that the formation of ACPAs provides a link between the risk factors for RA and the pathway that ultimately leads to clinical arthritis.…”

“…Notably, smoking can lead to formation of citrullinated proteins in the lung, the presence of ACPAs is associated with lung inflammation in RA, and ACPAs can be measured in sputum not only in those with RA, but even in individuals at risk for RA who do not yet have ACPAs in their serum (34)(35)(36)(37)(38). Periodontitis, which is bidirectionally associated with RA, is driven by the bacterium Porphyromonas gingivalis, which uniquely among oral flora expresses PAD and thus generates local protein citrullination, leading to formation of ACPAs (33,(39)(40)(41). These findings give important momentum to the notion that RA begins in organs and tissues other than the joints, such as the lung or periodontal tissue, with citrullination and ACPA formation being early and critical events in its pathogenesis.…”

Review: Preclinical Rheumatoid Arthritis: Progress Toward Prevention

“…Mikuls et al (68) Anti-P gingivalis antibodies Higher levels of anti-P gingivalis antibodies in at-risk individuals with RA autoantibodies compared to those seronegative for autoantibodies. Lappin et al (21) Anti-CCP antibodies Patients with PD had higher anti-CCP levels than healthy controls; significant reductions in anti-CCP and anti-P gingivalis titers seen after PD treatment. Scher et al (13) PD…”